Navigating the Transition to Precision Medicine in Early Cancer Detection

Candace Westgate, DO, MPH, FACOG: Our understanding and our acceptance of these kind of tests usually run along with when our societies tell us we should be doing it and their recommendations come out right. You know that the outcomes associated with this kind of cancer screening test, we need about a decade worth of research to actually show what mortality and morbidity decrease as well as cancer stage shifting or downshifting. But Mylynda, do we really have a decade to wait before we consider this as part of our patients’ cancer screening? Where do you think we are right now?

Mylynda Massart, MD, PhD: I don’t think we have another decade to wait. And I think this is just representative of all emerging precision medicine technologies right now where we’re really in a stage of medicine that is evolving from our historical evidence-based medicine into this era of precision medicine. And we don’t have decades and billions of dollars to sit around for massive, huge, randomized controlled trials anymore. And so a lot of this is going to be more in a pragmatic trial type of scenario where we’re really trying to capture real-world data as we actually roll out and implement the technology. You know, how many lives would we lose in the next decade if we waited to roll this out? I don’t want to see that happen. And you know that I myself am a cancer survivor. And this is really important to me. I think that anyone who’s high risk, we need to be getting this out to the clinic as soon as possible to increase our chances of identifying patients who may be developing an early cancer, try to get at the cancer earlier, where we know historically that there is more likelihood for survival if we can get that cancer diagnosis at an earlier stage and would even cost society less money, hopefully, if we can catch that cancer at an early stage. There’s a lot of research that still needs to be done. But some great model data has been published that actually says that we could avert 21% of deaths if we could add multi-cancer early detection to our current complement of USPSTF [US Preventive Services Task Force] screening guidelines. And another way to think about it is we can actually increase the likelihood of finding true positives, patients who truly do have cancer as opposed to those false positives. Again, [this is] always a big challenge with all of our screening exams. And as I said earlier, with our single organ screening, we have those high sensitivities because we don’t want to miss a cancer. But that comes with a trade-off of a little bit lower specificity. So we end up getting quite a few false positives for every true positive. And so with our current screening alone, just from our USPSTF guidelines, we have about 1 true positive for every 43 false positive aggregate of patients that we’re screening for cancer. If the model data holds true, by adding multi-cancer early detection in addition to our USPSTF screening, we could drop that down to 1 true positive for every 1.8 false positive. That’s a significant improvement. And imagine the cost savings then that we could have as a society if we’re not working up an additional 40 false positives to find that 1 true positive. So very exciting but more research to come.