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U.S. plans trial of early detection blood tests for multiple cancers
- melling 4y agoCraig Venter says early detection is the way to eliminate cancer: https://youtu.be/iUqgTYbkHP8?t=15m37s https://youtu.be/iUqgTYbkHP8?t=15m37s
- threeseed 4y agoBut that's kind of not the issue here. It's that false positives in the cancer detection process can sometimes be more likely to kill you than if you didn't check for cancer in the first place. And of course all the flow on effects where the cost of detecting cancer and doing all of these exploratory surgeries means you spend less money on food, well being, basic medical care, dental care etc. Which then may kill you faster than just living with the cancer.
- adamredwoods 4y agoAnd then what? Blast with chemo? Radiation? We don't have proper tools to stop cancer yet.
- bergenty 4y agoSo you’d rather not know?
- refurb 4y agoIf it's not actionable information, then it's not worth the time or the cost. "Our test indicates you have a 90% chance of <tumor type> cancer cells somewhere in your body. There is no solid tumor, so there is nothing to remove. We can do more work-up to try and find it, but unfortunately the government won't reimburse the cost because it's not cost-effective. Or we could just start giving you chemotherapy for a year, then check later and see if there is any cancer. But there is a chance this is a false postive and you don't have any cancer at all. How do you want to proceed?"
- FollowingTheDao 4y agoAt this point, since we don’t know if these early biomarkers lead to any significant harmful outcomes, yes, I would rather not know. If after they do a few decades of test with This and show me that The DNA they found was linked to premature death, then maybe.
- yazaddaruvala 4y agoThe smaller it is, the safer the operation, the less chemo needed, etc.
- doctoring 4y agoWait, but we do have the tools... We can (and do) cure so many cancers. Usually with surgery, +/- chemo/radiation. Sometimes just radiation. It's hard to overstate how curable most cancers are at early stage -- for some it's well over 90% and approaching 100%. The whole point of these screening tests is to try to find more cancers at more curable stages.
- FollowingTheDao 4y agoOf course you did! He’s a businessman! Always looking for a way to make a profit! I mean he tried to patent our genes!
- thadk 4y agoCxO-level health insurance programs have been covering routine cancer-detecting liquid biopsies for at least 5 years, no?
- lacker 4y agoAt some point DNA sequencing will be cheap and sensitive enough that consumers will be able to do it whenever they feel sick, and measure even tiny fragments. Instead of swabbing your nose for a Covid test, you could be swabbing your nose for an "everything" test. You have your DNA on file and then anything out of the ordinary is brought to your attention. Maybe some warning signs of cancer like this, maybe just identifying the precise mild cold you caught a couple days ago.
- hoten 4y agoIs sequencing a binary thing, or would there be reason to continuously do a swab for purposes of DNA analysis (or, as often as the technology advances). In other words, is this a one-and -done thing?
- cjbgkagh 4y agoYou’re not looking for your DNA, you’re looking for the DNA/RNA of viruses that shouldn’t be there. Checking sequences against a list of known pathogens.
- ekianjo 4y agonot every pathogen sheds dna strands throughout your whole body. its a lot more tricky than what you seem to suggest.
- cjbgkagh 4y agoWouldn’t it work for anything that a PCR test could be used for. Seems like a there could a useful subset.
- R0b0t1 4y agoIt would, but it generally takes many samples to piece together good evidence for a match. New technology related to reading DNA strands directly could probably make this feasible.
- CodeBeater 4y agoI'm pleasantly surprised at the effort being put into avoiding false positives. I can easily imagine a doctor put in a tough spot whilst deciding to treat a possible early stage cancer. If he gets it wrong a malpractice lawsuit is surely to ensue. I really hope we live to see a future where physicians have less noisy data to work with, especially regarding early detection.
- SoftTalker 4y agoI'm not entirely convinced that "early detection" results in anything but more worry, more time in doctors' offices and clinics, more time taking very unpleasant medicine, more time undergoing surgery, and absolutely devastating financial consequences.
- gubneor 4y agoLate detection is better? Ignorance is bliss? There is no golden path? What if early detection failures at scale lead to better medicine? What if more patients lead to more science? Resigning to, "fuck it, we aren't there yet" seems overly defeatist.
- inglor_cz 4y agoNot the OP, but to use an analogy, we are obviously misusing antibiotics "just in case". Between "no cancer" and "definitely cancer", there will be a gray field of "maybe cancers" and doctors will feel the psychological push to "do something" about them. Overmedication can kill as well, and it can definitely injure. There is a reason why doctors are reminded of the ancient "First, do not harm" maxim during their training - it is still valid. I am not yet convinced that this is going to be a problem, but I don't want to ignore this scenario either.
- onetokeoverthe 4y ago
- adamredwoods 4y agoNot just early detection, but detection in remission and being able to accurately tell which treatments are working!
- formerkrogemp 4y agoI have a different question. Who will be able to afford this, and under what insurance plans?
- killjoywashere 4y agoNo idea, but the signal:noise ratio is likely to make CERN look like a bargain.
