Now You Can Screen for Cancer Sooner Rather Than Later
The last few years have had many of us skipping our regular cancer screenings. Maybe your mammogram imaging center closed due to pandemic safety measures, or health insurance concerns kept you from finally scheduling that colonoscopy. But now medical appointments are getting back on track—and that’s a very good thing, because, when it comes to cancer diagnosis and treatment, early detection improves outcomes. Routine screens have helped cut cervical cancer deaths in half over the past 30 years and prevented 12,000 breast cancer deaths in the U.S. annually. And survival rates for stage 1 lung cancer could exceed 90%—as they did in a landmark study published in New England Journal of Medicine. The crucial factor: annual screenings of patients at risk for the disease.
When these annual screenings are as simple as a blood test, they could indeed become common practice. Multi-cancer early detection (MCED) tests can reveal cancers—including those with no recommended screenings—with a single blood draw. Here’s why these tests could be valuable enough to become part of your annual physical.
Many cancers can be detected months or years earlier than they currently are
The U.S. Preventive Services Task Force currently recommends screening for five types of cancer: breast, colorectal, cervical, prostate, and lung (for high-risk individuals). For many others, no routine screen exists, which means waiting until symptoms appear—often when they’re more advanced and difficult to treat. In fact, cancers without available screenings account for some 70% of cancer deaths among those aged 50 to 79 years old.
Still, there are already ways to get a heads-up when cancer is lurking. “There’s a laundry list of things in the blood that can tell you about the presence of cancer,” says Samir Hanash, M.D., Ph.D., a member of the National Cancer Institute’s Early Detection Research Network, whose research focuses on discovery and validation of biomarkers for early cancer detection. “These include circulating DNA (ctDNA), RNA, and proteins being shed by tumors.” Prostate-specific antigen (PSA) levels, for one, are known to rise in response to malignant cells in the gland, while patients with ovarian cancer commonly have elevated levels of cancer antigen 125 (CA125).
These potential warning signs often appear months, and even years, before you begin to have symptoms. In a cohort study published in Gastroenterology, Dr. Hanash and other researchers discovered that levels of CA19-9, a protein associated with pancreatic cancer, begin to increase in the blood exponentially two years prior to diagnosis.
Aside from a few well-known biomarkers, however, these trace amounts of genetic material and antigens have been difficult to detect until recently. Now new technology, such as advanced sequencing, is enabling scientists to pinpoint and analyze even the smallest tumor fragments.
Cancer screens could be much simpler
Being screened for cancer can be an ordeal requiring long hours and sometimes invasive procedures at radiology or a specialists office. MCED blood tests are much simpler, affordable, convenient and can be taken at more frequent intervals.
A type of “liquid biopsy,” these tests can reveal the footprint of multiple cancers—including those with no recommended screenings—with a single blood draw. Unlike genetic tests that predict your lifetime risk of the disease, MCED tests measure current cancer marker levels. “They’re meant to catch cancer when it’s still kind of small,” Dr. Hanash says. “You’re looking for the presence of cancer, but you don’t want to wait until a disease has spread to the brain or organs, when it’s not usually treatable.”
MCED benefits from serial measurements, testing yearly to show how antigen levels change over time. For instance, early-stage detection of ovarian cancer improves outcomes up to 50% in high-risk women if tested quarterly, and up to 40% in normal-risk postmenopausal women who test yearly, according to a study published in Clinical Cancer Research.
“With blood biomarkers there are trajectory-based calculations that could help define if somebody is likely to have cancer growing in their body or not,” explains Dr. Hanash. A value that goes from low to high is a red flag. “You’re not waiting to see if it reaches a high…value before determining someone has cancer.”
Though used successfully in China, Japan, and South Korea for decades, MCED tests haven’t been available in the U.S. until recently. Those that involve DNA-sequencing techniques tend to be pricey, costing upwards of $1,000.
But for around $200 a test, at least one American company, 20/20 GeneSystems, Inc. (20/20), offers a MCED test called OneTest™ for Cancer. It combines the results of six protein (tumor antigen) biomarkers (including the antigens associated with cancers of the lungs, liver, pancreas, ovaries and intestines among others). An algorithm, based on artificial intelligence and machine learning, uses those test results to calculate a probability risk score for many different types of cancers. In a comprehensive study of over 41,516 study participants over 15 years, researchers concluded that using OneTest’s panel of protein biomarkers to detect multiple types of cancer including liver, lung, pancreatic, and colorectal, was significantly more effective than the single biomarker tests.
MCED tests are gaining momentum. The National Cancer Institute (NCI) recently signed off on a $75 million, 4-year pilot study enrolling at least 24,000 people to determine the feasibility of MCED tests. The results will help NCI decide whether to launch a longer-term clinical trial, involving as many as 300,000 volunteers. On September 12, 2022, President Biden announced that NCI’s work in advancing MCEDs would be a “critical component” in his administration’s “Cancer Moonshot” initiative.
“You have to compare people who got the test to people who didn’t, then wait five or 10 years to see if you’re saving lives,” Dr. Hanash says. “This has been the most effective assay to prove something is beneficial, but it takes a long time.” In the meantime for those interested in reducing their odds of a later stage cancer diagnosis, MCEDs from companies like 20/20 are now available to the public.
More information empowers you to make better health decisions
By themselves, these blood tests aren’t enough for a definitive diagnosis. Abnormal findings usually need to be followed up with a repeat blood test and/or imaging. Importantly, MCED tests should be used in concert with, not as a replacement for, doctor recommended single-cancer screenings, such as mammograms and colonoscopies and routine blood tests. If markers are detected for cancer, additional tests will be needed to confirm the diagnosis, determine tumor presence and stage, and identify its exact location.
It’s also important to remember that just because a cancer is detected early doesn’t mean it requires immediate treatment. Different cancers can grow at different rates, and the protocol for care varies as well. But staying on top of screenings may help you become more proactive about your health in general.
If cancer is part of your family’s medical history, or you are at-high risk, talk to your doctor about adding a MCED test, such as OneTest™ for Cancer, to your annual blood tests.
As screens get easier and more efficient, they could become second nature. “You get your blood checked for cholesterol,” points out Dr. Hanash. “If there’s a nice-performing test out there, why not have another tube of blood taken to test for cancer?”
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