Cecily Rose Miller, PhD ’17, MPH : TB sleuth: finding hidden cases worldwide

While not her official title, “tuberculosis detective” would be an apt one for Cecily Rose Miller, PhD ’17, MPH. An epidemiologist, she helps lead a global effort to locate the “missing millions” – the estimated 4 million out of 10 million people with tuberculosis (TB) whose illness goes unreported or unnoticed every year.

Early discovery is key in treating TB: Many patients don’t exhibit symptoms of the slow-moving disease for years, if at all. In the meantime, they can unknowingly spread the airborne TB bacterium to family members and in their communities. In 2020, for the first time in a decade, the number of TB deaths worldwide rose – to more than 1.5 million.

“The need to find those people with TB is more urgent than ever,” says Miller, a technical officer with the World Health Organization (WHO) Global Tuberculosis Program and director of a recent update of WHO’s TB screening guidelines. The new guidelines include improved X-ray technology and other tools new to the WHO-sanctioned detection arsenal.

“A chest X-ray can detect TB in people before they start developing symptoms,” Miller says.

Modern chest X-ray equipment is safer (it emits negligible radiation) and far more portable (it’s the size of a large Polaroid camera instead of a van), making screening feasible even in remote communities. Equally exciting is a new way of interpreting those X-rays, given the scarcity of trained radiologists in many resource-constrained settings.

Advancements in artificial intelligence have led to computer-aided detection (CAD) software capable of automatically detecting TB on chest X-rays with an accuracy equaling that of a human reader. Miller led the process of WHO’s endorsement of CAD technology under the new screening guidelines, released in March 2021 – the first time the organization has approved artificial intelligence for health care.

Born and raised in the Bay Area, Miller landed at the UCSF Center for Tuberculosis as a data manager and research assistant after earning her MPH at UC Berkeley. Within a decade, she was conducting research in East Africa and Indonesia as part of the center’s investigations into undiagnosed TB – and had earned her PhD in epidemiology and biostatistics.

“I’d had a long-term interest in global health but hadn’t focused on TB. I really just loved it,” she says. “It felt at the heart of both a social and a biomedical problem, a disease that tracks so much with poverty and vulnerability.”

– Janet Wells for UCSF Magazine