“Ezra saved my life”

[Originally posted on Medium]

Two and a half years ago, we set out to create a new way to screen for cancer that is fast, accurate, and affordable. Eighteen months ago, we launched Ezra, with the mission of detecting cancer early for everyone in the world. And nine months ago, this email landed in my inbox from one of our members:

“So, Ezra saved my life. That’s the simple statement. I had surgery Sep 25 and today, Oct 1, I got the pathology back, and am now cancer-free. I’ll go into a regimen of surveillance against recurrence instead of chemo or further treatment. This particular kind of cancer is usually not discovered until late, and so even though it’s particularly operable, it’s also particularly deadly. But here I am, because my Ezra scan served as my early warning system against problems.”

Our year in review

Around the time I received this email last year, the Ezra team was just 12 people across our two offices in New York and Toronto. We had just launched our full-body MRI scan, and we were live in one facility in New York.

Fast forward to today — we are now a team of 30 people with offices in New York, Toronto, and Los Angeles. We are scanning Ezra members in 11 imaging facilities across New York, San Francisco, and Los Angeles. We are live with our full-body MRI, prostate MRI, and low-dose CT (LDCT) lung cancer screening programs across all our partner imaging facilities.

Most importantly, since going live in January 2019 we have helped 4% of our members — all of whom were asymptomatic — detect cancer early.

It has been incredibly rewarding to receive emails and letters from our members thanking us for helping them detect cancer, pre-cancer, and other significant health conditions, and I am grateful for all the hard work my colleagues have put in to make this a reality.

The Ezra COVID 360

Our mission at Ezra is to help everyone in the world detect cancer early, and we do that by giving our members a look inside their body through our proprietary, full-body MRI.

As coronavirus took New York City (our home) and the world by storm, we started thinking about how we could use our technology and expertise to help people who’ve had COVID-19 better manage their health. More than 1.5 million people in the US have been infected with the coronavirus, and many of them may have long-lasting lung damage caused by the virus.

So today, I’m excited to introduce the Ezra COVID 360, a low-dose CT scan of the lungs to look for damage caused by COVID-19, paired with an antibody blood test to check for igG and igM antibodies. This new plan is designed for individuals who want to understand the potential long-term impact of COVID-19 on their lung health, and check their antibody status.

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Ezra COVID 360 will be available for $390 in New York City starting June 1st, and we’re working tirelessly to bring the plan across California in the upcoming weeks.

We’re also offering 50 free plans to medical providers and first responders who have been on the frontlines of COVID-19. If you’re a first responder and would like to sign up, please email hello@ezra.com and our team will get back to you within 24 hours.

A great new partner

To support the Ezra COVID 360 launch and continue building our medical imaging AIs to make MRI-based cancer screening more accessible, today we’re also announcing that we have raised $18M in new funding.

The round was led by Rick Heitzmann at FirstMark Capital, alongside new investors Jeff Raider and Dave Gilboa (co-founders of Harry’s and Warby Parker), Vlad Tenev (co-founder of Robinhood), Fred Destin (co-founder of Stride VC), and Andrei Dunca (co-founder & CTO of LiveRail). Existing investors Accomplice, Seedcamp, Credo Ventures, Founders Future, LDV Capital, Esther Dyson, Taavet Hinrikus, Daniel Dines, Dave McClure, and Jeremy Arditi also participated.

I’m excited to become part of the FirstMark family and to add Rick Heitzmann to our board of directors. Rick is an extremely smart and thoughtful investor with a strong thesis on empowering people with their own health data and takes a long-term approach to his investments. He will be joining our board alongside Ryan Moore, partner at Accomplice (who led our Series A).

A paradigm shift in technology

Every few decades, a technological paradigm shift opens a window of opportunity to create what we previously thought was impossible. Artificial intelligence represents one of these paradigm shifts, and I am excited about applying it to democratize cancer screening and make it widely available to the world.

