New platforms deflect the financial impact of cancer tests

Cancer tests are usually a complicated process of physician consultation, referrals to a secondary/tertiary care centre, lengthy wait times, risk of radiation exposure from radiological scans, and the need to undergo inconvenient procedures like endoscopy or tissue smear which may be associated with other risks.

In most of these cases, the findings are inconclusive and necessitate repeat or additional procedures. On the other hand, while negative findings are relieving, they imply that the individuals underwent arduous procedures that are retrospectively deemed unnecessary or avoidable. No viable alternatives provide meaningful insight into the status of malignancy in an asymptomatic individual.

Platforms like Trucheck, a non-invasive blood-based test, are a new paradigm in multi-cancer detection — a 'giant technological leap' to nip cancer in the bud. They are a culmination of years of collaborative international research and innovation and have been developed, tested, and validated on population-sized cohorts.

To put into perspective, Trucheck, for example, can detect up to 77 types of cancers (including several aggressive types) that account for -81 per cent of all cancer cases and ~84 per cent of all cancer-related deaths in Europe. It also has 92.1 per cent sensitivity in detecting cancers across all stages and types and has a further 93.1 per cent sensitivity in localising cancer to the appropriate tissue or organ of origin in the CTC-positive cases (yielding a combined sensitivity of 85.8 per cent). In different cases, it further detects and localises cancers with 100 per cent specificity* (versus healthy individuals) irrespective of the extent of the disease and gives a zero False Positive Rate.

Adoption of such a system not only offers cost-effectiveness and efficiency but also helps prioritise referrals and clinical work-up in individuals with positive findings. This can significantly reduce the number of avoidable referrals and alleviate the burgeoning burdens on the cancer management infrastructure, which in turn can free up valuable resources for those individuals who need them most. It can further reduce wait times, free up resources, reduce the avoidable allocation of resources and go a long way toward saving precious lives.

In suspected cases, for example, those presenting with a palpable lump or mass on imaging, the usual ('Gold Standard') clinical work-up involves a biopsy to obtain a tissue sample followed by histopathological examination (HPE). However, this is not feasible for screening in asymptomatic cases in which other methods are used to identify or locate indications of malignancy, such as radiological scans or endoscopic procedures. These screening methods are, however, specific for particular cancer types and necessitate an individual to undergo as many tests as suspected of cancer.

Understanding the financial impact on cancer tests

Cancer has a significant impact on the financial health of patients and their families. Today, the estimated 16.1 million individuals living with cancer face annual out-of-pocket medical expenditures 61 per cent higher than those without cancer (US$1,000 vs US$622). About one in four report problems paying bills, and one-third worry about paying bills. A 2017 systematic review of 45 studies found that 12 per cent to 16 per cent of those with cancer were in debt due to their treatment, about half reported some level of financial distress, and between 4 per cent and 45 per cent were nonadherent with medication because of cost. 

Cancer also has significant indirect costs related to lost income. An analysis of 492,146 cancer deaths in persons aged 16 to 84 years in the United States in 2015 found US$94.4 billion in lost earnings, with an average loss of US$191,900, which likely underestimated productivity loss.

Many studies have examined the potential reductions in cancer-related deaths if malignancies diagnosed after metastasis were, instead, diagnosed at earlier stages. Although stage IV cancers represented 18 per cent of all diagnoses, they accounted for 48 per cent of all cancer-related deaths within five years.

Researchers found that if these patients had been diagnosed at stage III, there would have been 51 fewer cancer-related deaths per 100,000 (or 15 per cent of all cancer-related deaths).

If one-third of metastatic cancers were diagnosed at stage III, one-third at stage II, and one-third at stage I, there would be 81 fewer cancer-related deaths per 100,000 (or 24 per cent fewer cancer-related deaths).

Barriers to early cancer detection

There are numerous barriers to the early detection of cancer, both medical and socioeconomic, including:

• Lack of symptoms: Liver, pancreatic, and ovarian cancers are typically diagnosed late in the disease course because they rarely present with symptoms early within the disease course.
• Awareness: Individuals may not be aware of the signs and symptoms of cancer or assume they are part of some other condition.
• Access: Lack of access to screening and diagnostic testing can delay early diagnosis and treatment.
• Financial: Those who are uninsured or underinsured or who have low socioeconomic status, may be less likely to obtain screening or early diagnosis.
• Fear: This includes fear of learning about cancer as well as fear of its treatments.
• Human nature: Many young people feel invincible and healthy and reject the need for screening. Yet, among adults younger than 50 years, rates of cancer linked to obesity are rising. Millennials born around 1985 are now twice as likely to develop one of six obesity-linked cancers as baby boomers born around 1950 were the same age.
• Weak referral systems: Many people present with early-stage symptoms to their primary care provider. The clinician may not recognise the symptoms or may not have access to a robust referral network.

Dr. Ramin Ajami, Oncology Specialist and Founder, LifeGen.

Final thoughts

Despite significant improvements in detection and treatment over the past two decades that have dramatically improved the five-year mortality of many cancers, it remains the second most common cause of death worldwide.

Cancer diagnosis also exerts a significant economic burden on the healthcare system. Population-based screening may be responsible for mortality reductions in several cancers, particularly breast, cervical, and colorectal cancers. However, population-based screening comes with several risks, including the risk of false-positive and false-negative results as well as under- and overdiagnosis.

The advent of non-invasive blood-based tests for multiple cancers has revolutionised cancer screening and led to the early detection of numerous tumours.

Cost-effectiveness, sensitivity and specificity, and clinical utility are vital benefits that must be considered when determining coverage and screening recommendations, as well as the impact on the healthcare system if thousands more cancers are diagnosed in the earlier stages.

Cancer screening of a large population would still be cheaper than treating a few with late-stage cancer. What cannot be measured in figures are the psychological and social costs of the losses that could be prevented.

— Dr. Ramin Ajami is an Oncology specialist and founder of LifeGen.