The tech and tools closing the diagnosis gap

49.7%. A shade below half, but still the equivalent of around 3.95 billion.

You’ve no doubt already guessed that this is the number of women and girls in the world today. And at some point in their lives, pretty much all of them will need some kind of medical care. Often this will centre around their reproductive health and if they are fortunate enough to live where such programmes exist, they may receive routine screenings and vaccinations. Or they may just book appointments as the need arises.

But mostly, it’s not that simple.

For the purposes of this article, we will use ‘women’ and ‘girls’, but this, of course, also extends to transgender, intersex and non-binary people who were assigned female at birth. Unfortunately, we still have some way to go before the statistics accurately reflect all gender experiences. However, the data do we do have paints a picture of healthcare that is still some way from any level of gender balance. Particularly when we look at the numbers from a global perspective. According to the World Health Organisation, “every day in 2020, almost 800 women died from preventable causes related to pregnancy and childbirth”. And a study released last December in The Lancet has brought to light that while over a third of women experience lasting health problems after childbirth these conditions have been largely neglected in both clinical research and practice.

Wherever you look, there are negative reports around women’s healthcare, and this is particularly pronounced when it comes to reproductive needs, such as pregnancy care, as we have mentioned, or endometriosis, pelvic floor disorders, menopause and screenings for cervical, ovarian or breast cancer, among others. But the picture overall is complex and variable, depending on where and how you live. In some countries, difficulties in gaining specialist care are compounded by long waiting lists. In others, women might have limited health insurance options because they are more likely to work in lower-paying jobs or have less decision-making power within their household when it comes to how money is spent. In some countries, healthcare access of any kind is limited.

Recently, however, Europe has seen a significant period of awareness raising around women’s health, and has even accounted for issues of intersectionality, which is positive progress. Social media has certainly played a role in this, but taboo-breaking around women’s health has even found its way onto TV, radio and into the news cycle. The result is that women are feeling increasingly empowered to discuss their health in ways they wouldn’t have dreamed of in the past. What is even more interesting is that the work of feminist activists in this area, such as Caroline Criado-Perez, (Author of Invisible Women, exposing data bias in a world designed for men, which has sold over a million copies) comes at a time when we are closer than ever to applying standards of precision medicine to patients. Indeed, women stand to benefit most from the retirement of ‘Reference Man’ – the default male body that has been used as the basis for everything from safety standards to setting what is ‘normal’ in healthcare.

As part of the Canon’s Expo Talks series during Expo 2020 Dubai, Regius Professor of Medicine, Dame Anna Dominiczak, explained to Dr Ken Sutherland, President of Canon Medical Research Europe, how a data-driven approach can help clinicians to understand the many and varied ways that diseases present across large groups of patients. “Even breast cancer is several diseases,” she explained. “And that’s why we need to become much more precise in how we describe groups of patients and large, sometimes multimillion stratas of disease. And that allows us to diagnose better, prognosticate [predict] and most importantly, give the right treatment.” In practice, this could mean that risk factors for thousands of conditions are identified far earlier and, for women, give weight to the symptoms they report. Because it is often a sad fact that women are afraid their concerns won’t be taken seriously. Give ‘Yentl Syndrome’ a quick Google and you’ll soon see just how reasonable this fear can be.

There are also ongoing campaigns which highlight the discomfort which many women feel when undergoing gynaecological procedures, examinations and treatment for reproductive health issues. As well as physical pain, many report feeling a sense of deep vulnerability, anxiety and self-consciousness when being examined or having a breast screening, for example. And while clinicians do their very best to help their patients feel at ease in these scenarios, every moment counts. The temperature of an ultrasound wand. Or the speed and pressure of a mammogram. These are things that matter to our research and development teams at Canon Medical, who prioritise patient comfort just as much as the quality of the images the scanners produce and so they make as many elements as possible adjustable to the patient’s body. In an ideal world, where personalised medicine is the standard, these same advanced imaging tools will be deployed as early as possible, generating clear, accurate images quickly, so patients can, if necessary, start treatment without delay. But this speed also has another purpose – it will hopefully mean that clinicians can see more patients.

And what of the women who simply don’t have access to clinics, doctors and screening programmes? They may live in remote areas, have no transport, or live in a country that doesn’t have a national healthcare provision. There is also plenty of anecdotal evidence to suggest that there are many women for whom taking time off work to attend medical appointments leaves them out of pocket. In short, they simply cannot afford to visit the doctor, which is devastating. In these cases, mobile health clinics can give desperately needed access to routine appointments, screenings and vaccinations, sometimes round the clock. On a physically smaller scale, there are many NGOs around the world that support specialists as they travel from place to place with portable machines, such as lightweight ultrasounds. Both solutions are literally saving women’s lives in locations where such services are not readily available.

Equitable care for women does not, of course, lie solely in the hands of technology. But leaving behind ‘Reference Man’ and considering the individuality of every patient is certainly the path we see ourselves on, at least in Europe. However, it is clear that to take advantage of any progress in healthcare for women, society needs to be driving equity elsewhere too. Education, empowerment and, above all, access need to be priorities – considering the barriers and doing what is necessary to remove them. The World Economic Forum describes this control over one’s own health outcomes as ‘The Power of Choice’ – which ultimately leads to greater life opportunities for women and their families.