Moving Forward With True Early Detection of Cancer

An article in the current issue of Wired Magazine nicely details how the hope of new breakthroughs in the diagnosis and treatment of cancer run headlong into the realities that inevitably occur.  It also points out how perseverance and optimism—appropriately focused on the issue at hand—may take us to success as we pursue our dreams of reducing in incidence and burden of cancer.


 


The article, titled “The Truth About Cancer: Don’t Try to Cure It. Just Find It:  Inside the Science of Early Detection” and written by Thomas Goetz (a deputy editor for Wired), outlines in large part the work of the Canary Foundation, an organization founded by Don Listwin from California to pursue the question of how we can find cancers at the earliest moment possible when the chances for cure are greatest.


 


Mr. Listwin’s search was inspired by the experience of his mother, who was diagnosed with advanced ovarian cancer and died from her illness a year later.


 


He asked the question why it took so long to diagnose the cancer until it was so far advanced and beyond hope of cure.  He found out what many of us unfortunately are very familiar with: many cancers, like ovarian and pancreatic cancer, are advanced at the time of diagnosis.  They are truly silent, because it is their spread that eventually produces the signs and symptoms that lead to their discovery.  And then it is too late to do much about the disease.


 


There has been a tremendous amount of interest over the past several years in trying to find some way to make the diagnoses of these cancers earlier.  Scientists have been working hard to find what we call “molecular markers” which are early signals in the blood that may say to us that a cancer is present long before it even becomes visible. (In the interests of full disclosure, the American Cancer Society and the Canary Foundation have collaborated in the funding of several of these researchers.)


 


We have screening tests available for some of the common cancers that have enabled us to find cancers reasonably early in their course.  Screening for these cancers has resulted in real improvements in treatment and survival over the past years.  Such cancers include breast cancer, colorectal cancer and cervical cancer (the jury on prostate cancer screening is still “out” until we get solid evidence that the PSA test actually makes a difference in whether men with prostate cancer have an improved outlook and survival with early detection).


 


But those tests are actually fairly crude, when you consider that there are probably proteins or other markers circulating in the blood that could find cancers well before they are otherwise visible with the types of machines we have today such as mammograms, CT scans and ultrasound.


 


The good news is that we are making progress, as reflected in the article.  The bad news is that the progress is slow, moving forward in fits and starts, with some unfortunate detours along the way.  For example, some tests that have been promoted as being able to diagnose ovarian cancer through blood tests have been discredited on more careful investigation.


 


But hope remains, and the Canary Foundation is moving that research agenda forward. 


 


What’s unique in a very real respect is the approach used by the Foundation, which is not unlike that of a number of other “entrepreneurially directed” ventures.  More and more, there are businessmen who are taking the reins of directing research programs trying to cross the void between the traditional scientific methods of research and the more disciplined, goal-directed efforts of the typical business where you scope out an opportunity and move forward, changing directions and emphasis as you go learn from your successes and your mistakes.


 


The article points out the dilemmas faced by the researchers engaged in trying to solve this early detection problem when it comes to figuring out whether or not the various discoveries actually are clinically relevant.  That is no small matter, and sticking to the fundamental premise that proof of effectiveness is key to credibility in this field.  Otherwise we may end up with some fancy technology that really doesn’t measure what it is supposed to measure.


 


I recently wrote a blog which questioned the value of many of these new tests and technologies that are being promoted to either screen, diagnose or otherwise aid the treatment of cancer.  As I mentioned, there is a lot of hype, not infrequently little validation of these tests, and then massive marketing efforts to get a particular technology or test adopted in patient care. 


 


The sad reality is that there is no independent professional organization that has looked carefully at the utility and value of many of these tests, leaving it to patients and doctors to make their own assessments.  Unfortunately, neither are well equipped to make these judgments, relying frequently on manufacturers and promoters who create a “buzz” about a particular new test or technology.


 


As noted by the article’s author:


 


“For a disease like cancer, so often seen as a death sentence, early detection promises a trade-off.  At first, it makes things more complicated.  It introduces more doubt and complexity into an already complicated equation.  But in return, early detection promises that this doubt can be quantified, that these new variables can be broken down into metrics, analyzed and factored into our health decisions. Early detection proposes that the result of this calculation—complicated and ambiguous as it is—will yield better results for individuals and for their families.  In exchange for a modicum of doubt, it offers a maximum opportunity for hope.”


 


We don’t know how long it is going to take to get the benefits of research efforts into molecular markers and the very early detection of cancer.  Maybe it will be five years, maybe ten years, maybe longer.


 


But with persistence, dedication, and commitment such as that demonstrated by the Canary Foundation, I have no doubt we are going to get there.


 

11 thoughts on “Moving Forward With True Early Detection of Cancer

  1. When it comes to any prognostic/diagnostic test in cancer medicine, the fundamental premise that proof of “accuracy” (the test accurately measures what they are purported to measure) not “efficacy” (use of tests improves clinical outcomes) is key to credibility in this field.

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    I am not an apologist for genetic testing. I have a rather good understanding of its limitations. However, I will speak up for what is the appropriate standard to judge all medical tests.

