Early detection means higher chances of survival
One indisputable fact that our experience with cancers has taught us is that the earlier that cancers are detected, the higher the chances of survival. The five-year survival rates for patients diagnosed with stage 3 or stage 4 breast cancers, cervical cancers, ovarian cancers, prostate cancers, and colon cancers are 28%, 16%, 28%, 28%, and 13% respectively. The five-year survival rates for patients diagnosed at stage 1 or stage 2 of the same five cancers are 99%, 91%, 92%, 100%, and 90%, respectively.
It may now seem obvious for us to have adjusted our cancer focus towards early cancer detection, but no such adjustment has occurred. Our obsession with the national cancer objective of curing advanced cancers seems to have clouded our judgment. The truth of the matter is that almost all cancers are curable if they are detected early enough.
A reactive approach
However, based upon our objective of curing advanced cancers, our approach to cancer has been almost entirely reactivein nature. We wait until cancer symptoms appear, which in many cases is after the cancer has become advanced, and then attempt a cure. It is not that the war against cancer has been lost, it is that we have been fighting the wrong war.
A paradigm shift
To understand the positive impact that early intervention and detection can have in fighting a major disease, we should look at heart disease. For many years, the standard treatment for heart disease was to wait until the patient exhibited signs of the disease, much like our current approach to cancers. Over the past many years, our approach to heart disease dramatically changed to one of prevention and early detection. Millions of people now take statins to reduce cholesterol, angioplasties are routinely performed to clear clogged arteries, stents are inserted to keep arteries clear, and heart healthy diets and exercise are part of the routine. The result has been a 60% decrease in heart disease related deaths since 1971. We believe that emphasis on early cancer detection will have similar results.
Our existing cancer screening technologies have become outdated and suffer from one or more deficiencies. To be useful, a cancer screening test needs to have four key characteristics: accuracy, reliability, ease of use, and cost effectiveness. Many of our existing screening tests, such as the prostate specific antigen (“PSA”) test, colonoscopy, and other tests, lack one or more of these key characteristics. Even the mammogram, held by some as the “gold standard” of current cancer screening, has a high rate of unreliability. For every patient that undergoes invasive and expensive follow-on testing based upon the initial results of a mammogram, only about 1 in 5 patients are ultimately diagnosed as having breast caner.  That means that 80% of the mammography patients had follow-on medical procedures that were unnecessary, not to mention the negative psychological impacts. A screening test that has a combination of accuracy, reliability, ease of use, and cost effectiveness would be the “Holy Grail” of early cancer detection. Despite the lack of national resources that have been allocated to early cancer detection, many feel that the Holy Grail is within our grasp.
A new wave
We are now at the forefront of a new wave of early cancer detection technologies that has been fueled by innovative start-up companies in the private sector. Bodily fluids such a blood, plasma, urine, saliva, and even breath are currently being studied for early indicators of cancers called biomarkers. Biomarkers include things like cells, proteins, DNA mutations, and biological reactions that are indicative of cancers. This relatively new field of identifying biomarkers for purposes of early cancer detection is sometimes referred to as “Liquid Biopsies”.
A pathway to success
The concept of screening asymptomatic patients for early signs of cancer is as much a departure for the patient as it is for the existing cancer establishment. No presumably healthy patient wants to think about the possibility of getting cancer or the concept of regular cancer screening. That is why the national dialogue about cancer needs to change. Sometime in the near future, we expect that doctors will order cancer screening tests during routine physical exams, much like screening tests for cholesterol to evaluate cardiac health are ordered today. Perhaps when we have the ability to use new approaches, such as the immunotherapies described above, on early stage cancer patients identified through screening, as opposed to on late stage cancer patients where they are currently being tested, the effectiveness of such approaches will be high enough to replace existing treatments like chemotherapy and radiation.
We need to be realistic about the probabilities of curing all advanced cancers in the foreseeable future and the consequences of pursuing that single minded purpose. If the American Cancer Society is correct and 1 out of 2 men, and 1 out of 3 women will get some type of cancer , approximately 120 million people in the U.S. will become cancer patients. We need to better prepare ourselves for what lies ahead. Although efforts have been made to publicize the benefits of certain types of cancer screening, such as self examinations for breast cancer and skin cancer, we need to increase our efforts to publicize the virtues of early cancer detection for all types of cancers and the potential benefits of new cancer screening technologies.
We are at an inflection point in the fight against cancers with potential changes on the way from what some might consider to be disruptive technologies. Change is long overdue. Hence, the sooner that we begin to chip away at the monolithic thinking of the past 45 years and open our minds to new approaches to how we think about and fight cancer, such as early cancer detection, the faster changes will happen and the better our chances of success.