- doctoring 4y agoPer the article, Grail’s test is already on the market at $949. Insurance does not cover this —- yet. (That is a big goal of many of these companies). This is not cheap but not also not insane. Grail’s test screens for 50 different cancers (at a range of test performances, sure, but as the article mentions, many cancers currently have no screening mechanism). As comparison, the non-insured price of things like MRI and CT scans can run into the tens of thousands of dollars.
- deleted 4y ago[deleted]
- killjoywashere 4y agoAs a pathologist, good luck. The problem with early detection is getting enough signal. These liquid biopsies have historically worked for large occult tumors that are spilling a bunch of DNA. They won't work for in situ tumors, almost by definition. Maybe some really agro DCIS, but generally if the tumor hasn't broken across the basement membrane, you're going to have a hard time getting signal in the blood stream. Contradictory evidence is most welcome.
- Gatsky 4y agoYup this is what needs to be tested, in other words can cancers be detected early enough so that people are more likely to be cured with treatment. Secondary benefits of detecting early are needing less extensive surgery, less intensive chemotherapy and radiation, less expensive next generation therapies in the long run. We should also remember that the assays are improving all the time. Having said all this, early detection is not prevention, and the endgame still remains prevention I think. This whole field also serves as further confirmation that everything intestesting was discovered in the life sciences in the 1970s [1]. [1] https://pubmed.ncbi.nlm.nih.gov/837366/ https://pubmed.ncbi.nlm.nih.gov/837366/
- threeseed 4y agoBut the other question is whether the endgame is prevention or treatment at all. Are some types of cancer better treated like HIV/AIDS where it's simply managed.
- jmcgough 4y agoSeems like an odd example when HIV/AIDS can be prevented through PrEP now.
- arcticbull 4y agoHIV/AIDS is a bad example but theres a bunch of cancers or tumors that you get very late in life, which grow slowly. A good example is an acoustic neuroma [1]. In many cases, you're going to die long before it takes you out. [1] https://en.wikipedia.org/wiki/Vestibular_schwannoma https://en.wikipedia.org/wiki/Vestibular_schwannoma
- nonameking2026 4y agoSometimes the treatment is worse than the decease. But more profitable.
- jmcgough 4y agoYes, the entire field of cancer treatment is a scam and every oncologist spends 12 years of school/residency just so they can make as much as a good software engineer with no degree.
- adamredwoods 4y agoThe biggest scammers seem to be the ones promising a cure using supplements. https://www.justice.gov/usao-cdca/pr/doctor-who-distributed-unapproved-cancer-treatment-drug-convicted-more-two-dozen-felony https://www.justice.gov/usao-cdca/pr/doctor-who-distributed-...
- FollowingTheDao 4y agoThe test for cancer is not a cure for cancer.
- FollowingTheDao 4y agoThe doctors and oncologists are not the problem, it’s the companies that make these tests for the pharmaceutical companies that make the drugs Who make billions of dollars and then when something goes wrong you can pay the fine and no one goes to jail. Have we nut learned anything from the Sackler brothers?
- adamredwoods 4y agoHere's the actual (ahem) PowerPoint in PDF: https://prevention.cancer.gov/sites/default/files/uploads/major_program/Cancer-Screening-Research-Network-MCED-20220615.pdf https://prevention.cancer.gov/sites/default/files/uploads/ma... Interestingly, I've never heard of cfDNA fragmentomics: https://www.aacc.org/science-and-research/clinical-chemistry/clinical-chemistry-podcasts/2020/cell-free-dna-fragmentomics-the-new-omics-on-the-block https://www.aacc.org/science-and-research/clinical-chemistry... >> Well, initially, the main motivation for studying a cell-free DNA analysis is to look for species of DNA that might have been released from various organs that might be useful for doing diagnostics on them. So, for example, we have analyzed DNA that came from the placenta for prenatal diagnosis. We’ve analyzed DNA release from tumors for cancer assessment, but we need to somehow distinguish these molecules of interest with the molecules that are just floating around in the background that might not be from a diseased organ or the organ of interest. So previously, when the field first started, we tried to use genetic differences. For example, for tumor, we might be looking for mutations that were present in the tumor genome and use those features to distinguish the tumor DNA from the non-tumor DNA. But then, as time went on, we realized that those DNA of interest, they typically are shorter. For example, the DNA from placenta or tumor cells, they are shorter than the background DNA that we are not as much interested in. Then, when we looked into why these DNA molecules are shorter, then we found out that the fragmentation process is actually non-random. From this point onwards, people started as, why is it not random and how does the cell control which part of genome becomes fragmented and how can we make use of these fragmented features? And very soon, I mean, it became a field and the studies—the number of studies just exploded.
- yieldcrv 4y ago> NCI advisers endorsed a $75 million, 4-year pilot study Did any donations and city-wide marathons have any effect on the funding for this particular study? Just seeing what the best use of energy is.
- kemmishtree 4y agoReading all the comments here, there's a legit but crazy sounding scientific voice crying out in the wilderness "hey we need solid-state utility-scale molecular sensing and this is weirdly the way to get there." www.molecularreality.com If you want to help, get in touch.