Mole check technology for skin cancer screening: An Interview with MoleMap’s Chief Customer officer
In our previous post, our Founder Nick shared his personal experience with a detailed skin cancer check with the Australian based company Mole Map.
Mole Map is an innovative organisation who have more than 25 years of experience in skin cancer screening, and have pioneered new technology for imaging skin lesions (aka your moles) as well as a ‘surveillance’ system for tracking your skin continually over time.
Today, we’re following up on that content with an in-depth and exclusive interview with MoleMap’s Chief Customer Officer Vlad Mehakovic.
In this interview, we discuss the basics on how the service works, as well as Vlad’s own motivations for joining the company nearly two years ago.
With the basics covered, we dive into the details on how their ‘surveillance’ approach is enabling customers to manage their unique skin cancer longevity risk, and why the business model has been such a success.
Also, we ask Vlad a series of questions on where skin cancer surveillance is headed in the future.
This has some exciting answers, including emerging opportunities for the application of artificial intelligence to the skin cancer detection challenge, as well as a future where more of us are empowered to self-monitor our own skin using apps (some of which are freely available from Mole Map already).
There’s even a cool AI start-up company in the mix! There is plenty to learn about in this post, so without further delay, let’s chat with Vlad from MoleMap.
This interview was conducted on 20 May 2021, over Zoom and is an audio transcript with minor edits for clarity, brevity and correctness.
Our guest - Vlad Mehakovic, Chief Customer Office at MoleMap
Longevity Blog (LB):Vlad, thanks so much for joining us today. To kick things off - could you give us a brief history of MoleMap and its mission?
Vlad Mehakovic (VM): Thanks for having me!
MoleMap was started about 25 years ago by a group of medical entrepreneurs. Their key innovation was creating a system for better skin cancer diagnosis. Not only a set of hardware and software technologies, but also a system that took the dermatologist away from having to do the screening process themselves.
We see ourselves as pioneers within telehealth. What we've been doing is taking specialised photography and sending them to a remote dermatologist for review - and we’ve been doing that for 25 years.
How does skin cancer screening work?
LB: Those early medical entrepreneurs, they saw a specific ‘gap’ in the diagnostic capability. Could you comment on that gap? What was it?
VM: It comes down to standardisation. We've got a standardised way to map at your entire body, at a macro level. We then go micro and do diagnosis when there are lesions (medical term for all types of moles) of risk. These risky lesions are identified by a trained registered nurse (melanographer), they will take macro images of your skin followed by a micro, very close up, image of your skin. This is completed with a specialized camera (Molecam). [See the process yourself in Nick’s post about his MoleMap visit]
This camera can see under the first few layers of your skin. Those images are then passed on to a dermatologist who reviews them remotely. We've built one of the best dermatologist teams in Australia and New Zealand, some real leaders in dermatology.
A ‘melanographer’ use a ‘Molecam’ to image a mole on Nick’s foot!
This team-up between the melanographers and dermatologists with high quality images, allows people to track their body over time. This is the ‘surveillance system’ in action. It's not a one time solution, it's something that you repeat over time. This is important because skin lesions can change very quickly.
LB: MoleMap has clearly built a talented team, and have creatively structured the business so you can pull in the best dermatologists to review the images, leaving the technical side of assessing the skin and taking images to the melanographer. It’s a great model.
Speaking of talented people coming into the company, you're the Chief Customer Officer and have been in that role for going on two years now. Talk us through what drew you to MoleMap?
VM: I came onboard as a consultant initially and I saw lots of opportunities for growth. After a few months a new CEO (Tanya Houghton) came on board. Everything was working well, and I really liked the company. I was really honored when she asked me to keep on working with business.
LB: We like how you're talking about a team who is continuing to pioneer technology for skin cancer surveillance. It is quite a remarkable success story of applying a technology to cancer detection.
Does Skin Cancer Screening Save Lives?
LB: Can you tell us in the instance of skin cancer, why does early screening, save lives?
MoleMap provide extensive literature and supporting information about the many types of skin lesions, and the ones you need to watch out for
VM: It’s a pretty simple equation - the less cancerous tissue there is to remove, the less likely that cancer is getting into the bloodstream. The earlier you remove them, the higher the rate of survival. It's really that simple.
Again, it's not necessarily just the technology, it's the system that we offer, that really offers the step-change. There are a lot of different medical professionals, even with good technology, good dermascopes, but they don't necessarily get their education updated after attending med school. It is the application and the surveillance system that allows us to detect skin cancer systematically and comprehensively.
LB: In our Founder Nick’s personal experience with MoleMap, he reviewed the very technical way you map the entire body. It first calls out areas of interest, but then, of course, requires the user to come back.
It seems that this surveillance system has been remarkably successful. MoleMap have seen over 300,000 patients, mapped over 5 million moles. Can you take that a step further? What is the likelihood that this surveillance approach will save somebody's life?
VM: On average, we’ll see a bit more than 50,000 people a year, and that grows every year. About 30% will have some sort of recommended action. Most often, that is to continue monitoring a lesion closely.
We've started providing an increasing number of free tools for our patients & non-patients alike, to help support them. One of these is a web application that allows you to track your own lesions over time. This web app can also integrate that with the professionally taken photographs from our clinic.
So of those 30% where we advise continual monitoring, around 3% of people need urgent attention. We call them straight away and advise to see a dermatologist immediately.
If Skin Cancer Screening Reveals an Issue, What Next?
LB: In the case of a finding that is immediately actionable, talk us through what happens next for a patient.
VM: If there is a lesion requiring urgent attention, we'll call that patient to find out if they've got an existing dermatologist or GP whom we can send them a copy of our detailed report. If the patient gives permission, we send off the report and then the practitioner will understand what needs to be done and can act swiftly.
LB: In the case where there's an immediate finding we could argue the MoleMap visit has been a life saving intervention.
Should I Get a Skin Cancer Check?
LB: Coming back to those 50,000 or so people that come every year, nearly 40% of Australians have never had a skin cancer check, and many more of them fail to do it regularly. Why do you think it is such a difficult thing for people to manage? Why don’t more people complete regular skin cancer screenings?
