Medicine

Do supertests that detect cancer years in advance really work?

Within a month of each other, two British research centres have identified a series of proteins in the blood that signal early cancer diagnosis

by Francesca Cerati

3' min read

3' min read

Within a month of each other, two British research centres - the recently opened Early Cancer Institute at the University of Cambridge and Cancer Research UK at Oxford Population Health - have identified a series of proteins in the blood that could warn of a cancer diagnosis years in advance. Both studies were published in Nature Communications.

The first, carried out by researchers at the Early Cancer Institute - which has just received £11 million from an anonymous donor - is focusing on finding tests to tackle cancers before they produce symptoms. The research will exploit recent findings that have shown that many people develop precancerous conditions that linger for long periods.

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"The latency for cancer development can go on for years, sometimes for a decade or two, before the condition suddenly manifests itself in patients," said Rebecca Fitzgerald, director of the Institute. "We therefore need a different approach, one that can detect cancer risk early using tests that can be deployed on a large scale.

An example of this is the 'cytosponge' (a sponge tied to a thread) that was developed by Fitzgerald and his team. It is swallowed like a pill, expands in the stomach and is then pulled up the oesophagus, collecting cells along the way. If the cells contain a protein called TFF3 - found only in precancerous cells - the patient is at risk of oesophageal cancer and must be monitored.

Another approach taken by the institute - to be renamed the Li Ka-shing Early Cancer Institute in honour of the Hong Kong philanthropist who supported other cancer research in Cambridge - focuses on blood samples collected from women as part of previous ovarian cancer screenings and stored in special warehouses.

Using these samples (approximately 200,000), the researchers identified genetic changes that differentiate donors who were subsequently diagnosed with blood cancer 10 or even 20 years after the onset of leukaemia symptoms, compared to those who did not develop cancer diseases.

Tumours grow in stages and by detecting those at an early stage, one has time to intervene and avoid having to deal with the disease at an advanced stage, when the cancer has already spread.

The second centre, Cancer Research UK at Oxford Population Health, also focuses on predictive blood proteins on data from participants in the UK Biobank, a prospective cohort of 503,317 adults aged 39-73 years, recruited between 2006 and 2010 from across the UK. In the just-published study, out of 1463 proteins with a risk of up to 19 cancers, researchers identified 371 plasma protein markers at risk of cancer, including 107 associated with cancer diagnosed more than seven years after blood sampling.

For example, proteins associated with the risk of multiple cancers included GDF15, a stress-regulated hormone that they found to be associated with an increased risk of eight cancers (liver, digestive and gastrointestinal tract and haematological neoplasms), and MMP12, an enzyme expressed on macrophages that was associated with an increased risk of colon, lung and non-Hodgkin's lymphoma (NHL) cancer.

"These studies are important because they provide many new clues about the causes and biology of multiple cancers, including insights into what is happening years before a cancer is diagnosed," said Ruth Travis, senior molecular epidemiologist at Oxford Population Health and author of the study. "We now have technology that can examine thousands of proteins in thousands of cancer cases, identifying which of these play a role in the development of specific tumours and which might have effects common to multiple types of cancer.

The scientists also stated that further research is needed to discover the exact role that proteins play in cancer development and which ones are the most reliable to test. Indeed, in recent years there has been a controversial debate in the scientific literature about the potential benefits of this strategy, and the multi-cancer screening tools - or 'cancer supertests' - already on the market in the US, such as the Galleri test, it should be noted, have not yet been approved by the Fda.

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