▶ Expensive testing costs and concerns about unnecessary treatment
Jim Ford considers himself lucky. A blood test revealed that his pancreatic cancer was at an early stage. Pancreatic cancer is the most lethal of all cancers, but tends to be detected too late. Ford, 77, of Sacramento, underwent scans, biopsies, surgery, chemotherapy and radiation therapy, but found no cancer. After his blood test, he said, “As the doctor said, I won the lottery.” The test that diagnosed his cancer was the ‘Cancer Moonshot Program’, a project that President Biden announced to cut cancer mortality in half. Co-initiated by 254 people, the bill will be covered by Medicare for testing costs immediately after the Food and Drug Administration (FDA) approves it.
But companies are not waiting for the approval of supervisory authorities. Cancer screening specialist GRAIL is offering annual testing for a pre-approval price of $949. Another company, Exact Sciences, expects to follow with a supply known as lab-developed testing.
This blood test, which looks for tiny fragments of cancer DNA or protein, is a new frontier in screening. The companies that develop them say they can detect dozens of cancers.
Although standard tests are generally used to detect breast, colon, cervical, and prostate cancers, 73% of cancer deaths were due to cancer not detected by standard tests.
Proponents say cancer mortality can be lowered by finding small, treatable tumors. However, a final study to determine whether this test prevents cancer deaths will involve more than a million healthy adults randomly assigned to get cancer blood tests each year. Again, the results will take more than 10 years.
“Blood testing is in its infancy,” said Thomas Beer, a cancer researcher at Oregon’s University of Health and Sciences. “Those who are being screened for information are people who like to get ahead,” he said, who had done research to find Ford’s cancer, sponsored by Grayle.
The company wants to approve tests at less stringent standards than the FDA normally requires, and doing so could be a huge boon.
“Grail proposes to screen all Medicare beneficiaries annually to make Medicare a bankruptcy screening test,” said Gilbert Welch, a senior research fellow at Brigham & Women’s Hospital’s Center for Surgery and Public Health.
The cost of screening for 44 million Medicare beneficiaries and those who test positive for an annual test and tests that cost about $1,000 a year for testing can vary considerably in price due to expensive scans and biopsies.
He and other critics warn that the risks of making the experiments public are substantial. As paradoxical as it may sound, finding cancer early can mean that many deaths occur at the same time as if they were not diagnosed early. At least with current treatments, early detection of cancer does not necessarily mean a cure.
And there are other risks. For example, doctors may not be able to detect cancer when some people test positive. Others, left alone, may receive aggressive treatment, such as surgery or chemotherapy, for cancer that may not only grow or spread, but may even go away.
Dr. Beer admits that cancer blood tests are “not without risk or cost and will not detect all cancers.” But, he said, “I think it has the potential to have a real impact.”
Other experts are concerned. Dr. Barnett Kramer, a member of the Lisa Schwartz Medical Foundation and former director of cancer prevention at the National Cancer Institute, is concerned about the widespread use of the trial without proven benefits. “It’s hard to give a warning,” he said.
■ Damocles syndrome
Susan Iorio Bell, 73, a nurse from Portiport, Pennsylvania, joined immediately after seeing an advertisement on Facebook recruiting women her age to study cancer blood tests. She advocated preventive medicine and believed in clinical trials.
The study involved testing patients from Geisinger, a large medical network now owned by Exec Sciences. This test looks for proteins and DNA lost by the tumor.
Bell’s results were problematic. The blood produced alpha fetoprotein, which could be a sign of liver or ovarian cancer. She started to worry. Her father had colon cancer and her mother had breast cancer. Bell knew what happens when patients have poor prognosis. “Suddenly, your life can change overnight,” she said.
However, PET scans and abdominal MRI scans did not find any tumors. It is currently unknown whether the test results were false positives or whether the tumor was too small to be seen. All Bell can do is get regular cancer screenings and monitor liver function. “I live day to day,” she said. I am a believer and believe that God has a plan for me. For better or for worse, it’s God’s will,” she said.
Some cancer experts say Bell’s experience exemplifies concerns about blood tests. This may be the case for only a few, as most of those tested will find that the test did not detect cancer. This is because there are many cases where cancer can be found through scans or biopsy among people who find cancer in tests.
However, Dr Susan Domchek, a breast cancer researcher at the University of Pennsylvania, says false positives become “the real problem” when a large number of people are tested. .
Dr. Daniel Hayes, a breast cancer researcher at the University of Michigan, calls the situation Damocles syndrome: a situation in which you feel very anxious but don’t know what to do.
■ How good are blood tests?
So far, the Geisinger study is the only study asking whether it detects cancer early that isn’t detected in blood tests. In addition to Bell, the study involved 10,000 women aged 65-75 who had blood tests and were encouraged to get regular cancer screenings.
According to the blood test, 26 patients had cancer: lymphoma 2 patients, thyroid cancer 1 patient, breast cancer 1 patient, lung cancer 9 patients, kidney cancer 1 patient, colorectal cancer 2 patients, appendix cancer 1 patient, uterine cancer 2 patients, ovarian cancer 6 patients , where cancer cells were found, but it was unclear what kind of cancer it was. Of these women, 17, or 65%, had an early stage disease.
In the previous screening, 24 additional cancers were found that were omitted from the blood test.
Dr. Burt Vogelstein, a cancer researcher at Johns Hopkins Hospital who helped develop the test, said the study was not designed to show risks and benefits. He added that this would require a much larger detailed study.
By Gina Kolata>
