Stopping Cancer Early – The Best Possible Investment


The Early Detection of Cancer Conference at Stanford!

October 9, 2019

Canary Center at Stanford, Cancer Research UK, and the OHSU Knight Cancer Institute, hosted the Early Detection of Cancer Conference September 24 – 26 at the Frances C. Arrillaga Alumni Center, Stanford, California. Approximately 370 attendees, from 120 institutions, and 11 countries outside of the USA (including Australia, Canada, China, Finland, France, Great Britain, India, Netherlands, South Korea, Switzerland, and Ukraine) brought forth their latest findings and ideas. The annual Conference brings together experts in early detection from multiple disciplines to share ground breaking research and progress in the field.

The conference is part of a long-term commitment to invest in early detection research, to understand the biology behind early stage cancers, find new detection and screening methods, and enhance uptake and accuracy of screening.

The talks ventured widely, from finding ways to extract more information from cell-free DNA in blood, to building cohorts of people at high risk of cancer to prospectively study the emergence of disease, to the role of the tumor micro-environment and the immune system in cancer early detection, and going beyond traditional risk factors to better select populations for targeted cancer screening.

Highlights of this year’s conference included:

James Brooks, M.D., from Stanford University pointed out that each tumor type is going to present unique challenges and opportunities for early detection. For those, such as prostate tumors, that tend to advance slowly, finding ways to avoid overdiagnosis is a top priority. For types advancing more aggressively, such as lung cancer, it will be important to develop ultrasensitive assays and to find practical ways to monitor more continuously.

The key for all tumor types, Dr. Brooks said, will be gaining a much deeper understanding of the biology of precursor lesions. That will require more committed investing in projects such as assembling large cohorts for longitudinal tracking and establishing tissue banks with healthy controls needed for early detection research.

The Canary Prostate Active Surveillance Study (PASS) is good example. It’s a multi-center study enlisting men who have chosen active surveillance to manage their prostate cancer. Daniel Lin, M.D., from the University of Washington, said about a third of men in the study have had their moderate-appearing cancers advance. The investigators are testing a variety of biomarkers for their ability to predict which cases will become aggressive.

Gordon Mills, M.D., Ph.D., from the OHSU Knight Cancer Institute set the stage with a rundown of some key challenges. Biomarkers and screening methods must be exceedingly sensitive and specific, he said, but not too expensive for patients and payers, while also being profitable enough for companies and investors to back. He stressed the need for multi-modal approaches and more academic collaboration with industry.

Victor Velculescu, M.D., Ph.D., described how his group at Johns Hopkins Kimmel Cancer Center, is going beyond sequencing of cell-free DNA in blood by looking at patterns in the fragmentation of the DNA. Fragmentation profiles reflect the jumbled packaging of cancer genomes. Because fragmentation profiles vary by tumor type, it may be used to identify the likely tissue of origin of a suspected cancer.

From drops of blood, it’s possible now to simultaneously measure hundreds of metabolites. Jason Locasale, Ph.D., and colleagues at Duke University, School of Medicine are doing so to investigate the disruption of mitochondrial metabolism in cancer cells. His group is using this to better predict drug response and to explore the influence of nutrition in the development of cancer.

Tony Ng, M.D., Ph.D., of Kings College London, concluded the morning with a look at the potential of combing technologies for early detection. For example, measures of tumor hypoxia combined with the status of oncogenic receptor signaling may improve the specificity of early detection. Magnetic resonance elastography combined with innate lymphoid profiling may help identify cancers that are likely to spread. Imaging exosomes in blood samples and measuring immune changes may detect cancer recurrence early following treatment.

Fiona Walter, M.D., from University of Cambridge, highlighted the role of primary care in cancer early detection (in the UK about 67% of cancer diagnoses start with a report of symptoms to a general practitioner while only about 6% are detected by screening). Walter co-leads CanTest, an international team investigating ways of developing and implementing new and improved cancer diagnostic tests for the primary care setting.

Cervical cancer screening has been saving lives for decades. Philip Castle, Ph.D., from the Albert Einstein College of Medicine reminded us that a disorganized health system can stymie progress. In the U.S. only a fraction of women receive appropriate screening. Many are subjected to too much screening while others receive none at all, and there is something like a three-fold difference in cervical cancer mortality across U.S. regions.

Stanford University’s Douglas Owens, M.D., chairs the U.S. Preventive Services Task Force and he demystified how that panel makes its influential recommendations, balancing the magnitude of potential benefits and the certainty (often lacking) of estimates of the benefit versus harm. Julie Barnes, Ph.D., with the company Abcodia, related the difficulties of establishing a screening method for ovarian cancer.

Ideas and collaborations were flowing making early detection of cancer the priority.