VM: Compliance is a difficult thing, full stop. The number one barrier we talk about is apathy, as in, it won't happen to me. The main driver we see that finally gets people to act is when someone close to them - a loved one, a close friend - is diagnosed with skin cancer or dies from it. In the case of males, it's usually a spouse that drives them in to get screened. To be honest, guys don't tend to come in of their own accord.
LB: This is where we wanted to pivot to next - these objections: apathy, time, budget, nerves - what are some elements of the MoleMap service that help people get past those barriers and into a regular screening program?
VM: Our core service is going to cost what it's going to cost. So really, when people talk about cost, they're talking about value. What we're trying to do is support people in and around the visit, even before the visit.
Software management tools are a great example. First, risk assessment - we've got an online risk assessment. We also provide a free service where you can talk to one of our melanographers for 15 minutes to assess your risk and find the right service fit for your needs. We have a free online body map tracker, which allows you to actually track your own moles for a period of time.
“The number one barrier we talk about is apathy, as in, it won’t happen to me.”
Skin Cancer Screening with your GP?
LB: We understand there is currently an effort to get your technology directly into the GP room. In this model, GPs are provided the same system you offer and you train their nurse staff to complete the assessment. Tell us about the maturity of this strategy - Is it a pilot project? Or is this something you're in the process of going more widely?
VM: The pilot is well and truly done, and we've validated that it makes sense. It's got a lot of interest. We've rolled it out successfully in a number of practices across Australia, and we're beginning to roll that out in in New Zealand as well. It's going extremely well
LB: Is this something Australian’s should be asking their GP about - saying “Hey, have you heard about the MoleMap technology? I'm interested”.
VM: Look, that would be lovely. A significant number of GP visits are already skin related, and GPs are increasingly, in the last decade becoming increasingly educated around skin diagnosis. It's an already growing aspect of general practice. We're coming in with a holistic solution that hopefully, increases the patient outcome while decreasing the workload on the practice.
Artificial Intelligence for Skin Cancer Screening
LB: Continuing down the technology angle, looking into the future, MoleMap have created a very large database of skin lesions. Upon each visit, there is an opportunity for patients to opt in to allow their moles to be part of R&D.
Let's talk about MoleMaps R&D a bit, specifically where skin cancer detection technology is going in the future. As a starting point - explain what happens when one of your patients opts-in to allows their anonymous mole/lesion images to be sent off to improve the detection technology? What's happening there? What is their contribution, so to speak?
VM: Our vision is a world where all skin cancers get diagnosed and treated. That means we need to have a variety of options and solutions. The more lesion images that we can capture and categorise, the better that we can achieve that outcome. So that means we've got to look a lot further than just our own clinics.
MoleMap operates the biggest database of high resolution skin lesion images in the world. Perfect for training Artificial Intelligence algorithms. Picture: one of Nick’s moles that he needs to track!
We're starting to do that by offering that service to GPs and we are in the talks with a couple of big pharmacies. We have a workplace program where we come into your office.
About three years ago, we kicked off a process with IBM, because we have the biggest database in the world of high quality dermatologist diagnosed and categorized skin lesions approved to be used for research and development.
“Our vision is a world where all skin cancers get diagnosed and treated”
LB: That is a highly valuable and unique asset. So, what are your plans for this database?
VM: For the last three years, we've been using that imagery to train an artificial intelligence algorithm. Specifically, a convolutional neural network. And we’re continuing to optimise its ability to categorise skin cancers correctly.
We’ve also been working with Monash University, which has progressed to the stage where we've been comfortable enough to really want to invest in the commercialization of that technology. About six months ago, we formed a start-up company. It’s a stellar team of both technical business people, but also scientists within AI that have applied AI commercially in medical imaging in the past.
The team is now in the process of regulatory approval, which means, number one, being able to use that AI as a medical device. Secondly, the team needs to figure out how it makes sense to take it to market.
LB: Is this company currently in stealth mode, or can we know its name?
VM: Oh, it's called. It's called kāhu, named after a large hawk known for its sharp vision. The only thing that’s really stealth is what exactly the product is going to be. We've got some tight time pressures on that team and are expecting to get it to market quickly.
How Might AI Change The Skin Cancer Screening Process?
LB: When it does come to market, what is the vision for how that might change diagnosis or the surveillance process for catching potentially cancerous lesions?
AI will assist dermatologists by reducing the time they need to spend assessing each skin lesion.
VM: Well, again, if we go back to our global vision of the business, we're trying to get more images diagnosed. So this potentially helps that happen. It's unlikely that it's going to be the case where there is no human intervention. If you look at a lot of the best applications of AI, it's assisting an existing professional in the decision making rather than taking over the decision making process.
The AI technology would most likely be running alongside an already trained healthcare professional. It’s main potential is to deliver a higher level outcome to a wider audience - in other words, deliver the same level of diagnosis and categorization and patient outcomes, without having to have as much specialist contribution for every single lesion.
The Future of Skin Cancer Screening is Based on enabling patients to self-manage risk
LB: That's a great answer. Just as an aside to that, it was actually announced just today that Google had launched an AI health tool for skin conditions, including skin cancer. So that is another signal that artificial intelligence and good data sets in skin health is part of the future.
Pulling from your insights and some of the things you just talked about, what is your vision for how skin cancer diagnosis and treatment is going to change in the next 5 to 10 years?
VM: I think the key thing is, we've got to think about how to enable the patient to better manage risk themselves. There's a couple of levels of triage that happen. A patient goes to see a doctor, when they've got an issue, usually it is their family GP. They go and see that person for advice.
MOBILE APPS FOR SKIN CANCER?
Longevity Blog will soon be reviewing a selection of DIY options for skin cancer screening, be sure to subscribe below to get notified when that new content arrives!
Now, the nature of that is changing somewhat. There are now a number of mobile applications that are claiming various things that you can do by taking a photo of your skin with your phone and performing self-tracking. But the truth is the quality of those images and the ability of those people to really do the same job as a trained professional - there's quite a gap.
