Genetic mutations are public enemy number one for the simple reason that they are the engine that drives the growth of cancer cells. Unfortunately, most types of cancer remain undetected until their sequela has advanced to a later stage. As a result, successful treatment and disease remission are less likely.
New Cancer Screening Technology CancerSEEK
A new and novel technology has recently been developed that will allow doctors to screen for cancer via a noninvasive blood test. The screening finds remnants from the cells of dying tissue that have shed mutated cells into the blood. Researchers at The Johns Hopkins Medical Center used new technology called liquid biopsies that can analyze blood-borne tumor DNA and detect the presence of many types of cancer. This testing can also assist in determining odds ratio estimates on how a specific cancer type or location, e.g., stomach, pancreas, esophagus, colorectum, lung or breast would respond to a specific drug regimen. This novel technology, CancerSEEK, was able to identify cancer in the initial trials with median response at 70% of the eight cancer types. In addition, the sensitivity ranged between 69% to 98% for detection of ovarian, liver, stomach, pancreas and esophageal cancers, for which there are no available screening tests for persons at average risk. However the specificity of CancerSEEK was > 99%. Accordingly, only 7 of 812 healthy controls were scored as positive. In addition, CancerSEEK was able to narrow the location possibilities of the cancer to a relatively small number of sites in 83% of the patients. In cancer, like buying a home, location is everything.
As is the case for most screening tools, the specificity in detection rates decreases as more genetic material is added to the screening batch. Consequently, the researchers decided to sequence parts of just 16 genes that are commonly mutated into different types of cancer, plus the addition of eight known protein biomarkers that have been established for specific cancer types. As a result, the test sensitivity increased and allowed the team to narrow their search to the tissue type of a specific tumor.
This unique classification method combines the probability factor of observing various DNA mutations with the ability to assess the levels of several protein biomarkers. This novel methodology provides better analytics in the detection decision. Combined with CancerSEEK’s technology to “narrow the field”, so to speak. In tumor location this can be expedited by reducing the number of probable anatomical sites in most patients. In medicine, early detection almost always means better outcomes for the patients, not to mention the reduction in anxiety and fear patients experience while waiting for a diagnosis and possible treatment options.
Through this research and technology we now have the potential to screen for cancers in the primary care setting. If non-metastatic cancer is detected early enough, many can be cured by surgery alone. For others, early detection means getting a jump on systemic treatments that will improve outcomes, especially so, when the disease is less advanced.
Although CancerSEEK does not identify every cancer, it does however, non-invasively, identify many cancers that would most likely go undetected until they reached an advanced stage. To think that cancer screening of this magnitude could become part of routine blood work in the primary care setting is truly a technological breakthrough because early detection can save millions of lives.
Why Does This Matter?
The best available evidence reveals that persons with Substance Use Disorder get sicker and die younger than their age matched cohorts.
As a group, patients with Substance Use Disorder have significantly more cancers, infectious disease and chronic disease when compared to aged matched cohorts from the general population. Certainly the etiology of Substance Use Disorder, while not fully understood, includes both genotypical and phenotypical factors that conspire to adversely change one’s life trajectory. Persons with Substance Use Disorders are also a more likely to smoke cigarettes, drink heavily, use street drugs and use drugs intravenously which exposes them to countless toxins, infections and chemical adulterants, and are thus, more likely to attain a sexually transmitted infection, all of which, are major health risk factors.
But it’s not just street junkies or young heroin or meth addicts that are dying young. In a recent, well-designed and well-powered study of 45,000 men, (American Journal of Psychiatry, 2016) researchers found that those who had used marijuana persistently throughout adulthood were 40% more likely to die by age 60, compared to those who never used marijuana. Most of the early deaths, after adjusting for other variants and risk factors, were the result of a cardiovascular event.
Unlike alcohol and most commonly abused drugs, cannabis is lipophilic and the mechanism for elimination of cannabis from the body is not well elucidated. Certainly inhaling hot smoke causes damage to lung tissue, as has been established in cigarette smoking and lung cancer. In addition to the smoke, marijuana contains fungi, bacteria and toxic pesticides that are strongly correlated with inflammatory and autoimmune disorders. Some experts have speculated that chronic marijuana smoking may cause endothelial inflammation, a known risk factor for cardiovascular disease. And then there is alcohol—our favorite drug. The CDC reports that between 2006 and 2010 alcohol abuse led to approximately 88,000 deaths in the U.S., which adds up to 2.5 million years of potential life lost (YPLL) each year—shortening the lives of those who died by an average of 30 years. Alcohol abuse is responsible for 1 in 10 deaths among working-age adults aged 20-64 and a known risk factor for liver and pancreatic disease including cancer.
The combination of phenotypical factors, alcohol abuse, cigarette smoking and now 24 million Americans smoking marijuana, is robbing precious years of lives from far too many. Sadly–and in spite of this evidence–more and more states are liberalizing their drug laws.
In conclusion, taking a high altitude, holistic view of health, wellness, morbidity and mortality, one cannot escape the notion that the toxic effects of drugs and alcohol are having a dramatic effect on our nation’s health and well-being. Screening for cancer is a major breakthrough and will saves lives, but screening for the disease that contributes to cancer and so much sickness, sorrow and premature death is of equal importance.
- D. Cohen et al., Science 10.1126/science.aar3247 (2018).