The future has arrived in the battle against cancer. A single blood test can now screen for over 50 cancers. While not yet broadly covered by insurance, this diagnostic tool has the potential to revolutionize the way we find cancers. It also enables early identification, which typically improves treatment outcomes and optimizes survival rates by finding disease before it spreads.
One of these early identification blood tests, called the Galleri test, that can find multiple cancers was developed by GRAIL after extensive research involving over 20,000 participants at leading institutions including Cleveland Clinic and Memorial Sloan Kettering. It works by checking for DNA fragments (cell-free DNA) released into the blood by various types of cancer cells. The cell-free DNA provides information not only on the presence of cancer, but also offers clues as to tissue type, which indicates where in the body it will be found. To be clear, this test does not look at a person’s total DNA footprint to evaluate risk for cancer. It actually looks for active disease at the time of the blood draw.
Existing practice guidelines typically recommend screening for only a few types of cancer. These include mammograms for breast cancer, Pap smears for cervical cancer, colon- oscopies for colon cancer and CAT scans for those at high risk for lung cancer. Because all of these screenings involve a procedure or imaging, compliance may also be suboptimal. Yet there are well over 100 types of cancer. Also crucial is that while many cancers present with early symptoms, others such as those involving the ovaries and uterus typically present quite late and only after the disease has advanced.
When GRAIL’s Galleri test finds fragments of DNA associated with cancer cells, the next step is a focused, comprehensive physical examination and additional diagnostics that might include blood and imaging. Once the cancer is confirmed, the next step is a tissue biopsy with comprehensive laboratory analysis. When the cancer is fully characterized, a treatment plan can be proposed.
The future also has arrived for cancer treatment. “Novel, targeted molecular therapies have increasingly supplanted chemotherapy, but surgery remains the mainstay in curing most early-stage solid tumors,” according to Dr. David Tamara, an oncologist at Cancer Care Hawaii. Newer therapies have extended life expectancy in many cases and transformed many cancers from a terminal condition to a chronic disease that can be managed successfully over many years.
These blood tests require a prescription from your health provider. Manakai o Malama offers this test and works with our local surgical and medical oncologists for any positive findings. When is someone a candidate for the test? Most patients 50 years of age and over are reasonable candidates as cancer is 13 times more common at that point. It is not recommended for people currently undergoing cancer treatment, those younger than 22 or during pregnancy as the latter can result in false positives. However, those with enhanced cancer risk, either based on genetics, family history, environmental exposure or behavioral factors such as smoking and high alcohol use, may be particularly good candidates. The screening test should not replace standard recommendations for cancer screening, but in the future that could change.
The screening test also may be used following cancer treatment for survivors, not only to check for recurrence, but also for secondary cancers, associated immune deficiencies related to the primary cancer or changes to the immune system from cancer treatment itself.
Minimizing the risk of cancer begins with lifestyle that includes a healthy frame of mind, skillful and consistent fitness, appropriate weight and a healthy diet free of processed food. Much of the clinical care at Manakai focuses on preventive medicine.
This combination of preventive medicine, risk assessment, comprehensive blood screening for cancer, consideration of targeted molecular therapies to treat and ongoing surveillance for recurrence has the potential to reduce cancer incidence, support early identification and ultimately enhance longevity and quality of life.
This strategy also offers the possibility to lower the total cost of health care, which hit nearly 20% of GDP in the U.S. in 2020 at a cost of more than $4 trillion. This included approximately 1.8 million new cases of cancer, a close second as the leading cause of death after heart disease. A simple blood test for early identification of more than 50 cancers shows considerable promise.
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Ira Zunin is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center: manakaiomalama.com. Please submit your questions to info@manakaiomalama.com. His column appears the first Wednesday each month.