What we need to be able to do is get the best system and solution in as many doorways where patients are already visiting, as possible. The intent for us is really Australia and New Zealand as a testbed, before we begin to export globally. But we want to prove the case, really solidly here first, before we start to look at those options.
Bulk Billed Skin Cancer Checks
LB: Your answer actually flows on really nicely to an Australian specific question - when can we expect ‘bulk billed’ skin cancer checks to become available? It’s a legitimate question, given the prevalence of the disease in Aussies.
Is there a future for bulk-billed skin cancer checks in Australia? Not anytime soon, unfortunately
VM: We haven't heard any plans, even of it being reviewed. We don't go out and lobby or do anything like that. For us it's a step by step approach. We know that Medicare coverage for these checks would be hugely powerful. It would be good for Australians, it would be good for skin cancer diagnosis.
The first step that we can take, and we’re making some headway with, is working with major private insurance providers. More than one of the major private insurance companies in Australia are interested, and we're talking things through. We’re hoping to launch some partnerships very soon. That would be a really good first first step.
LB: At least there's some hope in the future with private health cover!
VLAD’s Personal Approach to Longevity
LB: We're gonna wrap this interview up now, Vlad, but before you go we always like to ask interviewees a little bit about what they do for their own longevity and health. To start, do you use the MoleMap technology yourself?
VM: Yeah, of course! I believe in proactive health management. I have an annual week of bloods, gut, dentistry, skin health that I personally go through. It's almost that via negativa process of ruling out the worst conditions. I totally believe in proactive health management to increase longevity and quality of life.
LB: Great to hear that! What have you learned from that week of focus that could be valuable to our readers in terms of putting together their own longevity strategy?
Establishing a good working with your personal doctor is a key longevity tip from Vlad. (GP = general practitioner, the same as Primary Care Physician in the US).
VM: I've got a great holistic GP, and I've started educating myself around the importance of gut health, more so than anything else. I know that skin cancer is bad, of course, and I need to be monitoring it. I know that heart attacks and strokes are bad, and I should be monitoring them. Putting it all together makes sense.
LB: So a good relationship with a high quality doctor has been one of the most important parts of that journey for you, as well as taking initiative to educate yourself on longevity risks.
VM: Yeah, totally!
LB: Thank you so much for contributing today, Vlad. We really appreciate it!
VM: Thanks mate!
FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
How Does Skin Cancer Screening Work
Skin Cancer Screening Saves Lives
“Don’t worry, be happy”
Getting a Skin Cancer Check “Mole Map”
“What are your plans for the day?” the tall brunette asked, as she rung up my Lulu Lemon shopping spree (I needed some new running shorts! They didn’t disappoint).
“I’m actually headed around the corner for a ‘mole mapping’, have you heard of that technology?”, I offered, excited to hear her reply.
Anxiously, she replied “Yes, you must be nervous! I’d be so scared of what they might find!”
I chuckled, “Well, actually I’m a bit used to it by now”, pointing to my Health Nucleus jacket and explaining this wasn’t my first cancer screening experience, quite the opposite in fact!
“Well, I’m sure you’ll be fine”, she offered.
“Actually, that’s what the appointment is for”, my somewhat cheeky reply.
In her polite laugh, I could see the point had landed.
“The clinic is just around the corner, you should check it out sometime”, my closing remark, as I headed off to a comprehensive skin cancer screening service, in search of that ‘sure you’ll be fine’ level of certainty - but not on a whim, instead, at the guiding hand of longevity technology.
Skin Cancer Spreads and Kills
Bob Marley - legendary musician, skin cancer victim
When Bob Marley, one of the most influential musicians of his time, collapsed during a run around Central Park, his first thought was not likely to fault skin cancer for the scare.
But further analysis revealed that a known cancerous growth in the skin under his big toenail had metastasised, spreading to his brain, liver and lung. He was dead only a few months later at age 36.
His death shook the world in a way not unlike that of Chadwick Bosemen, who died a similarly tragic death at the age of 43 from colorectal cancer last year, raising awareness of the disease, which has unfortunately continued to reek havoc on the lives of millions of people each year.
In my home country of Australia, skin cancer is particularly rife. 2 out of every 3 Australians will get some form of skin cancer by age 70. On average, an Australian dies every 5 hours from melanoma, the most aggressive and dangerous form of skin cancer.
However, it is not just older folks who are affected. Skin cancer is one of the most common cancer diagnoses for younger people in the ages of 25-44.
And while the 1970s did not offer the types of advanced skin cancer screening technologies that could have saved Bob Marley’s life - 2021 proves much different.
You don’t have to leave your skin cancer risk up to chance. You can manage the risk.
Let’s look at how.
Skin Cancer Screening Saves Lives
As I explain in the above video, my visit to a MoleMap clinic in the Sydney CBD was to provide a comprehensive skin cancer screening, leveraging imaging technology to make a ‘map’ of my skin, forming a baseline for future tracking.
The MoleMap clinic utilised a few key pieces of technology to complete this screening.
An example of one of the 26 high resolution images taken of my body.
Step 1: Full Body Images
The first was a series of high resolution photos, where, stripped ‘down to me undies’ (said in the lovely Irish accent of my melanographer Kathy).
In a series of coordinated movements, using a reference chart on the floor for my foot positions, I posed for more than 25 images.
These were taken with a Nikon DSLR, set for maximum focus on the skin of the body.
Each image was then mapped onto a virtual avatar in a specialised computer system.
Unfortunately the avatar was much more ripped than I, perhaps I will equal his masculinity next visit?
Step 2: Head to Toe Examination
After the full body images were taken, the melanographer (who was a registered nurse, specially trained by the Australiasian College of Dermatologists) reviewed my body from head to toe.
Side Note: I wasn’t asked to take off the underwear, unless I had a mole or skin issue I wanted them to track. Ladies - bra is optional, but recommend that you go without! Your female melanographer will be sure to make you comfortable and there is a robe you can use to cover up.