Aside from investing in the Ezra COVID 360, we’ll also use the fresh funding to expand our medical imaging AIs to make MRI-based cancer screening more accessible. Ezra’s first AI product will assist radiologists in their analysis of prostate MRI scans, helping them work accurately and more efficiently. The Ezra prostate AI is currently under FDA review, and we are working on more AIs to help decrease the cost of MRI-based cancer screening.

Join our mission

I’m fortunate to be working with an extraordinary group of team members, investors, and advisors toward our mission of detecting cancer early for everyone in the world. If you’d like to learn more about us or join our team, please visit our website or send me an email at emi@ezra.com.

Stay healthy and safe,

Emi Gal
CEO and co-founder

Introducing the Ezra full-body scan, covering 13 cancers in women and 11 in men

[Originally posted on Medium]

We started Ezra with one mission: help everyone in the world detect cancer early. In 2018, 18.1¹ million people worldwide were diagnosed with cancer². Of that number, almost 50% were detected late, and only 2 out of 10 of those individuals are likely to survive longer than 5 years³.

The numbers tell a compelling story: early detection could save more than 7 million lives each year.

A promising start

In January of this year, Ezra launched our first MRI-based cancer screening program, for prostate cancer. We chose prostate cancer because it is the highest incidence cancer in men (1 in 9 men will get prostate cancer during their life), and because the current standard of care (PSA blood tests) is highly inaccurate and often results in unnecessary prostate biopsies. In the U.S. alone, 1 million prostate biopsies are done every year, and the majority of them could be avoided. A study published in The Lancet⁴ in February 2017 showed that a prostate MRI can detect 18% more clinically significant cancers, while decreasing the number of unnecessary biopsies performed by 27%.

Since launching our MRI-based prostate cancer screening, almost 1,000 individuals have signed up, hundreds of men have been scanned, and Ezra has successfully helped our members find prostate cancer early and avoid unnecessary biopsies.

Move fast and try not to break things

From the beginning, our goal at Ezra has been to offer a way to screen for cancer everywhere in the body that is fast, accurate, and affordable. For the past year, my team and I have spent countless hours testing MRI sequences in order to build our proprietary full-body MRI scanning protocol.

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Today, having a full-body MRI scan in a typical clinical setting takes 2 to 3 hours. Together with an incredible team of physicians, radiologists and MRI specialists, we have reduced the scanning time for the Ezra full-body protocol to approximately 60 minutes for men and 75 minutes for women. In just about an hour, we cover up to 13 cancers in women and 11 in men (full list in Table 1 below). It is the most advanced scan of its kind, and it is now available at our Manhattan facilities.

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Table 1 — cancers covered

The imaging modality of the future

For those who don’t know much about MRI, the acronym stands for Magnetic Resonance Imaging, and the modality has been around for 30 years. An MRI scanner uses the magnetization properties of the protons in the water in our cells to create internal images of the body. In essence, MRI uses magnets to take photos of your organs.

That said, while an MRI scan is non-invasive, accurate, and painless, it’s also very expensive. Unlike other imaging modalities such as X-rays or CTs, MRI scans take a longer time — an average prostate scan, for example, takes about 30 minutes. They also require significant training to accurately analyze — an expert radiologist spends, on average, 15 to 20 minutes per scan to analyze a prostate MRI versus 1.5 to 2 mins for an X-ray.

That’s why, at Ezra, we’re building Artificial Intelligence to decrease analysis time while increasing radiologist accuracy. By building organ-specific AIs, such as our Prostate AI, we help radiologists become more accurate and more efficient when analyzing scans. Our prostate AI, currently undergoing the FDA clearance process, helps radiologists automate the functions of their job that are most arduous — measuring the volume of the prostate, the size of lesions, and segmenting lesions for Magnetic Resonance-Ultrasound guided biopsy preparation.

A plan for everyone

Making MRI cancer screening available to everyone means making it as affordable as possible. Right now, our full-body scan is $1,950, the torso scan is $1,350, and a pelvic or abdominal scan is only $675. We also offer affordable installment pricing options, where members can pay for their scans in 12 monthly installments.