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    Being that Dr. Len has referred to his eloquent blog which questioned the value of new tests and technologies to either screen, diagnose or otherwise aid the treatment of patient care, his redux url will be suffice in my reply (in the comments section).

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    However, I do agree with him that there is no independent professional organization that has looked “carefully” at the utility and value of many of these tests. Private insurers, like National Heritage Insurance Company and Highmark Medicare Services, contractors that administer Medicare programs, have done quality, transparent tech assessments on a number of diagnostic tests.

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    Medicare has only 20 doctors and 40 total clinicians making coverage decisions (and not a single oncologist on staff). That’s not enough staff to do a thorough analysis of valuable diagnostic tests. Private insurers employ thousands of doctors, nurses and pharmacists to do tech assessments, which would include cancer diagnostic tests.

    ———-

    There must not be “closed” tech assessments, trying to invent a brand new criterion for validating a laboratory tests. And there is nothing wrong with the choice of physicians to intergrate promising insights and methods that remains an essential component of quality cancer care.

  2. It has been some time since I have replied to one of the articles. Gregory Pawelski always comes up with some great answers. I am surprised that there isn’t an Oncologist on the staff of Medicare. With all the new tests out etc and approval of PET Scans etc., you would think that where Cancer is concerned, an Oncologists view/opinion would be critical. Also, I read articles on European medical care and the European’s try various medications, procedures, tests etc prior to the USA and have known successes and approval can be 5 years earlier than in the USA. They of course, do not have the FDA which in my opinion, tends to hold back medicine in the USA, rather than help it. The cost of medical care and drugs in Europe is also much cheaper than in the USA.

    Anyway, good comments.

  3. Dr. Scott Gottlieb, a former senior official at CMS and a fellow at the American Enterprise Institute, made the recent revelation in a Wall Street Journal op-ed piece. I would suspect it is one of the reasons they rely on private insurers (above) to independently look at the utility and value of many diagnostic tests. Yet, in the delivery of cancer benefits since the year 2000, Medicare issued 165 restrictions and directives on the use of cancer drugs and diagnostic tools.

  4. I had a melanoma on my left arm removed in May. Wide excision border was done and no cancer was in the margins.
    It was a Clark’s level two but the other factors were minimal. I had a mole removed in November on my back and it showed “atypical hyperplasia”. I had a mammogram done in December and it showed micro-calcifications in a cluster pattern in my left breast. I had stereotaptic biopsy done and a week later a lumpectomy. Although no cancer was found, many cells showed up “atypical hyperplasia”. I know I am at a greater risk for breast cancer and my doctor recommended going on Tamoxifen. My question is, with all this “atypical hyperplasia” is my whole body undergoing this change? What treatment can I have that will stop this atypical hyperplasia before it does become cancer throughout my body? Thank you for your advice.

  5. I regret that I cannot provide specific medical advice in this blog. That said, the finding of atypical hyperplasia in your breast biopsy does suggest that you may be at higher risk of breast cancer. You should work with your doctor to determine your actual risk using one of the risk estimators such as the Gail score and carefully weigh the risks and benefits of preventive treatment with tamoxifen or raloxifene (assuming you are post-menopausal. The fact that you have one melanoma puts you at higher risk for a second one. The presence of atypia in another mole raises the question of whether you may have a familial tendency to melanoma. In any event, you should see a dermatologist regularly to examine and perhaps “map” other moles on your body to check for any changes at the earliest possible opportunity.

    There is no “generalized” aypical hyperplasia syndrome. You should be certain to follow the Society’s guidelines for the prevention and early detetion of cancer, which is good advice for anyone.

  6. What about early detection for lung cancer, which kills more than all the other cancers combined? is there a reason ACS does not list early detection options for these patients?

  7. There is controversy in the medical community about the value of screening for lung cancer with CT scans. The key question is not whether or not CT scans can find early lung cancers–they can. But the larger question is whether or not the benefits outweigh the risks, and whether screening actually saves lives that would have otherwise been lost to the disease.

    There are large clinical trials currently underway which will likely answer the question.

    It is possible that this is one cancer that when found early may not increase survival. We may be finding cancers that would otherwise not have caused harm, and patients who smoke and develop lung cancer have other medical problems that could complicate surgery and/or radiation therapy, resulting in significant problems and even death.

    We do advise people who want lung CT scans to have a very thorough discussion with their doctors. You can find more information on this topic at:
    http://www.cancer.org/docroot/CRI/content/CRI_2_4_3x_Can_Non-Small_Cell_Lung_Cancer_Be_Found_Early.asp?sitearea=

    or call us at 800 ACS 2345.

  8. I am just familiar enough to be concerned and have been educated enough to follow all of my patients and watch for early signs to help prevention. I recently had my 4 year old son go for warts or skin tags and they noticed a mole and it was removed now the next step they say is removing more, no word if it's Basal or not but they did say it was not melanoma. I have concerns if this is to be handled my a cosmetic based group or should it go to more cancer based group.

  9. thank you for any and all help. my wifes brother has just finished interferon for melanoma.
    I know we are always our own worst care takers but it's even worse as many know when it is our children,

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