Changing the World, ONE BREAST at a Time

“I’m trying to change the world, at least the tiny part that I know,” says a smiling Dr. Kathryn Pearson Peyton, standing on the stage in 2015 at Generation W, a women’s motivational conference where she is a featured speaker. Pearson Peyton is a local radiologist who built a successful career detecting breast cancer, first in California and later in Jacksonville, and is more recently known as the founder of Mammosphere, a cloud-based storage and image-exchange network for mammograms.

Dressed in a fitted sleeveless dress and a long scarf that drapes nearly to her knees, Pearson Peyton, surveys the crowd, whose number is reported at more than 1,000 attendees, and makes a bold claim: Storing medical records in the cloud can save lives. The idea, she says, is to interpret scans with greater accuracy by comparing new and old exams. Without prior results, it is far more likely patients will be called back for additional testing to rule out cancer, she says.

Data backs her up. According to a 2002 study published in the Journal of the American College of Radiology, having prior scans available improves early detection of breast cancer by 25 percent. Other studies have concluded that the rate of diagnostic false alarms, known as ‘false positives,’ that lead to biopsies and other follow-up tests, can be reduced in some cases by as much as 80 percent. For screenings, the rate is up to 60 percent.

“This is really important,” she says.

Despite the research, one in four patients do not bring their prior scans to their exam appointment, she says. The problem for many people is trying to locate records. This is where Mammosphere steps in with a solution.

“So, what Mammosphere does, we allow for images to be electronically transferred between hospitals and facilities so that women have access to their prior mammograms wherever they go,” she says. “And this is really important when women are moving between different states and cities and then going to different facilities, based on what their doctors and insurance companies tell them to do.”

The company is concise about the mission on its Twitter profile: “Wherever a woman goes, her mammograms should follow, possibly saving her life.”

For Pearson Peyton, the work is personal. Three generations of women in her family have had breast cancer and, after meeting at age 27 with a genetics counselor, she learned she had an 85 percent risk of getting the disease, too. In her mid-40s, an MRI showed signs that bilateral breast cancer was likely present.

“So, it was finally my turn,” she says.

Pearson Peyton decided to have a mastectomy because the odds were so heavily stacked against her. She shared the decision and news of her reconstruction surgery at the conference. In a recording of the presentation, her candor is met with wild cheers of support and people laugh when she sweeps her arm down her torso and back up again to highlight the area of her “downgrade” and her “upgrade.” (Amid the laughter, there may also have been some envy. Each time Pearson Peyton moves her arms, her biceps pop. This intelligent, successful and ambitious woman can literally flex her muscles.)

Following the news of the mastectomy, Pearson Peyton reset her priorities.

“I had to step back and analyze what was important in my life,” she says.

Her answer was family. Pearson Peyton left her clinical practice to spend more time with her two young sons, ages 11 and 9, and husband, former Jacksonville Mayor John Peyton, who served two terms in the city’s top job, from 2003 to 2011, and now heads the family oil business, Gate Petroleum. The two were married in 2003, about a month before he took office.

In retirement, Pearson Peyton hoped to regain balance in her life. She says her work left her physically and emotional drained. Because she knew firsthand the struggles patients and their families face with breast cancer, she would often internalize her patients’ anxieties and fears. “It was difficult not to,” she says.

She was also active in the community and served on various boards, including the Jacksonville Zoo & Gardens, University of Florida Proton Therapy Institute, Women’s Giving Alliance, and the American Cancer Society. In 2009, she was awarded the Girl Scouts of Gateway Council Women of Distinction honor.

Busy days left little time for her children.

“I would sadly be looking at my watch, wondering when they’d be going to bed so I could wake up and do it all over again,” she says.

Retirement didn’t last long. After two months, she was ready to get back to work. “Everybody who knows me will tell you that I can’t sit still,” she said in an interview in early January.

Pearson Peyton says she was raised by the ultimate ‘tiger mom,’ and was pushed to always work hard and strive for perfection. When she was four, her mother gave her a violin, which she played every day for hours. By the time she reached college, she was on track to become a concert violinist, practicing four to eight hours daily. (Pearson Peyton says violin practice defined her biceps.) The intense training schedule led to nerve damage in her wrist which required surgery. The injury also derailed her career plans. Pearson Peyton turned to science; she was already studying biology at Stanford University. She received her medical degree at the University of California at San Francisco, with the initial intent to become a surgeon for performing artists. Instead she became a breast-imaging radiologist.

In 1999, while teaching at her alma mater, she was recruited by Mori Bean & Brooks Radiology in Jacksonville to be chief of breast imaging at Baptist Medical Center-Beaches.

It appears she has no regrets about turning to medicine.

“I’m passionate about helping women beat and defeat cancer,” she says.

When she went back to work in 2012, Pearson Peyton launched Mammosphere as a nonprofit organization and called herself “chief volunteer,” though officially she was CEO and Chief Medical Officer. She believed her work in radiology could help improve women’s healthcare.

“I knew from years of experience that we could significantly improve breast cancer screening and detection just by improving patients’ access to prior mammograms for comparison,” she says.

She developed and owns two patents on security and verification measures for releasing stored images in the cloud, both using biomarkers from a patient’s current mammogram. “This is not currently being applied to the Mammosphere platform, but has tremendous potential in the future,” she says.