As we build our collection of AIs to optimize image acquisition and analysis, our goal is to bring down our prices as quickly as possible in order to make MRI cancer screening available to everyone.

Backed by world renowned medical experts

Ezra is headquartered in New York City, the epicenter of oncology innovation. Over the past few months, we have been fortunate to add a number of world-class medical experts to the Ezra Medical Advisory Board: Columbia University Medical Center doctors Azra Raza, Siddhartha Mukherjee, and Joseph Alukal, as well as Dr. Oguz Akin from Memorial Sloan Kettering Cancer Center and Radnet’s Dr. Lawrence N. Tanenbaum, Dr. John Melnick, and Dr. Charles Fiske.

Join our mission

Our mission at Ezra is to detect cancer early for everyone in the world. We plan to do so by offering fast, accurate, pain-free MRI-based cancer screening; provide access to expert radiologists, assisted by the Ezra AI (once we obtain FDA clearance); and deliver compassionate, ongoing support from our team of Ezra Physicians and Ezra Guides. Our goal is to remove the stress, anxiety, and human error from the cancer screening process, and give people a better way to take proactive care of their health, year after year.

To learn more about our full-body cancer screening program or sign up, visit ezra.com. If you’d like to join us on our mission and help build cancer screening solutions that are fast, accurate, and affordable, visit our Careers page and join us at our offices in New York City or Toronto.

[1] https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21492
[2] https://seer.cancer.gov/ – 46.8% of cancers are detected in stages with disease spreading outside of the original tumor.
[3] https://seer.cancer.gov/ — calculated based on 5-year survival rates for individuals with distant metastatic disease.
[4] https://www.ncbi.nlm.nih.gov/pubmed/28110982

Meet Ezra, a new way to screen for cancer

[Originally posted on Medium]

18.1 million¹ people across the world will be diagnosed with cancer this year, and over half will be diagnosed late². Of the 9 million people who will receive a late diagnosis, only a third will survive longer than 5 years³. If their cancer had been detected earlier, more than 85% of these men and women would survive. That’s 5 million lives that could be saved by early detection every year. So why isn’t everyone having their cancer detected early?

Screen for cancer, save more lives
I’ve been interested in cancer screening my whole life. As a child, I developed hundreds of moles over my body that put me at increased risk of melanoma. Having annual dermatology check-ups to screen for abnormal moles has always been part of my life. Then, in 2015, a friend introduced me to Hospices of Hope, a non-profit in Romania that builds and operates hospices for terminally ill cancer patients. Speaking to patients and their doctors helped me learn that one of the biggest problems in cancer is the lack of a fast, accurate, painless way to screen for cancer anywhere in the body. So I embarked on a personal quest to see if we could use technology to help everyone in the world detect cancer early.

Inspiration and a new idea
I spent the following two years reading about cancer, meeting with doctors, speaking to scientists, and trying to learn everything I could about the disease. I cycled through a dozen different ideas, ranging from DNA nanobots to digital microfluidics biochips (neither technology is ready for clinical use), with the goal of finding a way to screen for cancer anywhere in the body with a single test. And then, while reading research papers on my honeymoon (I know!), it hit me. One morning I asked my wife, “What if you could get a full-body MRI scan and have it analyzed by AI in order to detect cancer anywhere in your body? Would you sign up for that?” She loved it, and that’s how Ezra was born: a direct-to-consumer membership that offers cancer screening using a full-body MRI analyzed by AI.

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I returned from my honeymoon and started reading everything I could about MRI. My previous company, Brainient, had just been acquired by Teads, and I had been promoted to CEO of Teads Studio and Global CMO. But I devoted my nights and weekends to researching this new idea. Then, in January 2017, a study⁴ published in Lancet convinced me that I was on the right track. The study compared the current standard of care for prostate cancer screening — a PSA (prostate-specific antigen) blood test, followed by a prostate biopsy if PSA levels are elevated — with an alternative, a prostate MRI. The conclusion? When prostate biopsies are guided by MRI findings, 18% more clinically significant cancers are detected. And there was more: using MRI to triage men decreases the number of unnecessary biopsies by 27%. In other words, MRI yields a more accurate, less intrusive test with a better patient experience. I was sold.

