From Imaging AI to Proton Therapy: Japan’s Accessible Cancer-Care Innovations

With new cancer cases projected to nearly double by 2050, the World Health Organization has highlighted how humanity’s scourge is increasingly “universal in its reach” but remains “highly inequitable in its impact”.

According to the WHO’s report, one in five people will develop the disease while currently one in six dies from it. Over 90% will be affected by their own or family member’s diagnosis of cancer during their lifetime. In 2024, there were 20 million new cancer diagnoses but this is projected to hit 35 million by 2050.

Thanks to years of scientific progress, many of these cases are curable. The crux, however, is continued unequal medical access. In high-income countries, where cancer is more often detected early, five-year survival rates exceed 85%, compared with under 45% in low-income countries for all types of cancers. For example, 85% of those diagnosed with breast or childhood cancers in richer countries will survive at least five years but the figure drops to less than 45% in poorer countries.

These stark and unjust differences stem from uneven availability of equipment and treatment. To take one example, low-income countries average only 0.7 CT scanners per million people, compared with 38.8 in high-income countries, while at least 36 countries have no radiotherapy equipment. These gaps reflect not only limited equipment but also shortages of trained radiologists, oncologists, and other specialists.

As a country widely admired for its highly effective universal health care system and advanced medical science, Japan has long worked to share its knowhow with the world. In cancer care, the country is working to provide funding, equipment, professional training, institutional partnerships, and capacity-building for countries that lack adequate cancer-treatment infrastructure. Advanced medicine has been chosen as one of 17 strategic fields by the current Takaichi administration, with intention to attract ¥11.6 trillion in public and private investment into these medical fields by 2040.

Japan is also home to cutting-edge medical technologies in cancer detection and treatment. Two Japanese startups, LPIXEL and B dot Medical, illustrate Japan’s advanced solutions. One helps clinicians and researchers make better use of image data while the other works to make advanced proton therapy more accessible.

Founded in 2014, LPIXEL is an AI startup specializing in medical and life-science image analysis both for diagnosis assistance but also medical and pharmaceutical research. Its key platform EIRL is a suite of AI-powered medical image diagnostic support products which analyses images such as chest X-rays, CT scans, MRI scans and endoscopic video to identify areas that may require a physician’s attention.

“LPIXEL is leading the development of the Japanese medical AI market, having obtained regulatory approval or certification for nine products in its EIRL series. The priority is to identify serious diseases in time to treat them, with cancer the central focus. Specifically, our chest-screening product detects lung cancer, while our colon-polyp product supports detection of colorectal cancer,” explains Tomihisa Kamada, CEO for LPIXEL.

Using AI can help doctors more quickly and efficiently find potential tumors, providing an additional layer of checking to not miss cases. It can also support less experienced physicians and regions with few specialists.

One reason the technology emerged in Japan is that the country produces one of the world’s highest volumes of medical images per capita, while having a relatively limited number of radiologists. Doctors are therefore required to interpret large numbers of images. Fatigue, particularly later in the day or after reading hundreds of cases, can increase the risk of missed findings.

“We saw that this was clearly a major challenge, so that is where we began our efforts in AI-powered medical solutions. It has now come to be used quite widely in Japan,” explains Mr. Kamada.

EIRL has been introduced at approximately 1,200 facilities across all Japanese prefectures. Users include major university hospitals as well as smaller regional hospitals and clinics operated by a single physician. Large hospitals use AI to manage high image volumes more efficiently. Regional hospitals and clinics use it to compensate for shortages of radiologists and specialists.

LPIXEL’s AI imaging technology also has strong export potential. The company obtained regulatory approvals in six Southeast Asian countries where the number of doctors has not kept pace with population and economic growth, and cancer cases are rising with life expectancy. In Vietnam, LPIXEL is working with the national telecommunications provider to develop cloud-based medical imaging AI support to increase the quality and access to imaging diagnoses for cancers but also diseases like tuberculosis that is common in developing countries.

B dot Medical’s mission is “Proton for Everyone”, explains Takuji Furukawa, CEO and former award-winning researcher at the Japanese National Institute of Radiological Sciences from which this startup spun out, in 2017.

“Proton refers to proton-beam cancer therapy. We are a medical-device start-up dedicated to making this treatment available to far more people than today. Our goal is to create ultra-compact proton-therapy infrastructure for global cancer care that will be widely accessible and transform cancer treatment itself.”

Proton therapy uses a fast-moving beam of positively charged protons to precisely target and destroy cancer cells. By concentrating radiation more precisely in the tumor while reducing exposure to normal tissue, it has, for some cancers, demonstrated lower side effects and higher survival rates than traditional x-ray therapy. Nevertheless, few hospitals are equipped with the humongous 12-metre proton therapy machines that require a dedicated building and shielding walls several meter thick to house it.

With so few facilities (Japan currently has around 20 proton-therapy centers, and the United States around 50), patients often do not know proton therapy is available, and even when they do, there may be no centers nearby to receive it, explains Dr. Furukawa.

B dot Medical has developed and received regulatory approval for a proton therapy machine a third of the size in height of a conventional one. It has also developed systems to maximize throughput, where patients can be prepared for the actual irradiation which only takes a few minutes and is positioned outside the treatment room, then transported in via wheeled shuttles. AI used as an operational “control tower” will coordinate patients, shuttles, treatment rooms, and staff which could roughly double capacity.

“With conventional large-scale systems, it can take about 20 years simply to recover the initial investment. Our system requires about half the upfront cost and can treat more patients, so the return curve is much steeper. Depending on patient volumes, we estimate a much shorter payback period of roughly five to eight years based on Japan’s medical reimbursement rates, with potentially shorter payback periods in markets with higher reimbursement levels,” says Dr. Furukawa.

B dot Medical’s proton therapy system is attracting global interest—not just from Japan. Asia leads today because their business network is strongest there, but enquiries are also coming from the US and Europe. “The prototype has validated the principle; the next inflection point is clinical use. Once hospitals can prove the projected revenues and returns in practice, we expect global interest to accelerate sharply,” says Dr. Furukawa.

Japan’s medical innovators show how advanced imaging, AI, engineering and clinical expertise can help address the global cancer-care gap identified by the WHO. By making diagnosis and treatment more accessible, technologies from companies such as LPIXEL and B dot Medical have the potential to extend the benefits of medical progress beyond Japan.

As the WHO has emphasized, “Whether a person survives cancer should never depend on where they were born or however much they earn.” Japanese innovation can help move the world closer to that goal.