In a rural medical office, only the bare minimum of medical technology is either affordable or practical, and doctors rely on their own diagnostic skills rather than the expensive tests that doctors at urban centres can more easily access.
This can become a problem when a patient appears whose symptoms could represent a bad flu, but could also be indicative of cancer. In the absence of proper equipment from which many urban doctors benefit, rural patients can be misdiagnosed or mistreated due to the impracticality of running the gamut of tests on them.
Linda Pilarski, a University of Alberta oncology professor and Canada Research Chair in Biomedical Nanotechnology, has been working since 1998 to change this.
Researchers have made great strides in diagnostic tools for detecting the genetic abnormalities that lead to or signal cancers, but many of these remain solely the province of experimental labs because of practical impediments like the cost of equipment.
Aiming specifically to make clinical medicine easier and less expensive to conduct, Pilarski and her team have created a microfluidic chip about the size of a thumbnail that can test for up to 80 different genetic markers of cancer.
“Most of the things we were doing were much too complicated to do in a clinical lab,” Pilarski said. “Their technology has to be far more regulated than what we’re doing in the lab. It may be feasible [to use current experimental tests] in a big research hospital, but not in Stony Plains, in our little health care centre, for example.
“And with tests that are feasible, they’re feasible only because they study many samples at once.”
Acute lymphoblastic leukemia, for example, is a rare cancer that mostly affects children. When detected and treated early enough, it has an exceptionally high cure rate. But if left untreated, it can prove fatal in as little as a few weeks.
The equipment to test for this kind of cancer is typically only at centrally located labs, and 100 or 200 samples from different patients need to be tested using current technology.
“There might not be 100 cases [of the disease] in all of Canada in a year,” let alone at one time in one area, Pilarski said.
This was part of the thinking that led her and her team to work on a way to test individual samples, and for several different possible cancers at once. They have reversed the normal procedure, studying several samples for one disease, in the hopes of making tests easier to do in more remote locations.
There are about 80 small posts attached to a glass chip, and each post carries out a different test for a different mutation. Unlike the currently used larger equipment, Pilarski says these chips should allow clinicians to perform the tests within an hour, and rather than make patients wait a nerve-wracking few days for their results, they can find out before they leave the lab.
While Pilarski’s work has focused on cancer, the chip she has developed could be used to test for any number of illnesses, which is precisely what medical equipment company Aquila Diagnostics plans to do with Pilarski’s technology.
“Some of the first things to come out might not be for cancer but for infectious diseases,” Pilarski said.
The microfluidic chip technology could be used to quickly rule out several infectious diseases when a patient appears at an emergency room with a fever, which could, for all attending physicians know, be anything from a mild flu to the West Nile virus, which is much more dangerous.
In addition to ERs in the developed world, a small, transportable chip would be immensely useful in areas with more patchwork health facilities, which can often also be places where infectious diseases run rampant. Pilarski mentioned sub-Saharan Africa specifically, where nearly 11 million children die every year. Major causes are pneumonia and diarrhea, which are treatable, and malaria, which causes 16 per cent of the deaths of children under five, and which is also treated easily.
Pilarski said she expects the chip to be ready for field-testing in the next year. These will not be clinical trials, which take place shortly before a technology is approved for widespread use, but simply trials outside the research lab.