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Sarah Catherall’s Cancer rising series concludes today with a look at the future for cancer detection and treatment, including vaccines and new screening tools. You can read Part I here and Part II here.
Imagine a future where people could be screened for lung and ovarian cancers, and jabbed with vaccines to prevent lung, pancreatic and ovarian cancers in the first place. Those scenarios are on the horizon, according to the head of the Cancer Research UK, Dr Catherine Elliott.
The council is one of the largest funders of cancer research in the world, with an $800 million annual budget. Elliott was one of the keynote speakers at the recent Cancer Society conference in New Zealand, where she outlined some of the cancer projects the council has backed over the decades – such as the development of the HPV vaccine - and some of the multi-million-dollar cancer prevention, screening and treatment trials and investigations under way.
Along with cancer vaccines, she also sees a future where a single blood test overseen by a GP could identify whether someone has cancer in their body, and even which organ it might be lurking in. A multi-cancer detection blood test – called the NHS-Galleri trial – is under way in the UK to see if using the Galleri test alongside existing cancer screening can help to find cancer early. About 140,000 people aged 50 to 77 have signed up and results are likely next year.
“It’s a very big and exciting randomised trial of what would happen if you just did these tests at regular intervals in people who don’t have any symptoms of cancer,” says Elliott.
A similar council-funded trial is also using blood tests instead of potentially unnecessary and costly biopsies to find biomarkers in people who present with possible cancer symptoms.
“This would be a really valuable both for patients and GPs and also for health systems to have better ways of discriminating.”
Some cancer trials can take many years – especially when developing drugs or vaccines, for example, the HPV vaccine to prevent cervical cancer was first initiated in the 1980s. But developing cancer tests for early detection using biomarkers can be done more quickly.
The same tests could also be used to track the progress of cancer treatments in patients, and also for those in remission who want to check for any trace of cancer rather than resorting to costly scans and MRIs.
Screening for lung cancer
In the UK, a screening programme is rolling out where smokers and people at risk of lung cancer aged 55 to 74 are offered lung screening. As of August last year, more than 1.9 million Brits had been invited for a lung check, and 5037 lung cancers had been detected. Over 75% of those cancers were diagnosed at stages 1 or 2, meaning a much greater chance of survival. People diagnosed with lung cancer at stage 1 through screening have an average five-year survival rate of over 90%. This contrasts with a five-year survival rate of only 4% for those diagnosed at stage 4.
Australia is also introducing lung cancer screening this year, using low-dose CT scans to look for lung cancer in high-risk people without symptoms. Screening starts in July.
Tailored approach
Over time, Elliott expects we will see more personalised, tailored screening for all cancers rather than a mass-population, one-size-fits-all approach.
Immunotherapy and cancer vaccines are the new buzz words in cancer research. Two huge council-backed international projects are under way to find an ovarian cancer vaccine (in pre-clinical stages) and a lung cancer vaccine, which is about to be trialled in the UK on people at high risk of developing lung cancer, or those in remission from the disease.
Elliott was a gynaecologist by training, and says that screening for ovarian cancer is difficult, and the disease often presents late. A vaccine is the way forward, although in the meantime, there are projects to try to find better markers for ovarian cancer. “A lot of the work being done on either vaccines or other ways of bolstering our own immune systems to recognise those abnormal cells is likely to be one of the hooks for ovarian cancer,” she says.
AI for speed
AI will speed things up. Cancer Research UK has funded a group, CD3 (Cancer Data-Driven Detection), which is partnering with the UK government on early risk detection, where a patient’s medical records, any health data and cancer registry data creates an individual risk profile.
Going further, AI will also identify treatment and drugs needed for individuals.
Referring to the decades it took to get the HPV vaccine onto the shelf, Elliott says: “The goal is to speed everything up to get better outcomes for people sooner and prevent cancer deaths.”
At the Cancer Society conference, Professor Nasir Rajpoot, a chair of computational pathology at Warwick University, talked about his AI colorectal diagnostic tool currently being trialled using data from 10 NHS hospitals across the UK and more than 10,000 biopsy samples.
How it works is that a colorectal biopsy is run through his diagnostic tool and if it shows nothing suspicious, it doesn’t need to be assessed by a pathologist, saving time and money. A patient would get an all-clear diagnosis within two hours.
Rajpoot told the Listener: “Decreasing the bowel cancer screening age is absolutely fantastic, but it does fill the pathologist with dread because they know all that increased workload is going to come to them. The only way that we can deal with these large workloads for pathology labs is get assistance from AI.”
Aiming to launch it via the NHS in 2027, Rajpoot also hopes to take it to other countries. While here, he met with leaders of Awanui Labs to consider a trial here and the goal would be to see if it works with other ethnic groups, such as Māori.
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