The dermatoscope in action. This tool is used after a mole has been marked by visual inspection, to further screen its shape, colour and size.
In this head to to review, Kathy would look at each of my moles using a Dermatoscope
This handy gadget uses a LED lighting and a magnifying lens to assess the surface features of a mole (more broadly referred to as ‘lesions’).
It allows up to 2.5x magnification and allows for the colour, shape and size to be reviewed in more detail.
Any more that ticks the boxes of being at increased risk (more on that in a moment), would have its location ‘tagged’ on my virtual avatar.
Kathy reviewed me thoroughly, including within my hairline, in a highly professional and considerate way.
Step 3: Enter the MoleCam
For any mole displaying any of the characteristics of skin cancer (basal cell carcinoma, squamous cell carcinoma or melanoma), further imagery was take using specialised device aptly named the “MoleCam”.
The dermatoscope identifies a mole with asymmetry and irregular border on my leg.
To be clear - this is not to say these moles are likely to be cancerous.
Instead, they match known characteristics of skin cancer risk are best remembered by the “ABCDs”:
Asymmetry (irregular shape)
Border (ragged or uneven)
Colour (more than two shades)
Diameter (greater than 6mm)
For each at risk mole, the MoleCam was used to capture two images.
The first, at a set distance and focal length - you can see the ‘slide’ extended from the device.
Second, with a ‘contact’ dermascopic image, where a dab of alcohol is placed on the lens, and the MoleCam is placed directly against the skin.
In the below 3x images, from left to right, we can observe the process.
The first image at extended focal length. The second ‘contact’ image. And finally, the contact image of the mole on my left foot is displayed on the device - you can see that Kathy rightly spotted its irregular shape, border and colour.
Step 4: Teledermatologist Review
In total, I had 26 moles of interest tagged and submitted for further review.
This is above average, and does suggest that my longevity is at elevated risk for skin cancer.
In general the moles were present all over my body, including the back, chest, abdomen, legs, arms and feet.
In some areas, sun exposure did appear to play a role, but in others, my naturally ‘mole-y’ complexion likely drove their prevalence.
Each of the detailed images that were taken by the MoleCam will now head off for a review by a ‘teledermatologist’, which is pretty much a fancy way of saying that a skin cancer expert will review each of the moles.
After this review, there will effectively be a ‘ranking’ of the risk each of the moles represents.
I will then receive customised advice on the MoleMap online patient platform, about 7 days or so after the appointment.
In most cases, the actionable information will be - watch & wait.
This is because the 5th aspect of the ABCDs of skin cancer is actually an E, standing for Evolution, or changes over time.
Cancerous moles, due to unregulated growth driven by DNA damage, generally have an inability to heal and fast cell turnover.
Whereas normal skin/moles will be steady-state, skin cancers will be changing. This is why your first MoleMap visit is so important - you form a baseline by which to assess the Evolution of your unique mole makeup.
This brings us to Step 5!
Step 5: Monitoring for Skin Cancer
The brilliant aspect of this mole mapping longevity technology is the ability to track changes in your moles over time.
New moles, quick changing moles or any areas of the skin which begin to react to excessive sun damage, need to be re-assessed over time.
Your MoleMap appointment will provide you with valuable reference material for self-assessment and tracking at home.
Depending on your individual risk factors (age, sun exposure, existing moles, genetics), MoleMap will provide you with guidance on how often you should re-assess with a follow-up appointment.
By the way - you can check your personal risk with this handy tool on the MoleMap website.
This of course also depends on your budget, and is one reason why you should form a personalised longevity strategy, and include skin cancer screening as a part of your approach to life a long and healthy life.
For me, this will be an annual visit (every 12 months), supplemented by a self-exam every 3 months.
Since I now know where each of my moles on interest are, and have been provided with some handy tools by the MoleMap team.
This includes a thorough information sheet, which I’ve uploaded here (see image).
However, one interesting fact to keep in mind - you can only ‘see’ about 40% of your skin - so be prepared to ask for some help!
Skin Cancer Screening - the Future
Coming up in our next post, Longevity Blog will interview MoleMap’s Chief Customer Officer Vlad Mehakovic.
We’ll dive deeper into how you can use skin cancer screening technology to manage your longevity risk, as well as chat about where this longevity technology will go in the future!
Be sure to subscribe below, so you won’t miss it!
FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Full body MRI screening technology - Interview with Health Nucleus Part 3
In this post you’ll learn about:
The power of Health Nucleus MRI algorithms (e.g. early detection of brain aneurysms or quantifying visceral fat levels)
Same examples of how multiple Health Nucleus visits enable deeper personalised analytics
How the Health Nucleus is prevention focussed, rather than on optimisation (but that’s a good thing!)
Part 3 - MRI analytics & health optimisation
Be sure to read Part 1 and Part 2!
Longevity Blog (LB):
Q: What kind of data will you be pulling out of the MRI scans? Besides the heart analysis and some of the cancer detection, which we already discussed. What will be showing up in that data and what will you use it for?
The blood vessels of my brain as revealed by Health Nucleus MRI data. Aneurysm free and healthy :)
Dr Duchicela: I think primarily it’s used for detecting the big things that we don’t want to miss that we really want people to know about early on, so things like cancer or aneurysms. With the post processing that they do on it, they’re able to reconstruct vasculature and vessels to look for aneurysms, even without using contrast which i think is really neat.
And then we have these different imaging biomarkers, so for Alzheimers we do hippocampal volume assessment where we look at the volume of the hippocampus and the ventricles surrounding them, and essentially see how do you compare to a healthy peer group? Are you a little bit lower or a little bit higher in these volumes, which correlates with Alzheimer’s risk. That’s one aspect.
At left, my visceral fat levels are highlighted by Health Nucleus MRI algorithms. Visceral fat is known to increase with age, and increased levels are risk factor for many diseases.
