Advances in Early Cancer Detection

In recent years, MGB and Dana-Farber have established centers focused on identifying and researching early-stage cancers—essentially, the stages when treatment is generally more effective. The doctors at these facilities are actively coordinating which screenings are suitable for patients and determining how to proceed based on the results.

“There are several companies working on blood-based screening tests that might allow for screening multiple cancers at once,” commented Dr. Lecia Sequist, a medical oncologist and director of the Early Detection and Diagnostics Program at MGB.

However, she cautioned that not all these tests are proven to be effective. “It’s crucial for us to clarify to patients what’s experimental and what has been validated.”

Overall, the data is striking: the sooner a cancer is detected, the easier it is to treat and the higher the likelihood of survival. For instance, over 99% of women diagnosed with the earliest stage of breast cancer will live for at least another five years. In contrast, that number plummets to just 33% for those diagnosed at the most advanced stage, according to data from the Centers for Disease Control and Prevention. The survival rate for colon cancer exceeds 90% when it’s confined to the colon, yet drops to only 13% when it spreads, as noted by the American Cancer Society.

Nonetheless, not everyone benefits from cancer screenings, and some tests may even pose risks. For example, CT scans expose patients to small amounts of radiation, and undergoing anesthesia for colonoscopies carries inherent dangers. Sometimes, screenings may reveal non-threatening growths, leading to unnecessary—and costly—procedures.

The real question is how beneficial early detection truly is for patients and those paying for the screenings. Procedures can be anxiety-inducing, uncomfortable, and expensive.

John McDonough, a professor at Harvard T.H. Chan School of Public Health, noted that it remains ambiguous whether early detection centers genuinely provide value to patients or primarily serve as revenue sources for large health systems, potentially at the cost of insurers and patients. The truth, perhaps, is that it’s a bit of both.

“It’s nearly certain this will increase overall healthcare spending in the state,” McDonough remarked. “There’s no doubt about that.”

Cancer treatment is lucrative for hospitals, incentivizing their investment. MGB announced plans to allocate $400 million over the next four years to enhance its cancer center.

Preventive screening and early detection methods—ranging from blood panels that assess genetic mutations to comprehensive scans aimed at spotting tumors early—are on the rise. The market for multi-cancer early detection tests is expected to double to $2.86 billion by 2030, according to Grand View Research, a consulting firm from San Francisco.

In April, Dana-Farber received a $5 million donation specifically geared towards cancer prevention and early detection initiatives.

MGB, the state’s largest health system, recently expanded its Early Detection and Diagnostics Program in Waltham, adding a new location at Brigham and Women’s Hospital in Longwood.

“Our focus is on providing exceptional care for patients diagnosed with cancer. We do want to offer cutting-edge treatments and clinical trials for those facing a diagnosis, but the journey actually begins much earlier,” said Sequist.

Most individuals who visit MGB’s early detection program are referred by their primary care doctors, usually due to concerning risk factors or symptoms. Just a decade ago, only patients with clear, alarming medical histories—like multiple family members with cancer—were referred, according to Sequist. Now, patients can receive referrals based on less obvious family histories or because they work in higher-risk occupations, such as firefighting or military service.

This was the case for 24-year-old Jessica Reilly, who found herself in MGB’s Early Detection office in Waltham. Living in New York City but initially from Wayland, she is all too aware of the impact cancer can have. Her mother, a nonsmoker, passed away from lung cancer in 2007 when Reilly was still in kindergarten. Four years later, her father was diagnosed with blood cancer but has been in remission for over a decade.

“The fatigue he experienced sticks with me,” Reilly reflected. “Chemotherapy took a huge toll on his body. Seeing that made me determined to avoid going through something similar.”

Her family history made her a suitable candidate for genetic testing, but the results were unexpected. She discovered she carries a BRCA-1 gene mutation, which significantly increases her risk of developing breast or ovarian cancer. This was a twist since her father had encouraged her to seek testing primarily for lung cancer-related mutations.

Things escalated quickly thereafter. Reilly consulted with doctors in New York to explore her options. Even though she doesn’t have cancer, her risk levels were critical—an 80% chance of developing breast cancer in her lifetime—leading her to opt for a preventive double mastectomy.

“I put myself in [my parents’] situation,” said Reilly, who is currently recovering from her first surgery out of three. Her parents, she believes, would have wanted early knowledge of their cancer risks if it meant being able to prevent it or lessen its effects.

“I think anyone who has experienced cancer would likely choose that path,” Reilly speculated.

Regarding testing advancements, MGB’s Sequist remarked that technology is evolving rapidly, especially with new blood tests originally meant for detecting cancer markers in diagnosed patients.

Patients often find it challenging to differentiate the purpose behind each test or scan. Some assess future cancer risk, while others look for current cancer presence. Sequist’s team helps patients navigate their options, pinpointing which tests are relevant and worth the investment.

“These technological breakthroughs have really brought the issue into the public consciousness,” said Sequist. “There’s been growing visibility around stories of young people facing cancer, who might be too young for traditional screenings.”

Despite the heightened focus on younger demographics, cancer death rates among individuals under 50 have improved for all cancers except colorectal cancer, based on a recent American Cancer Society study.

The decline in cancer mortality can be attributed to several factors, including improved treatments and more extensive screening for prevalent cancers like breast and lung.

There’s still more work ahead, stated Dr. Betsy O’Donnell, co-director of Dana-Farber’s Centers for Early Detection and Interception.

Determining which tests are most effective for different cancers is an ongoing challenge, requiring the same level of caution and thoroughness as assessing various cancer treatments, O’Donnell noted. Early detection programs could significantly contribute to this endeavor.

“We’re on the frontier of new technology—like the BlackBerry compared to today’s iPhones—and while some tools may fade quickly, we’ll continue advancing,” O’Donnell remarked. “I’m eager to be part of this evolving field, especially since there’s such an unmet need.”