Geetha Manjunath

Interview with Geetha Manjunath, Founder and CEO of Niramai

Revolutionizing Breast Cancer Screening with AI-Powered Thermalytix

Geetha, could you tell us about your background and what inspired you to found Niramai?

“I am a computer scientist with a Ph.D. in Artificial Intelligence from the Indian Institute of Science. I started my career working on India’s supercomputer project at C-DAC, and later spent 17 years at HP Labs as Principal Scientist, followed by leading AI research at Xerox.

Unfortunately, my cousin was diagnosed with breast cancer at just 42 years old. It was detected at a late stage, and she passed away within a year. Six months later, another close family member also passed away from breast cancer at the age of 38. That’s when I decided I wanted to dedicate my career to addressing this problem. Initially, I began some research within Xerox, but eight years ago, I left my job to start Niramai.”

How does Thermalytix work, and how does it differ from other breast cancer screening methods?

“Thermalytix is a novel method for detecting breast cancer by measuring temperature variations on the chest using a thermal sensor, and analyzing the data with AI algorithms. It should not be confused with traditional thermography. Although we use a thermal camera, we do not analyze the images visually. Instead, we extract raw temperature data directly from the camera.

The woman sits on a chair while five images are taken from different angles. Because we are measuring tissue activity, the woman rests for five minutes beforehand to allow body temperature to stabilize. At the same time, we gently blow cool air over the breasts to create contrast enhancement on the skin surface. Contrast enhancement is a widely accepted technique, also used in MR and PET-CT scans, where contrast agents are injected into the body. In our case, it’s simply a harmless, cooling airflow — like a gentle breeze.

The entire test is completely pain-free, touch-free, and radiation-free, with no side effects, and it can be used for women of all ages, starting from 18 years old.

We analyze approximately 400,000 temperature data points per person to generate a report that indicates whether abnormalities are present, where they are located, and the likelihood that they are malignant. When we generate a high-risk report, we also provide scores explaining the likely causes — for example, possible inflammatory activity in one breast but not the other, increased vascularity, higher milk duct activity, or a combination of these factors along with age, menopausal status, or family cancer history.

All of this information is automatically included in the report. In addition, we highlight the specific area of concern so that if the doctor wants to confirm the finding, they can perform a targeted ultrasound or other tests before proceeding to biopsy or invasive procedures.”

What do clinical studies say about the accuracy of Thermalytix?

“When we started in 2017, our sensitivity was around 70-78% in laboratory conditions. Over time, as we collected more data and retrained our algorithms, the performance improved significantly — today we achieve over 95% sensitivity.

We have conducted several prospective, blinded clinical studies in India, Europe, Africa, and a smaller one in the U.S. All studies consistently show that our sensitivity and specificity are very high for a screening test. For example, a study published in the ASCO Journal of Clinical Oncology in October 2020 reported over 95% sensitivity and 92% specificity in the screening population. Across all studies, we consistently achieve over 95% sensitivity and over 85% specificity.”

Where is Thermalytix currently being used, and how has its adoption evolved?

“We initially started in India, where breast cancer poses a huge public health challenge. Mortality rates in India and similar countries are very high — close to 50% of women diagnosed with breast cancer die within 2 to 5 years. This is what we wanted to change.

For almost four years, we focused exclusively on research and real-world field implementation in India. So far, we have screened more than 250,000 women, and close to 300 hospitals and diagnostic centres are using our test, often as an alternative to mammography, which has relatively low adoption in India.

Outside India, we are now present in 22 countries, including the Philippines, Thailand, Nepal, Kenya, Ghana, Zambia, UAE, several European countries, and the U.S., where four centers are currently offering our test.”

How have Western healthcare markets responded?

“Initially, many doctors confuse our technology with traditional thermography and are sceptical. But once we explain that we are using AI to analyze temperature data — not thermal images — and show them our peer-reviewed research in journals such as ASCO, The Lancet Oncology, and the European Breast Cancer Conference, they become interested.

Patients are very satisfied because they receive a CE-marked, physician-certified report with concrete scores and clear explanations.”

What potential do you see for Thermalytix in Western healthcare systems and markets?

“I see huge potential, particularly for four groups:

• Women with dense breast tissue, where mammography often misses cancers.

• Women under 45–50 years of age, who are typically not offered regular screening.

• Women who wish to have additional yearly screenings between their regular mammograms.

• Women who avoid mammography due to concerns about radiation or discomfort.

In addition, pregnant women, breastfeeding mothers, women with implants, and women living in remote areas without access to mammography could benefit greatly.

Overall, we see Thermalytix primarily as a complementary tool in Western countries — at least initially — but it may also evolve into a standalone screening method in the future.”

In Denmark, a new national cancer plan has just been released, which includes a proposal to reassess the current screening systems. One idea is to move away from a one-size-fits-all model towards a more personalized approach to breast cancer screening. How do you see this shift, and in what ways could Thermalytix play a role in such a personalized screening model?

“This is an ideal time to introduce our technology into the Danish healthcare system. Our solution is perfectly suited for personalized screening by considering each woman’s individual risk profile. We are also developing mobile and home-based screening solutions, which could fit very well into a flexible, personalized screening model.”

How does the use of Thermalytix in India differ from its potential use in a country like Denmark?

“In India, Thermalytix often serves as the primary screening method because only around 1.3% of women participate in regular mammography screening. We offer the test in hospitals, clinics, and mobile units that reach rural villages.

In countries like Denmark, where mammography is widely available, we see Thermalytix as a supplementary tool — especially for the specific subgroups we’ve discussed. In the longer term, it may also evolve into a primary screening option there.”

What barriers do you foresee for implementing Thermalytix in Denmark, and how do you think they can best be overcome?

“As with any new technology, the biggest initial barrier is building trust among clinicians and radiologists. This requires local clinical studies — like the one that is now being initiated in Denmark — to validate the technology.

Additionally, awareness needs to be raised among women through education campaigns, social media, and community outreach. Finally, collaboration with healthcare authorities and insurance providers to establish reimbursement will be key to achieving large-scale adoption.”