With MRI we also get the body composition like visceral fat levels, liver fat levels, liver iron levels, and muscle composition. What we’re doing with the MRI data is essentially training algorithms to better detect the sorts of cancers that traditionally you can’t detect with a non-contrast MRI, one we are working on right now is pancreatic cancer. We’ve developed a screening tool to use in MRI for pancreatic cancer and we’re in the process of validating it which is really really exciting. But that will just add to the overall comprehensiveness of the scan and of the experience, so yeah there’s lots of different things we get from the MRi, it’s pretty amazing how much data you can get from it and how much you can start to train these algorithms.
LB: Diving deeper into MRI analytics - I have a full body scan from May 2018, I’m soon to have another scan from January 2020, and plan to continue to do these scans every 12 to 24 months depending on my travel schedule, so you’re going to get a bit of a time series going with the data.
You’ve talked about disease risk and obviously we’ll keep assessing those things but in terms of somebody who’s trying to optimise, like myself who’s a bit of a biohacker or maybe an athlete who’s thinking about their performance and their muscle composition…
Q: What kind of optimisation intelligence could we derive from MRI data over time?
“If you come back multiple times, year to year or every two years, we can trend many things and see how you’re doing. ”
MRI analytics of muscle mass. At left, my colour coded leg muscle groups in May 2018. At right, January 2020. I added 1.3L of muscle mass during that time. Note: the pictured images are from a slightly different ‘slice’ of the data.
Dr Duchicela: I would look at the imaging biomarkers, looking at the visceral fat measurements and subcutaneous measurements that we get and quantifying and trending that. The scanner software automatically marks out where your subcutaneous fat is, where your visceral fat is, we can trend your liver fat measurements, your liver iron measurements and then obviously your muscle composition too and where you’re distributing your muscle.
If you come back multiple times, year to year or every two years, we can trend many things and see how you’re doing. Some people, even if their metrics are “within a normal range”, they want to get them better, and so when you have such an accurate test like the MRI you’re able to make that quantification, you’re able to make those comparisons versus for example other machines out there that measure your visceral fat too and kind of trend it, but really MRI is pretty darn accurate for that and one of the most accurate assessments available, so if you really want to know the numbers and get that in addition to your cancer assessment and your aneurysm assessment, I think MRI is the way to go.
LB: That’s really spot on in terms of the answer I was looking for, one thing I’d like to prompt you on…
Q: Is there opportunity to analyse the strength or flow volumes of the heart from your MRI data?
Dr Duchicela: We can see that your ejection fraction or how much blood you’re pumping out of your heart changes over time, now the question is does that actually translate into performance increases? We don’t necessarily think so for healthy individuals, because there’s lots of other things, like how fast your heart rate is going etc. So I would say not yet, I see where you're going with the question in terms of, could it be used to measure and trend athletic performance, not only for elite athletes, but for lay people who want to really maximise their athletic performance. I don’t think we’re there yet and I don’t think that’s necessarily the overall goal of this test. I think there’s a different series of tests that probably could do better than just the MRI for athletic performance trending and monitoring.
LB: Q: Are there any unique Health Nucleus tools that could be applied to assessing athletic performance and/or optimisation?
Dr Duchicela: I think with genetics we’ll start to get more information on that. There's already genetic predispositions to things like muscle tissue fibers and that sort of thing. What I would want to do as a medical director is to try to delve more into that and gather information on athletic history and get these metrics like VO2max and mile time etc and then start to work with the genetics to see if there are any predictors where we could make some correlations. That I think would be really exciting to do at some point in the future.
“I’m really excited what we have in the pipeline with this sort of scoring ... incorporating that with the coronary calcium score and putting it together and getting a global integrated risk score”
LB: Yeah I agree with you that it would be very exciting, and again it’s not your current focus, but I was curious to ask a few questions on the topic of optimisation, so thanks for that.
One of my big outcomes from my last visit to the Health Nucleus was a ‘prescription’ for cardio exercise and to increase my muscle mass on direct guidance from one of your doctors. I took that exceptionally seriously and have been dedicated to cardio fitness routinely since that time. So I’m really curious what you think might be evident in terms of one’s biometrics and data coming from their visit to help one measure their improvement in fitness over time.
Q: You’ve talked about MRI, and a bit about genetics, what else in there might show up in this visit compared to last time if I’ve done a good job at that cardio and exercise routine?
“ the best areas to look for changes and improvements would be in your imaging biomarkers, your core lab tests for metabolic biomarkers, lipids, a1c and fasting sugar. ”
My blood lipid panel over time; some great changes in between my first Health Nucleus visit (May 2018) and my second (January 2020).
Dr Duchicela: Yeah we’ve already mentioned the imaging biomarkers like your body composition, your liver fat level, those will definitely change with lifestyle change for sure, and then I would look at your traditional blood markers. You’ve probably already been measuring those, but making sure your [Hemoglobin] A1c is good, as well as your fasting sugars and your cholesterol numbers. In terms of trending data, that’s the kind of metabolic panel we would do. We can’t trend genetics so much, so I would say the best areas to look for changes and improvements would be in your imaging biomarkers, your core lab tests for metabolic biomarkers, lipids, a1c and fasting sugar. That’s where you’d probably best be able to see improvement and change.
LB: Cool, thanks for diving into that. And in terms of the genomic data that we’re pulling out, Q: what information in there will be actionable for somebody who wants to optimise? There’s examples of the ways you might metabolise certain precursors to vitamins, such as not being a good converter of beta carotene to retinol in the blood or the MTHFR mutation for methylation.
“It’s probably too early to hang your hat on these variants that tell you to eat a certain food or to do something very specific in terms of lifestyle unless you have one of these obviously high risk genes”
Dr Duchicela: Yeah I think that’s kind of the challenge with the genetics, the focus of the company from what I’ve seen so far is more on the hidden health risks with these high risk cancer genes, high risk cardiovascular disease genes or neurodegenerative disease genes.
In terms of optimising genetics, from what I’ve discussed with the clinical geneticist here and the genetics team, It’s probably too early to hang your hat on these variants that tell you to eat a certain food or to do something very specific in terms of lifestyle unless you have one of these obviously high risk genes, these monogenic findings. But I think it’s an area of consumer interest, what we're hearing from a lot of people is they want more specific lifestyle modifications based solely off genomics. I think that our genetics team needs to be a little more convinced that there are really good actionable things there.