Early detection of breast cancer is critical and many women understand the need for regular screening, says Pearson Peyton. Some 60 million women in the United States are screened each year, though there are differing recommendations on when to start examinations. The American College of Radiology recommends that women start annual mammograms at age 40, while the American Cancer Society recommends annual screening from age 45 to 54, with screening every two years after that. The U.S. Preventive Services Task Force recommends screening every two years, starting at age 50.

Breast tissue “holds the key” to cancer detection, says Pearson Peyton. But the tissue is unique in every woman and no two breasts are alike, she says, which means “there is no normal mammogram appearance.”

Perhaps nowhere is this diversity more evident than in medical offices, where physicians, using a trained eye, deft touch and a specialized X-ray imaging system, study the subtle and sharp contrasts of mammary glands. Pearson Peyton, who spent about 15 years examining patients and their scans for signs of cancer, says breasts are as distinct and individual as a human face and there is no standard for what a mammogram should look like.

Pearson Peyton understands this information may surprise most people. “Even doctors are confused,” she says. She knows patients are looking for the physician to say their scan is ‘normal’ and their breast is free of cancer. Yet so much of what can be seen on a scan can be confusing and open to interpretation, she says. Where one doctor sees a benign blur, another sees a worrisome spot and orders more tests, like biopsies, and that, says Pearson Peyton, can create anxiety as well as lead to unnecessary testing.

“And it could be avoided if prior scans had been available,” she says.

Giving physicians access to prior mammograms is crucial to help identify whether changes have occurred in the breast over time, but Pearson Peyton is also making the case that storing mammograms in the cloud can save time and money by decreasing the number of recall examinations.

Medicare reimbursement rates are higher for diagnostic exams ($165) than they are screenings ($135), and the diagnostic exams take more time, says Pearson Peyton. Writing (along with coauthors Dr. Ray Cody Mayo, Dr. David Avrin and Dr. Jessica Leung) in October for the Journal of the American College of Radiology, she says three to four patients per hour can be scheduled for screenings, while one patient per hour is typically scheduled for a diagnostic exam. The conclusion: “Diagnostic exams are revenue losers.”

Pearson Peyton knows about crunching the numbers. When she started Mammosphere, she sought grant funding and private capital investment and raised $350,000, she tells Folio Weekly. Contributors, she says, included the Riverside Hospital Foundation, the Dolores Barr Weaver Foundation, and the Florida Blue Foundation, among others. Over the next four years, Pearson Peyton says she uploaded 25,000 scans.

The organization made its first public appearance in 2013 at One Spark, the crowd-funding festival for entrepreneurs to pitch their ideas, innovations, music and art to a broad audience. While Mammosphere didn’t generate any new investment at the festival, Pearson Peyton says it was a positive experience.

Last year, Mammosphere was acquired by lifeIMAGE, the country’s largest medical image sharing network. A relaunch is expected soon, says Pearson Peyton.

With a network that includes 400 hospitals and 700 partner sites, lifeIMAGE significantly broadens Mammosphere’s reach. According to the company’s website, lifeimage.com, the network has exchanged more than two billion medical images to date. Though Pearson Peyton will remain in Jacksonville and serve as chair of the company’s women’s health advisory board, lifeIMAGE moved Mammosphere to its headquarters in Newton, Massachusetts and recruited Pearson Peyton’s intern, who had been the organization’s only fulltime employee. Two other people, including a Stanford MBA and Harvard doctor, volunteered their time for Mammosphere, says Pearson Peyton.

“Healthcare is a tech-savvy business and that’s where they need to be,” she says.

Pearson Peyton’s role includes outreach and advocacy. Currently, she is lobbying state lawmakers to require a woman to receive a ‘dense breast notification’ after mammography. According to industry groups, including the American College of Radiology, dense breasts make it more difficult to detect cancer — and 40 percent of women have dense breasts. Obesity can be a factor, says Pearson Peyton, and 27 states have notification requirements in place. “I can’t believe Florida won’t pass this,” she says. “We need to inform our patients about the risk.”

Later this month, she is scheduled to speak to high-level IT professionals in Orlando at a meeting of the Healthcare Information and Management Systems Society. Pearson Peyton told FW that IT directors are a tough sell when it comes to incorporating cloud-based imaging networks outside their own systems.

“As a group, they’re slow to adopt new and disruptive technologies,” she says. “They worry about security and privacy issues.”

In a write-up about her upcoming presentation in Healthcare IT News, she says there is concern about the increase in workload. And no one likes that.

“IT staffers at hospitals are overwhelmed with responsibilities,” she is quoted in the publication. “If we can show them how this specifically helps patients and is more than just integrating systems, we can make real progress.”

Top-level executives who study the bottom line are an easier sell, she says, because they’re always on the lookout for ways to save money and improve patient care.

In addition to her work for lifeIMAGES, Pearson Peyton began consulting in January for a company based in Shanghai, China that is developing algorithms and collecting mammograms in the United States to develop a system that can detect breast cancer earlier using artificial intelligence. Pearson Peyton says she is helping Cambrian AI create system standards. “They’re intent on using our dataset for deep machine learning,” she says.

As she looks to the future, Dr. Kathryn Pearson Peyton says she would be happy in retirement (really, next time) to read letters from people telling her she made a difference in their lives. On Feb. 8, she received the ‘Women with Heart’ award from Volunteers in Medicine. She repeats a statement using almost the same words she used two years ago at the Generation W motivational conference.

“I want to make a difference in my tiny little world,” she says.