Detecting Cancer Earlier: The Importance of Collaboration, Funding and Technology
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In the UK, someone is diagnosed with cancer every two minutes. Unfortunately, for many this diagnosis comes when the patient is symptomatic, the disease is well established, possibly already spreading to multiple sites in the body. Treatments are usually less effective the later cancer is detected, meaning survival rates also tend to be lower in those diagnosed with late stage cancers.
We recently spoke to Dr David Crosby, Head of Early Detection Research, Research and Innovation, Cancer Research UK, to learn more about the importance of early cancer detection. David touches on current approaches to early detection and the associated challenges, he also discusses Cancer Research UK’s efforts to promote collaboration between academia and industry and tells us more about the launch of their Early Detection Research Committee.
Why is early detection of cancer so important?
David Crosby (DC): We know that the chance of survival increases significantly for the majority of patient groups if cancer is detected at an early stage. Early detection research is a key part of achieving Cancer Research UK’s (CRUK) vision of 3 in 4 patients surviving cancer by 2034. By focusing on advancing the early detection field we hope to drive progress and improve patient outcomes. The identification of novel markers should go hand in hand with a better understanding of the biology of early cancer and of what defines a lethal cancer. This will in turn drive patient benefit through a better understanding of how to treat cancer and earlier application of existing therapies.
Could you tell us more about current approaches to early detection and the challenges and limitations associated with existing initiatives?
DC: Existing screening programmes like breast, cervical and colorectal cancer have saved a great many lives, but they lack sensitivity, meaning some cases are missed, and poor specificity can lead to unnecessary invasive procedures. Research is needed to enhance our biological understanding of early cancers, to increase our ability to detect them, and to improve the technologies used. High quality research focusing on the early detection of cancer is currently being carried out in several locations in the UK and worldwide. However, progress in this field relies upon bringing these pockets of expertise together to form a cohesive, international research field, spanning many disciplines. At CRUK, we recognise the need to establish an early detection community, and we are supporting the development of the field in a number of ways.
We have established a new Early Detection Committee and launched new funding schemes to provide much-needed dedicated support for this area. While our Early Detection of Cancer Conference, co-organised with the Knight Cancer Institute at OHSU, and the Canary Center at Stanford, held in Portland in October this year, will also help bring the field together internationally.
What can be done to enhance our ability to detect cancer early?
DC: We need to enhance our understanding of the biology of early cancers (and pre-cancerous states) and the markers they may exhibit. We also need to develop innovative tools which can detect cancer with high sensitivity and specificity. To achieve this, we need to bring together expertise from a wide range of currently siloed research areas to push the field in new directions. This means engaging with researchers outside traditional cancer biology fields such as engineering, physics and computer science.
By bringing together these scientists, we hope to encourage the application of novel approaches and techniques to cancer research. We are actively encouraging interdisciplinary collaborations through our funding schemes, and are organising events with other funding bodies, such as the Engineering and Physical Sciences Research Council (EPSRC), to build a collaborative network and challenge researchers to consider their work in the context of cancer detection.
Another key element to success in early detection is sharing resources, such as biobanks, data and technology, and we are working on ways to achieve this through building the early detection community.
How important are partnerships between academia and industry, and how is CRUK working to improve these connections?
DC: Our efforts in early detection will only be successful with active engagement from industry. We are asking our committee and research community to consider the line of sight to clinical implementation and where projects will sit in the pathway to developing a new diagnostic tool. However, we recognise that the pathway from the bench to successful development of a novel diagnostic tool is unfamiliar territory for many researchers and industry will play a key role in bridging this gap.
We need industry players to share their knowledge and expertise about what is required to move work along the pipeline and we encourage collaborations between academics and industry at the earliest possible stages of study development. Academic and industry collaborations formed at early stages of a project will ensure the sharing of knowledge, technology and biological insight needed to increase the chances for translational success.
What impact have technology advances had on the detection of cancer over the last 10 years? Where does current technology fall short?
DC: Some advances in defining signs of early cancers have already been made, leading to the roll out of population-wide programmes, such as screening for cervical, breast and bowel cancers. However, these measures cover only a limited number of cancer types and a large number of cancer patients are still diagnosed with advanced disease. The sensitivity of these technologies is not currently sufficient to routinely catch the earliest cases. We now need to focus on developing novel technologies and tests with clinical utility to combat this problem, and this presents a significant challenge to the field.
Samples available for investigation of cancer signatures have predominantly come from patients with established disease, rather than pre-malignant or early stage disease. This means there are very low numbers of robust markers available for early disease, which, to make things worse, are typically present at very low levels in patients. This creates the need for highly sensitive and specific detection technology, or sufficient resolution/contrast of imaging technologies to enable the detection of lesions or abnormalities, whilst avoiding false positives and over-diagnosis.
Recently we have seen an explosion of potential marker types for early detection such as circulating tumour cells, cell-free DNA, exosomes, micro RNAs, antibodies and white blood cell signatures, as well as great technological advances in e.g. imaging and sequencing. While we are not yet where we want to be, this is a very promising and exciting time for early detection research.
Why has progress in early detection lagged behind developments in other areas such as therapeutics?
DC: Historically, much of cancer research has focused on established disease, as the majority of cancers are detected at a later stage. Although these studies have supported the development of therapeutics, they have not revealed the biology underlying changes arising in early (and pre) disease. Timelines for early detection research can be long, and the price point for diagnostics is comparatively low, which has deterred industry activity in this area. We are now at a critical point where technological advances and biological understanding are at a stage where we can shift our attention towards early stage disease and take on the challenges involved in detecting cancer early.
Until now early detection has also suffered from low levels of funding, and although we have always been open to research proposals in this area, a limited number of projects have been funded through our established funding schemes. We created the Early Detection Committee to address this problem, providing dedicated funding for early detection research. The committee aims to support projects which will make significant advances in understanding the changes arising early in cancer development, bringing forward the time when cancer can be detected and an intervention can be made.
Do you think pre-cancerous states will one day routinely be detected as part of health MOTs by general practitioners (GPs)?
DC: Yes. Our newly established committee aims to identify and fund projects which will lead to a clinical intervention or test, and a GP surgery is a very good first-contact environment to employ them. We emphasise this angle by asking researchers to consider the clinical line of sight of the work they are proposing to carry out. We also want them to think about when and how a new technology would be implemented in the clinical pathway, and the evidence required to work towards this.
Involving clinicians and health professionals in early detection projects is vital to ensure that tests are mindful of the clinical context. Crucially, the work being proposed does not need to lead to the immediate development of a test, but needs to consider how data obtained from the project can be built upon or inform the development of a future test. We expect findings from supported projects to lead to the future development of new detection tools which could be used by GPs (or other environments such as national screening programmes or perhaps even, in the future, through consumer-driven devices) as part of routine medical checks.
Dr David Crosby was speaking to Anna MacDonald and Laura Elizabeth Mason, Science Writers for Technology Networks.