It’s also a matter of prioritisation of where we put our resources, do we want to be more of a lifestyle service versus more of a medical service that’s catering towards physicians and the medical community? I think we’ll always have tension on where the focus should be. Right now the testing is looking for high risk medical issues that we can intervene on, like is there a BRCA mutation or a gene that puts you at high risk of colon cancer?
I am curious to know and to see where the science takes us with more of these lifestyle influenced variants, but i would say for right now for our testing [optimisation] is not one of the big focuses - we really want to try to prevent disease first and build off of that and then delve more into and put more resources toward lifestyle genomics.
LB: I think that that focus area is apparent from the way your suite of testing and reporting is arranged. In my view, everybody needs to be taking advantage of these proactive aspects of medical technology before thinking about health optimisation. You’ve got to take care of the core risk and any acute issues first, in order to maintain your wellness. So I don’t think that focus is misplaced at all. It’s intriguing to hear that your team is interested and noting increased demand for this sort of individual attention. I certainly think that that’s a growing market as well.
“what is the patient’s goal?”
Dr Duchicela: Totally. There’s a lot of companies out there that will do some direct testing and tell you exactly what to eat or avoid this food based off of you having this variant. I think we want to be a little bit more careful with that just because you really have to look at things holistically. I don’t think we really want to say - stop eating cucumbers based off your genetics, we really want to take into account what the patient’s preferences.
Like i was mentioning before with the wine example, really what is the patient’s goal, is their goal to have a super restricted diet so they can live forever, or is it to enjoy time with their family, or to be able to do a certain activity better, so I hesitate to hang everything onto genetics and dictate lifestyle just based on your genetics. We really want to develop something that's more holistic.
LB: That’s where the physician comes into the picture - in having a relationship with them that’s ongoing and aligned with your personal goals and values. I think it’s excellent you’re even mentioning personal values and thinking about them as a physician.
One of the things I think is totally rad is that - I’m sitting here interacting with you, I’m going to be talking to a doctor and several team members on my visit next week - Q: I was curious if you could remind me of how many medical professionals will be interacting with me directly or with my data as an outcome of my Health Nucleus visit?
I’ve split this interview into FOUR parts, due to its length! Part 4 will drop next week!
Previous Posts: Part 1 - Part 2
Follow-up Posts: Part 4
Note: the Health Nucleus has recently appointed a new Medical Director - Dr. Pamila Brar. Dr. Duchicela has transitioned to a role as full-time physician at the Health Nucleus, working directly with patients to optimise their healthcare!
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FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Screening for cardiovascular sisease with MRI and CAC - Interview with Health Nucleus Part 2
In this post you’ll learn ABOUT:
Health Nucleus tools for assessing cardiovascular disease risk
The role of the Coronary Artery Calcification (CAC) score in assessing risk, particularly for younger people (30s, 40s)
How CAC scores might influence statin use
The limitations of MRI data in assessing risk
How genetic risk factors might influence risk
Combining imaging data, genetic factors and blood tests to further clarify risk
Part 2 - Cardiovascular disease
Be sure to read Part 1!
Longevity Blog (LB):
We’ve talked a little bit about cancer. Another big killer whose risk is a function of how old you are and a number of genetic factors is cardiovascular disease and in particular atherosclerosis.
I understand my risk as a man in his thirties is low for an acute event now, but the disease risk grows with time as the result of a decade on decade buildup of plaque, inflammation and wear and tear on the arteries…
Q: So how does coming to the Health Nucleus help inform someone about how their risk might change as they get older? What could a young person do using this information to minimise their risk of atherosclerosis and cardiovascular disease?
Coronary Artery Calcium Scoring. Credit: Cleveland Clinic
Dr Duchicela: Yeah that’s a great question. So in terms of cardiac assessments, one of the most powerful ones that we do here is the coronary calcium score. This is looking at calcified plaque buildup in the arteries of your heart. Essentially, the more plaque you have the higher your risk is of a heart attack.
You’re right, for someone in their thirties, who’s young, who is otherwise healthy, the chances of you finding plaque are low. Based on the general standard of care in the community, we wouldn’t be getting a coronary calcium score on somebody who’s 35 years old or younger. But here, because we’re under a research protocol, we have a little bit more leeway to push the boundaries in terms of testing in groups that may not otherwise be traditionally tested.
“we’re finding that actually about 15 to 17% of individuals around the age of 40 to 45 or younger actually have significant plaque build up. ”
And so for the coronary calcium score for example we are able to do it on a 35 year old, or 36 year old and we’re finding that actually about 15 to 17% of individuals around the age of 40 to 45 or younger actually have significant plaque build up. So we are probably missing a good amount of people out in the community who have atherosclerosis and calcified plaque in arteries of their heart which will predispose them to heart disease.
So when you come here to Health Nucleus and you if you meet the age requirement of 35 years or older (that’s what do here for the coronary calcium score), you’ll see what your plaque level, your score is, and then we will compare you to other people your same age and gender. So you get a sense of how you stack up to a healthy peer group as well and based on that, we take that into account with your cholesterol numbers and so, let’s say you have high cholesterol numbers, your LDL is elevated and your doctor is trying to push you to be on a statin or a cholesterol medicine.
If you get a coronary calcium score and your score is 0, there’s no calcified plaque seen, then you actually have a pretty good case to make that you shouldn’t be on a statin just yet . A lot of men and women come through here and their doctors are pushing and pushing them to be on a statin because their cholesterol is on the higher side, and we scan them and we get their coronary calcium score and it’s zero or very low that actually is pretty powerful in that it makes it not as urgent to be on a statin and you can talk more about lifestyle modifications and the diet, the exercise and maybe hold off on that statin for awhile longer.
A lot of men and women come through here and their doctors are pushing and pushing them to be on a statin because their cholesterol is on the higher side, and we scan them and we get their coronary calcium score and it’s zero or very low
LB: That’s a really clear answer Keegan, thank you for that.