The right technology, the right people
I believe startups succeed or fail based on the quality of their teams, and I knew I needed a medical imaging expert to complement my computer science background. I sifted through the profiles of 2,500 deep learning and medical imaging experts across the globe. I reached out to 300 of them, 150 responded, and I conducted 90 interviews. I narrowed my search to four applicants whom I engaged in a 3-month project to train a deep learning network and validate their skills. That’s how I found Diego Cantor, PhD, my co-founder and one of the smartest people I’ve ever met.

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Emi Gal, CEO & co-founder (left) and Diego Cantor, CTO & co-founder (right)

Together with Diego, we started tackling our first cancer — prostate cancer. We chose prostate cancer because it is the most common cancer in men, and because the current standard of care for prostate cancer screening is broken: elevated PSA levels are often caused by non-cancerous conditions such as benign prostate hyperplasia (BPH) and prostatitis, so a lot of men undergo unnecessary prostate biopsies. For those unfamiliar with a prostate biopsy, a needle is inserted through the wall of the rectum to sample prostate tissue from 12 to 14 different locations, and requires antibiotics before and after the procedure. And most important, prostate biopsies often have side effects such as bleeding, infection, urinary issues, and erectile dysfunction⁵. That’s no fun, and while I wouldn’t expect cancer screening to be fun, I do believe it should be comfortable, accurate and safe.

A new approach to prostate cancer screening
Diego and I spent a year building the Ezra AI, and thanks to Diego’s extensive deep learning and medical imaging expertise, we created what is likely the most accurate prostate AI in the world, with over 90% accuracy when compared to an expert radiologist. (Note from our legal counsel: The Ezra AI is an investigational device that has not yet received marketing authorization from the FDA. The safety and effectiveness of the device have not been established. After further study of the Ezra AI technology, the Company plans to seek FDA clearance in 2019).

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Radiologist (left) vs. Ezra AI (right) for prostate lesion segmentation

A clear mission
Our ultimate mission at Ezra is to detect cancer early for everyone in the world. We plan to do so by offering fast, accurate, pain-free MRI-based cancer screening; access to expert radiologists, assisted by the Ezra AI (once we obtain FDA clearance); and compassionate, ongoing support from our team of Ezra Physicians and Ezra Guides. Our goal is to remove the stress, anxiety, and human error from the cancer screening process, and give people a better way to take proactive care of their health, year after year.

The Ezra launch — today
Today, we’re announcing that Ezra is available as an invite-only private beta program in New York City. We’ve partnered with RadNet, the nation’s leader in outpatient imaging, and Ezra members will be able to get their prostate MRI scans at RadNet’s Lenox Hill Radiology facility in Manhattan (61 East 77th Street, New York, NY). Additional facilities are scheduled to be enrolled through 2019.

We’re also pleased to announce a $4M seed round led by Accomplice, with participation from Founders Future, Credo Ventures, Seedcamp, Esther Dyson, and a number of startup founders and angel investors. We are humbled and thrilled to have such an extraordinary group of investors on board and look forward to building a meaningful company together.

Diego and I are very excited to finally launch Ezra, and we look forward to keeping you updated on our progress. If you’re a man at risk of prostate cancer and would like to become a private beta member, request an invite on our website. If you’re inspired by what we’re working on and want to join our team, visit our Careers page. And if you’d just like to stay in touch, subscribe to our newsletter or drop me an email.

Stay healthy,

Emi Gal
CEO & co-founder of Ezra

¹ https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21492
² https://progressreport.cancer.gov/diagnosis/stage
³ https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2018/cancer-facts-and-figures-2018.pdf
⁴ https://www.ncbi.nlm.nih.gov/pubmed/28110982
⁵ https://bit.ly/2B5DlvV