It all started with a smartphone
23 April 2019
A cancer research center led by AO CMF faculty member Moni Abraham Kuriakose has been awarded the first phase of a US $1 million Bill & Melinda Gates Foundation grant to support a novel point-of-care diagnostics for oral cancer in India’s first cancer technology incubator.
The new Biomedical Research, Innovation and Commercialization in Cancer (BRIC) incubator, associated with Cochin Cancer Research Centre (CCRC), was inaugurated in Kalamassery, India in January 2019 will use the grant to pioneer India-focused cancer care innovation and development, with an emphasis on leveraging emerging artificial intelligence (AI) technology to diagnose oral cancer in its early stages. There’s particular urgency around early detection of oral cancer in Southeast Asia, which—due to local risk habits of tobacco, areca nut, and alcohol—accounts for more than 70 percent of oral cancer globally. Moreover, over 90 percent of oral cancer is diagnosed at advanced stage III and IV lowering the possibility of sure to less than 20 percent, while the diagnosis of oral cancer at an early stage can improve the cure rate to about 80 percent. Early detection of oral cancer is a life and death situation.
Kuriakose, who has been active in the AO and AO CMF at various levels since the 1980s, immediately recalls a patient case where such technology could have saved a patient’s life. That patient, from a remote village, came to him in the 2000s with a fungating ulcer in her cheek, had been already been through two years of treatment but the tumor had not responded, so she sought treatment by Kuriakose.
'Early detection can save lives'
“She had initially presented with dental complaints to local physicians, which then slowly grew to an advanced stage to involve the jaw. Limited resources at the local hospital necessitated her undergoing radiotherapy, an inappropriate treatment. Only when it recurred and fungated as ulcer of the cheek that she presented to a higher center for further treatment. Although we performed surgery, the disease could not be controlled and she succumbed to the disease,” says Kuriakose, Director of the Cochin Cancer Research Centre (CCRC), Government Medical College Campus in Kerala, India. “The unfortunate fact is that the battle against cancer is often lost even before an oncologist has a chance to examine the patients.”
In 2003, a study in Lancet caught Kuriakose’s eye. Carried out by a group in India, the study found that trained health care workers could diagnose oral cancer at a very early stage, with an almost 30 percent improvement in the rate of survival.
“That really stuck in my mind,” he says. “Unfortunately, this approach could not be systemized because training health workers for a population of over 1 billion is a huge challenge.”
“The unfortunate fact is that the battle against cancer is often lost even before an oncologist has a chance to examine the patients.”
The wheels, however, were set in motion, and Kuriakose became involved in a study to examine whether the eyes of a health care worker could be replaced with the camera of a smartphone- to photograph the patient’s oral cavity and the remotely located specialists to interpret the images to decide further management.
“This study showed the concordance of direct clinical examination and remote mobile phone detection of a lesion was close to 100 percent,” Kuriakose says. “That means cancer can be diagnosed remotely using photos taken by a smartphone.”
‘I couldn’t believe it!’
Kuriakose and the BRIC team have ambitious plans for the Bill & Melinda Gates Foundation grant: development of a homegrown technology employing AI to identify oral cancer at its very earliest stages. Collaborating with the Memorial Sloan Kettering Cancer Centre, New York, and Indian Institute of Science and Mazumdar-Shaw Centre for Translational Research, Bengaluru, India, they have developed a molecular marker that could tag cancer cells harvested from oral lesions and the cytology images could be interpreted using AI as well as sent remotely through a mobile device for further verification. In this approach the BRIC team hopes to address two major issues of oral cancer cytology: minimize the subjectivity of the prevailing oral cancer cytology technique and take the technique to the patients at the point of diagnosis.
Kuriakose was seeing patients in his clinic in December 2018 when he heard that the grant application had been approved.
“I couldn’t believe it! Beyond the money, which we certainly needed, recognition by the Bill & Melinda Gates Foundation will have a major influence in making this project a clinical reality,” he says. “This will make it easier for our technology to be adopted into India’s health care system. Digitally connected cancer management, such as the tele-cytology platform being developed through this grant, will significantly improve the logistics of cancer care and could serve as a platform for treatment of other kinds of cancer.”
Kuriakose is quick to point out that the AI-assisted innovation to be undertaken by BRIC is not intended to replace clinicians but, instead, to help them do their job better. His memory darts back to the young woman he treated years ago.
“Before she came to us, she had seen a dentist three times, was diagnosed with a toothache, then saw an ear, nose and throat surgeon who gave her antibiotics. And then there was a six-month delay before she was diagnosed with oral cancer,” he says. “The system failed. We have an opportunity with BRIC not only to diagnose cancer at its earliest stages but innovate novel technology to impact the whole cancer health care system to optimize the process of cancer care delivery from diagnosis to rehabilitation.”
Initially trained as a dentist at the University of Manipal (India) in 1983, he earned his medical degree in 1992 at the University of Bristol (United Kingdom). He completed residencies in both general surgery (University of Bristol) and maxillofacial surgery (University of Newcastle, United Kingdom) and head and neck oncology fellowship at Roswell Park Cancer Institute (New York, United States). Additionally, Kuriakose is a professor of oncology, vice chairman of the Department of Head & Neck Surgery/Plastic & Reconstructive Surgery, director of Translational Research for head and neck/plastic and reconstructive surgery, and director of the Skull Base Program at Roswell Park Cancer Institute in Buffalo, New York (United States). He was an attending surgeon at New York University and Bellevue Hospital (New York, United States) and director of the Head and Neck Oncology Translational Research Program at New York University.
Kuriakose has held a wide range of national and international leadership positions, including president of the Indian Head and Neck Oncology association, president elect of the International Academy of Oral Oncology, chairman of the 6th World Oral Cancer Congress and president of the Indian Head and Neck Cancer Society. He has authored more than 200 peer-reviewed publications, and a four-volume textbook, Contemporary Oral Oncology, and has been editor in chief of the Journal Oral Oncology.