Take early detection of cancer to the next level

Early detection of cancer can save lives, Cancer is predicted to be the number one murderer in the world We are still too late to diagnose most cancers. In the United States, we are currently screening only five common types of cancer. The rest are identified only when signs or symptoms appear and often indicate disease that has progressed when the outcome is poor. It is estimated that these five single cancer screenings detect only 16% of the 1.2 million cancers diagnosed each year in cancers aged 50 to 79 years in the United States.

Medical students are taught that the sensitivity of the test is important when it comes to cancer screening. Screening tests need to find the cancer that is present. Here is the challenge. We spend $ 27 billion annually on screening tests and get about 9 million positive results. Of these, only 204,000 were found to be real cancers, and eventually 8.8 million were false positives. Many women with suspicious mammograms are familiar with this tragic journey, and after only a few months of additional diagnostic testing, they were eventually declared cancer-free. In fact, the screening tests recommended for 60-year-old women who have smoked (breast cancer, colon cancer, cervical cancer, lung cancer) have a 43% chance of at least one false positive test. .. This sensitive but suboptimal specificity approach to cancer screening targets one cancer at a time, until it is adopted in a way that maximizes profits, minimizes harm, and is cost-effective. Will take decades.

For COVID-19, the importance of balancing high-precision, high-sensitivity testing with screening of large populations became apparent. It is time to adopt a similar population-based strategy for other public health issues such as cancer.

Improving early detection of cancer may be the only way to actually dent the cancer mortality curve. However, early detection of cancer suffers from the streetlight effect, a common illness in medicine and public health. I’m looking for 5 cancers “here” under a street light where early detection tests are being conducted, 70% of deaths from cancer It’s happening “over there” in the dark, even if we don’t see it. Some may think that they are not screening for these cancers because there is no cure, but after reviewing clinical practice guidelines and literature, careful follow-up is recommended for some of the following: Almost all early-stage cancers have been shown to have effective treatments, even if they are. Non-invasive early-stage prostate cancer.

Patients cannot choose the cancer they will receive. But what if we move away from screening individual cancers and start screening for all possible cancers? What if you dramatically improve your overall cancer detection?What if I move to tracking? Cancer detection rate (CDR) In the population?

First, the CDR represents the total number of cancers detected out of the total number of cancers expected in the monitored population. This is a measure of population yield in screening programs. In the United States, for example, about 1.2 million cancers will occur in adults aged 50 to 79 years this year. Mammography detects 114,000 of these cancers and is expected to have a CDR of about 9%. Even with all five single cancer screenings combined, the CDR is only about 16 percent. While great results, this alone cannot bend the cancer mortality curve or address the public health crisis posed by cancer.

The Genome Revolution offers the opportunity to rewrite this chapter and has a potentially happy ending.There are many novels now Multicancer Early Detection (MCED) Test It is approaching commercial availability. These MCEDs use advanced technology to find early cancer footprints of easily accessible body substances such as blood, urine, saliva, and stool. Several new tests under development can detect a variety of cancers, many of which are potentially fatal cancers without recommended screening tests. Such tests should be used in combination with existing single cancer screening tests during preventive care visits or regular blood tests. About 70 percent of 50-year-old Americans– –79 have at least every year.. In addition to current screening tests, if everyone has an annual blood test, all cancers, including the most deadly cancers with a 5-year survival rate of less than 50%, such as pancreatic cancer, stomach cancer, and lung cancer 50% can be detected.

Why is MCED so profound and a game-changing idea? This is because it is simply not feasible to spend decades developing and testing new screening approaches for individual cancers. With higher cancer detection rates and lower false-positive rates, the balance shifts to greater benefits than harm to the population. When used alone, the MCED test may still miss some cancers, but some detections are better than not. From a public health perspective, a 50 percent CDR can lead to early detection of many cancers if potentially curative treatments are available.

Just as we track COVID-19 infection, detection, and mortality, we need to adopt a CDR model to track the progress of early detection of cancer. Dramatically improving CDRs using the Genome Signature may be just one of the first population-level benefits directly from the huge investment in the Human Genome Project.