"AI can only work, especially in radiology, if workflow and AI support are well integrated."

One in eight women worldwide will be diagnosed with breast cancer in the course of their lives, while at the same time screening programmes are already helping to reduce the mortality rate by 25 percent. In 2019 alone, a total of more than 250 million mammograms were carried out, which means that the repetitive assessment of findings is becoming more and more of a burden for both health insurance companies and the radiologists performing the examinations. The Berlin start-up Vara from the Merantix venture studio has thus developed a software of the same name which, with the help of artificial intelligence, can automatically distinguish healthy mammograms from abnormal ones and thus provides doctors with a tool for working more efficiently. #ki_berlin talked to Dr Moritz Brehmer, a radiologist and Medical Director at Vara, about the beginnings of the young start-up, the promise of AI as a cure and the German screening programme.

Vara was founded in 2018 and emerged out of the company-builder Merantix . How did the spin-off company come about and how is your team set up nowadays?

I already worked together with Jonas Muff on a solution for mammography screening in 2017, and with the seed financing from Merantix, we as a small team got lots of leeway to try a few things out. Once we had certainty and clarity as to what the AI software product might ultimately look like, the time had come to stand on our own two feet.

The spin-off then followed almost instantly and financial independence came with the Series A financing, which we successfully concluded in April of this year. It was of course very helpful that Merantix made this biotope available to us so that we were able to get to the point at all where we could seriously achieve Series A financing.

In terms of team composition, we’ve grown quite a bit since 2018: we’re now a team of 25 doctors, researchers, developers and entrepreneurs.

Since the end of last year Vara has been the first CE-certified AI software for cancer screening in Germany. What’s special about your product?

What’s special about Vara is that we’re not just an algorithm, but an end-to-end workflow solution for mammography screening, which as a core competence combines AI and workflow in an optimal solution. Our solution doesn’t exclude any results when probing the screening results, but instead aims to make a pre-selection – sorting into normal and abnormal findings – so that doctors can better prioritise their work into activities that require more or less attention.

How can artificial intelligence help us in the field of radiology? What can it do and what shouldn’t it be?

The promise that artificial intelligence would completely take over and change the job of a radiologist has by no means come true. In our opinion, AI can only work, especially in radiology, if workflow and AI support are well integrated. This isn’t a matter of replacing medical services, but of augmentation. The human expert has the last word and not the algorithm.

How is data security set up at Vara?

Data security is an important topic in our field and both we and our customers attach great importance to it. We’ve therefore decided that our server infrastructure should be on German soil and we have our security levels regularly tested by independent experts. To this end, we use state-of-the-art encryption technologies and have implemented many so-called “technical and organisational measures” so as to guarantee adequate data protection.

In the past, CE certification was awarded for physical products and somewhat rarely for software. Do you see this rethinking as a step in the right direction, also towards an increased recognition of digital health applications?

CE certification has been awarded to software products even before us. Nevertheless, the regulations still largely refer to physical medical devices – which will continue to exist – so it’s sometimes more difficult as a software to meet the requirements, because they’re sometimes less applicable. In general, it’s a positive development that digital medical devices are becoming more and more important. However, the regulations could be a bit better adapted to this in the future.

Breast cancer is the most common type of cancer in Germany and is also responsible for the most cancer deaths. What’s the situation regarding breast cancer prevention and mammography screening in Germany – also in comparison to other countries?

In Germany we have a really excellent mammography screening programme, but it’s also facing challenges. It’s a very sophisticated programme, which is very well evaluated and digitally indexed: It involves two medical colleagues who independently make what we call a “double-read” decision on every mammogram that is made in the screening process. If the results don’t match, a so-called “consensus conference” is convened to determine the final result. All mammograms are documented in two different systems and statistically evaluated centrally – especially via the Mammography Cooperation Group here in Berlin.

In general, other European countries are well-positioned in terms of early detection of breast cancer, but not to the same extent as Germany. There it’s sometimes difficult to get a “single-read”, let alone a double-read, and there’s no such sophisticated evaluation and documentation. The reason why we’re so successful is that we are offering a solution that may make it easier for high-quality screening in the European region too in the future.

What are your plans for the future? The American market and FDA approval are probably also a focus for Vara...

The American market is, of course, in a very different position from the one we’re familiar with in Europe. For example, there are no population-based screening programmes with a centralised invitation system as we have here. Here, every woman who is registered with their local residents’ registration office and is between 50 and 69 years old receives a notification, whereas in the USA the format of walk-in screening is used. This is where there’s a lot of advertising, appealing to women to come for screening. And often the patient has to pay for it themselves.

What’s also different compared to the European region is the technology of the screenings: In the USA, 3D instead of 2D mammography is used, which means that more layers of breast tissue can be acquired. We can’t do that in Germany at the moment – that may come later. The American market and FDA approval are certainly exciting options for Vara in the future, because we think that what we offer here in Germany is transferable to a certain extent and that we can improve the American screening programme with our product.

Let’s get back to Berlin: The local AI scene is well established, especially in the health sector, and Merantix is planning an AI Campus for next year. How do you see Berlin as a location – also in terms of the networking of start-ups, larger companies and the research community?

The Berlin ecosystem with its large number of companies, start-ups and research is leading the way in Germany. As well, there’s lively interaction within the AI community, for instance with colleagues in the field of machine learning. Merantix’s AI campus, planned for 2021, will contribute to a further growth in networking and help the city to further strengthen its position as an important centre for AI.

Many thanks for the interview.