Software to improve early detection of breast cancer

The young entrepreneur Jonas Muff wants to conquer the international market with his Berlin start-up Vara. A lot of money is now available for this.

26-year-old Jonas Muff, who comes from Cham, has travelled a lot in the USA in recent months to find the right investors for his Berlin start-up Vara (see box below). He met potential donors in New York, San Francisco and Boston, who peppered him with questions about privacy and the competitive situation.

The effort was worth it: EUR 6.5 million have now been raised in the first major financing round – despite the abrupt outbreak of the Corona crisis in the middle of the preparations. Smaller amounts are being contributed by the former seed investor Merantix, the German investors Think.Health and Soleria Capital, as well as the Silicon Valley investor Plug and Play. The lead Canadian investor, Omers Ventures, will take over the majority of the EUR 6.5 million. For Muff, the latter is a donor with a long-term perspective, who will not become uneasy in the event of temporary crises. Muff and the people from Omers spent a lot of time talking. As it turned out, their philosophies fit together wonderfully. "Omers wanted to invest in exactly our area, and have a deep understanding of our product," says Muff.

Software sorts out non-abnormal screenings
But what exactly does Vara do? The start-up is developing a screening software, also called Vara, that works with artificial intelligence (AI) and helps radiologists detect breast cancer at an early stage.

Breast cancer is the most common cancer in women, but there is a good chance of a cure if it is diagnosed and treated early enough. Mammography screenings are used for this. If the X-rays show changes in breast tissue, this could indicate cancer. Further studies such as a biopsy, in which breast tissue is taken, will then bring certainty. But everything is fine most of the time: only 3% of the mammographs indicate a suspicion of cancer. This means that, in 97% of cases, radiologists almost always have to deal with non-abnormal mammographs. Nevertheless, two doctors have to independently examine the recordings - a tiring task that always follows the same processes. And this leads to mistakes: doctors often overlook carcinomas simply because they so rarely come across them. The finding is then a false-negative, which can be life-threatening for the patient.

This is where the Vara AI software comes in: it sorts out the non-abnormal screenings, the statistical 97%, in advance. Radiologists can thereby fully concentrate on the 3% with suspected cancer. And because they thereby see carcinomas much more frequently, they are less likely to miss them. Vara is also expected to reduce the number of false-positive findings. Breast cancer is often diagnosed In these cases, even though the patient is healthy. "The software does not replace the diagnosis, it only makes the binary decision: normal or abnormal," explains Sven Piechottka, who is responsible for quality management. In order to make this decision, Vara analyses the pixel values of all the image data and calculates an abnormality score.

2.5 million X-rays
The software is already in use, although so far mainly in test runs. In order to be able to "read" mammography images better and better, the Vara algorithm needs a lot of training material, and, for this purpose, it is fed with the anonymised data from radiology centres in Germany, Austria, Spain, Poland and Switzerland. There are currently 2.5 million X-rays available. In addition, there are medical findings that have been confirmed by tissue removal, in order to avoid false positives.

Vara is also provided with long-term data from healthy women, which is aimed to exclude false negatives. The software also takes into account any limescale deposits in local regions of the breast, an indicator of breast cancer. At the moment, the algorithm reliably filters out 40% of non-abnormal mammographs. That alone will save doctors a lot of work. Internal tests have also shown that Vara has found some carcinomas that radiologists had overlooked or couldn’t see.

Vara, which is based in Berlin, was founded by Jonas Muff (left) from Cham and the German Stefan Bunk

Leap overseas in preparation
Piechottka is convinced that doctors can increasingly rely on Vara, and that checks of the pre-sorted findings of the software will be needed less and less. "That would be the first steps towards automated reporting." The risk of errors in the screenings can never be completely ruled out with AI software, of course. For the foreseeable future, Vara will support one of the two examiners in the screening, but not both. It is also not yet allowed to take the human being completely out of the examinations. And there is a further precaution: before a radiology centre uses Vara, the software must be specifically tested against the centre's patient data. "We then analyse the results together with the doctors. And we adjust for high sensitivity. This means that whenever the algorithm is not completely certain, it will classify the mammograph as suspicious.»

With the financing now assured, Jonas Muff has come closer to his entrepreneurial goal: to develop a medical product that will help many people. Following the CE approval in the autumn, nothing will stand in the way of Vara's entry into the European market. Further planning aims in two directions. "The operational focus is on Europe. We want to get into more radiology centres and build up trust in our software." The move overseas is in preparation at the same time. They have already checked what documentation will be needed by the U.S. Food and Drug Administration in order to approve the software. The US market is strategically high on the list of Berlin-based medical technology start-ups with Swiss roots.

Founded in 2018

The start-up Vara now employs 25 people, including its own team of radiologists, and has its headquarters in Berlin. Jonas Muff moved to the German capital at the invitation of Adrian Locher, who is also Swiss and is a co-founder of the "Dein Deal (Your Deal)" platform.  Jonas Muff will help him build up the Merantix company, an incubator for start-ups that uses artificial intelligence as a basic technique. Muff became the project manager at Merantix. Together with the German programmer Stefan Bunk, he founded Vara in 2018 as a spin-off from Merantix, with the company first being named ‘Merantix Healthcare’. Muff takes care of the business at Vara, while Bunk is responsible for the technical engineering. In addition to Muff, two other Swiss work at Vara: Janette Wiget (Personal and Administration) and Julian Hürlimann (Sales).