Q: Could you comment a little bit on what the Health Nucleus can do with the MRI technology in terms of cardiovascular risk?
My heart beating, as observed by the Health Nucleus full body MRI scan and post-processing technology.
Dr Duchicela: For heart attack risk you get most of the assessment from the CT scan and the coronary calcium score. From the MRI what we’re doing is more structure of the heart so this is like what the chambers look like, how large the chambers are, or if they are hypertrophied or thickened because of high blood pressure or if it’s not pumping as well as it should be, like the ejection fraction is low because of early congestive heart failure or some sort of other heart failure. That’s what we get from the MRI. The MRI is more structural. It can find congenital abnormalities of the heart sometimes too, where as the CT scan, the one that involves a little bit of radiation, that is more for heart attack risk.
LB: That’s a good differentiation. Thanks for taking the time to answer that. And so in terms of a young person coming in, you’ve mentioned this kind of threshold of 35 years or older to do the calcium score, I don’t meet that criteria quite yet, but I’ll certainly do it when I get to that point.
Q: What other Health Nucleus tools can sit alongside the diagnostic imaging tests (MRI, CAC score) which can help a young person evaluate their lifetime risk of atherosclerosis?
Dr Duchicela: In terms of genomics, there are some genetic markers that predispose you to very high levels of cholesterol, that would be picked up not only in the blood screen testing, but also in the genetic testing.
Let's say you're twenty years old and we’re not doing a coronary calcium score, what we would use instead to help predict your overall risk would be the blood test, the lipid panel, your other metabolic markers like your haemoglobin A1c, your fasting sugar. And then from the MRI we’d be looking at your body composition, visceral fat deposition, visceral fat level. With MRI we’re now actually able to quantify pretty accurately your visceral fat volume and compare you to other people your same age and gender.
So those things would build into this risk profile, and then the traditional things like how much you drink, how much you smoke, how much sleep you’re getting, if you have signs of sleep apnoea. Even thirty year olds have sleep apnoea now, so those sorts of things all help build a risk profile for young people if you don’t have let’s say a coronary calcium score.
LB: Right and in terms of the genetic analysis, besides being predisposed to familial hypercholesterolaemia or other acute high LDL cholesterol genetics, Q: Is there another set or group of markers that you might be looking at at an early stage that can show someone’s risk?
Polygenic risk scores from my own Health Nucleus genomic report.
Dr Duchicela: What we currently have is a polygenic risk scale that tells you your relative risk. What we do is we look at gene variants that are more present in groups or individuals that have for example coronary artery disease, or who have had heart attacks and then we see if you share those same gene variants, there are weights given to each of these gene variants, and then you come up on a scale of low, medium or high risk.
“I’m really excited what we have in the pipeline with this sort of scoring ... incorporating that with the coronary calcium score and putting it together and getting a global integrated risk score”
But we’re not able to give specific numbers just yet, other than relative risk or absolute risk just because our dataset wasn’t large enough to do that. But what we’re developing right now, you’d essentially get a polygenic risk score or polygenic risk assessment that takes into account these genes associated with familial hypercholesterolaemia, but also other ones that on their own don’t dramatically increase your risk, but in aggregate if you take 20 or 30 of them together they can tilt you one way or the other.
So that’s actually the really exciting part, using polygenic risk scales and scores and building those models out. And we’re just at version one of this I’m really excited what we have in the pipeline with this sort of scoring and also incorporating that with the coronary calcium score and putting it together and getting like a global integrated risk score. So that's where we’re headed, but right now I’d say these polygenic risk scales can tell you you’re a little bit more like people with heart attacks or you’re a little bit less like people with heart attacks but it doesn’t give you an actual number just yet.
LB: That’s really clear and you’ve mentioned version one a few times so it’s clear that one of the things we need to do is get more and more people to come through the Health Nucleus and share their genetic information and family history etc.
One of the things I get really excited about and really enjoy in my visits to the Health Nucleus is going into the MRI machine. I think that’s one of the coolest things you guys do, I love picking the scene, the light color, the music, the things to look at. It’s really awesome.
Q: What kind of data will you be pulling out of the MRI scans and what will you be using it for? Besides the heart analysis and some of the cancer detection, which we already discussed. What will be showing up in that data and what will you use it for?
I’ve split this interview into FOUR parts, due to its length! Part 3 will drop next week!
Previous Post: Part 1
Note: the Health Nucleus has recently appointed a new Medical Director - Dr. Pamila Brar. Dr. Duchicela has transitioned to a role as full-time physician at the Health Nucleus, working directly with patients to optimise their healthcare!
Follow me on Twitter for the latest #Longevity news!
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RT @rebeccavziegler: The cryonics payoff matrix. Choose wisely my friends. https://t.co/l1rzsmOC2w
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My rate of aging: 0.79 It’s the new street cred What you got? https://t.co/aHzWHAfCnD https://t.co/L3rZC4QFN2
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It’s official - I’m co-producing and hosting a new #longevity docuseries, and will begin shooting in a few months… https://t.co/wLGqRrBfbp
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“The #longevity segment opened my eyes to the groundbreaking advances in biotechnology, health, and wellness. The i… https://t.co/F8YB7PAeMW
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I’m completely mindblown by what AI has done over the past 3-6 months, and it continues to accelerate… https://t.co/hh0JslucRg
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Longevity legends take on many shapes and sizes https://t.co/X9vGa7gvOe
I post related #Longevity content to Instagram as well, follow me @nickengerer
FDA & TGA DISCLAIMER
This information is intended for educational purposes only and is not meant to substitute for medical care or to prescribe treatment for any specific health condition. These blog posts are not intended to diagnose, treat, cure or prevent any disease, and only may become actionable through consultation with a medical professional.
Body composition data - Tracking lean muscle mass and fat over time
InBody and Styku body scan technology - Is it actionable?
