Contributed Commentary by Maria Zannes
January 19, 2021 | When it comes to cancer, there are many tools for cancer diagnosis, from initial screenings to invasive biopsies. The one selected depends on a number of factors, not the least of which is how the patient presents. But we know one thing for sure, early detection of cancer can dramatically increase survival. Look, for example, at cervical cancer where there has been a 70% drop in death related to the disease since the 1960s when American Cancer Society guidelines first called for widespread use of the PAP test for screening.
Screening for cancer can take the form of physical exams, lab or genetic tests, or imaging. Still, tests that find cancer early—when people are asymptomatic—can result in false positives that lead to unnecessary worry and follow-up procedures for many who are cancer-free. Much of the new research into early diagnostics focuses on detecting genomic or proteomic abnormalities that predict cancer’s existence. This approach is useful in subtyping an already detected cancer for effective treatment. But the genomic approach can be less effective in early stages and with cancers that have a high mutation rate, such as lung cancer.
Mutational analysis may not be the key to early cancer detection. Cancer is insidious. It develops in a stealth-like manner to escape recognition by the immune system. Promising research focuses on how cancer changes the micro-environment to make a more hospitable home. For example, cancer cells promote subtle changes in its surrounding cells, including immune cells and growth of blood vessels for the delivery of nutrients. These changes in the micro-environment serve two major purposes for the cancer: to support cancer cell growth and escape immune surveillance. Cancer, in effect, tries its damnedest not to be found. Seeking to better understand this early tumor micro-environment may prove to be a powerful harbinger of early cancer development. In our quest for early cancer detection, we should look more closely at the complex and potentially detectable changes in the micro-environment surrounding the tumor.
A validation trial of a test looking at lung cancer’s micro-environment offers promising results. Using flow cytometry, an instrument that interrogates individual cells in a fraction of seconds, the early lung cancer diagnostic used AI-generated automated analysis of sputum to identify, among others, defining factors in the micro-environment of the lung that characterize cancer in people at high risk for the disease. The test showed 92% sensitivity and 87% specificity in detecting cancer in high risk participants who had small nodules 2 cm or less, adding to growing evidence that research into the tumor micro-environment can open new avenues, not only for early diagnosis but for new cancer therapies as well.
We understand more each day about where and how cancer lives within the body. And we see more and more evidence that diagnosis of cancer at an early stage can dramatically increase survival rates. Screening programs are essential to catch cancer before a patient is symptomatic, often at an early stage when treatment is more effective and less caustic. New tests that target early cancer can help. We should continue our search in the subcellular realm, but we need to diversify our approach to early detection if we want find cancer at a stage when subtlety is its hallmark. To find cancer when it’s a newcomer, the best road may lead us to a better understanding of how the disease sets up its home.
Maria Zannes is CEO/President of bioAffinity Technologies advancing early cancer diagnostics and targeted therapeutics. With 25 years as a C-Suite executive, Maria began her career as legislative aide in the U.S. Congress. She received Columbia University’s Earth Engineering Lifetime Achievement Award and her law degree from the University of Puget Sound. She can be reached at mz@bioaffinitytech.com.