Very Early Cancer Detection: What is possible and how does the patient benefit?
Arun Kumar Goel
Chairman, Surgical Oncology @ Andromeda Hospitals | Promoter Director, MD
Recently I was approached to participate in a panel discussion about early cancer detection. It is about a method to do "early Pan-Cancer detection". I was reminded of something from nearly 25-30 years ago. At that time also, there were some presentations about a blood test which could detect occult cancer (again agnostic of the cancer type). The question that was in everybody's mind at that time was "If this test is reliable, what happens to the individual with a positive test?".
The same question is still existing. When we have a Pan-Cancer marker that has a strong correlation with presence of very early cancer, what is the remedy to be offered to the individual??
The primary issue is the ability to intervene and alter the natural history of disease for the concerned individual. First question is the localization of the malignancy. We should assume that the cancer detected through such a test will be small in size and below the limit of detection of current imaging modalities including PET CT and MRI. If the tumor can not be physically localized, local modalities of therapy would not be applicable.
What is the other option?
The other option could be identification of the organ of origin through additional molecular markers. This may work for some and may not work for some. Even then, how do we target the cancer if it can not be physically localized??
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What else is possible?
Another possibility that can be explored is systemic therapy that could be administered without physical localization and be effective in altering the natural history. Definitely a possibility but would such a possibility be applicable to all the cases of early cancer?
I am keen to hear from you what is your opinion about this.
Dr. Vaishali Zamre Raman Narang Dr Babita Bansal Dr. Dinesh Singh Dr USHMA Singh Nitin Zamre Rishu Sangal Dr. Vikas Goswami
Chairman, Surgical Oncology @ Andromeda Hospitals | Promoter Director, MD
2 个月Came across another write up in JCO (https://ascopubs.org/doi/full/10.1200/jco.23.02665). This one discusses the possible application of MCED in high risk populations. While this article discusses cancer mortality due to metastatic cancer and lack of screening for most of the cancers, the detailed discussion is about high risk patients including those with genetic risk and cancer survivors. The possibility discussed in this article is more about doing the test as a modality to judge when there is an imaging abnormality, the key question about setting the benchmark for a positive or negative test and correlation with tumor volumes is still there. Hope to see more comments..........
Chairman, Surgical Oncology @ Andromeda Hospitals | Promoter Director, MD
2 个月Today, I was going through recent issues of NEJM. One of the articles (https://www.nejm.org/doi/full/10.1056/NEJMp2400297) is talking about Multi Cancer Early Detection (MCED). It is highlighted that these tests are performed on blood samples and somewhat similar to liquid biopsies. Currently, there is no data from randomized trials to support the use of these tests, some have become commercially available and are being marketed direct to consumers. There is also controversy about what the right end point in randomized trials that evaluate these tests. While the theoretical potential of having benefit from early detection is there, there is also the potential risk of over diagnosis, harm due to additional diagnostic procedures required to identify the primary cancer and psychological impacts. The medical profession and regulatory agencies need to pay careful attention to the "use and abuse" of these tests. We need to be sure of the benefit before the "horse has left the stable". Raman Narang, Dr. Vaishali Zamre, Dr Gopal Sharma, Dr. Vikas Goswami, Dr. Dinesh Singh, DR ABHISHEK GUPTA
Founder Health Vista Diagnostics and Senior Consultant Breast Radiology at Andromeda Cancer Hospital. Transforming the world of imaging and diagnostics with Innovation & Passion.
2 个月Valid point sir! probably there is no clear answer to this!
Senior Consultant Medical Oncologist
2 个月Insightful!! A multi cancer detection test is already being tested in trials and it also predicts origin of cancer which may prove to be much more helpful to decide treatment.
Director and Head of Breast Cancer Surgery, Andromeda Cancer Hospital
2 个月This is a great write up. While the concept of very early detection of cancer is being discussed on various platforms, there are many unanswered questions. Will the test provide enough sample to perform biomarker assessment for organ localization and how to do follow up to assess the efficacy of the treatment offered and many more.