While we are (im)patiently waiting on the results from my blood tests at NextHealth, let’s take a look at another longevity and wellness datapoint that I was able to collect during my recent visit. In my meeting with my “Health Coach” at NextHealth, we completed two types of body composition scans. The first was an ‘InBody’ scan which uses bioelectrical impedance to estimate:
Total skeletal muscle mass
Total body fat in kilograms
Total body fat percentage
Visceral fat
As well as make estimates of your basal metabolic rate and a few other body composition items.
The second was a a Styku which actually uses an Xbox Kinect and a rotating platform to create a full 3D scan of your body.
A key question that I have for these types of body scans and body composition data overall is - “Is this information actionable/valuable?”. In this post, I’ll aim to answer that question from my perspective.
Let’s dive in and take a look at some results!
Comparing my InBody scan across 18 months
The biggest value in body composition data lies in tracking how it changes over time. On shorter timescales of months to a year, you are able to track how your diet and/or exercise routines are affecting your lean mass, fat mass and/or visceral fat values. Over longer timescales, on the order of several years, you may even be able to track the impacts of aging on your body composition (e.g. the loss of lean muscle mass as the years stack up - yikes!).
I did my first InBody composition scan at the Health Nucleus in May of 2018. At the time, I was about 11 months into a year-long experiment eating a (very clean, whole foods based) ketogenic diet. I was doing an above average amount of physical activity (12k steps/day), but was not ‘working out’ or completing any cardio exercise.
However, that has all changed significantly. As I recently wrote, one of the key outcomes from my visit to the Health Nucleus was a life-long dedication to cardio fitness! So in the 18 months since my first InBody scan, I had added several days/week of cardio training (mostly running), and some strength training (still working on adding more of this), and I had returned to a whole-foods, carb-based diet (retaining plenty of healthy fats). One additional factor on the diet front has been my experiment over 2019 of water-only fasting for 2-4 days per month.
What did my two InBody scans show (before & after)?
“As you can see here”, Sirish the health coach pointed out with his pen, helpfully marking up my scan results, “Your body is actually pretty symmetrical from left to right. That’s not actually very common”.
I was immediately pleased. Symmetry was something I had been working on religiously, aiming to correct the imbalances I had in my body from left (weak) to right (strong), particularly in my running stride and strength workouts like push-ups.
“Your lean body mass is 157lbs (71kg), and with a total body weight of 177lbs (80kg), that places you at 10.7% body fat, which is at the low end of the normal range”, he commented. “We will get some further detail on this with the Styku body imaging data next”.
“That’s great mate!”, I responded. “That’s actually about the same number I get on my FitBit scale at home”. It was a solid ‘calibration’ of my in-house data, which is very useful.
In the following images (you can click through using the embedded controls), I have add some call-out annotations to draw attention to some actionable insights from my reports.
Conclusion: The InBody scan can definitely provide you with actionable data. Knowing where you stand with respect to your visceral fat mass alone is hugely valuable for assessing your disease risk For me, it was able to provide evidence that changes in my diet and exercise routine had contributed positively to my lean body mass. It also provided me with evidence that my efforts to increase symmetry in my body were fruitful and worth maintaining.
A Styku Haiku
One spinning platform
I stand upon with arms spread
Where did my hand go?
Styku body imaging
“Go ahead and strip down to your underwear and jump on this platform.”, Sirish beckoned, “I will step outside until the scan is completed”.
“Naw, mate. I couldn’t care less if you stick around!”, I explained, as I jumped upon the pedestal and started a slow rotation with my arms spread wide. Hey, it was just another day at NextHealth, where between the Cryo, the Infrared Sauna and Instagram, everyone’s half-naked most of the time anyway 😉!
Nudity jokes aside, the Styku scan provided some damn good data! Superceding the InBody scan with its detail, the Styku scan reported on the individual components of the legs, arms and trunk. Despite the accidental truncation of my left forearm (oops!), I was able to get a fairly comprehensive set of data points regarding my lean muscle mass distribution across the body.
Conclusion: The Styku data was certainly actionable. For example, while I had great symmetry in my thighs from left to right, the Styku was able to detect and measure asymmetry in my left and right calf muscles. I now will be adding some additional hypertrophy exercises to that lagging left calf muscle, and hopefully this will lead to performance gains in my race times!
Detailed Styku esults:
Body scan data is actionable - But blood markers will be even more exciting
Overall, I believe that this type of body scanning data is valuable for folks like me, who are trying to optimise their body and mind, relentlessly (hey that’s what being a biohacker is all about!). It may have additional benefits for folks who are overweight/obese, as it can highlight their elevated risks from carrying high amounts of visceral fat. I plan to continue tracking my results with both the Styku and the InBody tools on a yearly basis (and of course I will share what I learn on this blog!).
Body composition discussions aside, I only have to wait a few more weeks until I get the results from the 15 vials of blood I gave to NextHealth. I’m totally jazzed about this, and can’t wait to share what I learn from detailed analysis of my blood. Be sure to subscribe to the blog below to get notified whenever I add new longevity, healthspan and biohacking focused content!
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RT @rebeccavziegler: The cryonics payoff matrix. Choose wisely my friends. https://t.co/l1rzsmOC2w
-
My rate of aging: 0.79 It’s the new street cred What you got? https://t.co/aHzWHAfCnD https://t.co/L3rZC4QFN2
-
It’s official - I’m co-producing and hosting a new #longevity docuseries, and will begin shooting in a few months… https://t.co/wLGqRrBfbp
-
“The #longevity segment opened my eyes to the groundbreaking advances in biotechnology, health, and wellness. The i… https://t.co/F8YB7PAeMW
-
I’m completely mindblown by what AI has done over the past 3-6 months, and it continues to accelerate… https://t.co/hh0JslucRg
-
Longevity legends take on many shapes and sizes https://t.co/X9vGa7gvOe
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RT @BradStanfieldMD: Avoid These Popular Supplements (shout out to Professor Matt Kaeberlein @mkaeberlein & Professor Brian Kennedy… https://t.co/cy9CXldgUS
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Who are influential persons in #longevity who are of Asian, African American or other “minority” group in the US?
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