The University of Colorado Cancer Center is one of eight cancer centers nationwide that will evaluate the feasibility of blood tests that can screen for several types of cancer.
Organized by the National Cancer Institute through the National Institutes of Health, the Cancer Screening Research Network (CSRN) will support the Biden-Harris Administration’s Cancer Moonshot initiative by investigating how to identify cancers earlier, when they may be easier to treat.
On the Vanguard
The CU Cancer Center, along with partner organizations Kaiser Permanente Colorado (grant leader Debra Ritzwoller, MD) and Kaiser Permanente Hawaii (grant leader Stacey Honda, MD), is among the institutions taking part in a pilot study, known as the Vanguard Study on Multi-Cancer Detection, to address the feasibility of using multi-cancer detection (MCD) tests in future randomized controlled trials. MCDs are blood tests that can screen for several types of cancers.
“Being selected to take part in this trial is a compliment to our cancer center, to our Cancer Prevention and Control Program, and to the work we have done in our community,” says Linda Cook, PhD, associate director of population sciences for the CU Cancer Center. “It also puts us at the forefront of cutting-edge screening issues in cancer. It’s a great way for our junior investigators to get involved, and it gives us the opportunity to be immersed in this data and think about secondary analyses or grants we could submit that would specifically help people in Colorado.”
Benefits vs. harms
The Vanguard Study will enroll up to 24,000 people to inform the design of a much larger randomized controlled trial involving about 225,000 people. The larger trial will evaluate whether the benefits of using MCD tests to screen for cancer outweigh the harms, and whether they can detect cancer early in a way that reduces deaths.
“These multi-cancer detection tests are looking at biomarkers, commonly DNA in the blood, and many companies are proposing to use these as a screening test,” says Marie Wood, MD, medical director of the Cancer Clinical Trials Office(CCTO) and one of the CU Cancer Center investigators on the Vanguard Study.
“Currently, we have standard of care screening for five cancers — breast, cervical, colorectal, lung, and prostate — but these screenings are all done using different modalities, done at different intervals, starting at different ages, with differing amounts of invasiveness,” Wood says. “They’re also associated with a high false positive rate and low predictive value.”
Fifty percent of all cancers occur in cancers for which there currently screening tests; however, a substantial portion of cancer deaths occur from cancers for which there is no standard screening, Wood says. A simple blood test that screens for multiple types of cancer — including cancers with no current standard-of-care screening — could improve early detection of cancers, but only if they work properly and don’t create more problems than they solve.
“The problem with multi-cancer detection tests is that they just give you the probability that you might, for example, have pancreatic cancer, which is a cancer for which there is no screening,” Cook says. “So you arrive to your specialist doctor and say, ‘I have an X percent chance of having this cancer,’ and then they have to do massive workups on you to figure out what the cancer is and if you actually have it. It’s not as much about the cost and the investment in the screening tool itself — it's the downstream consequences.”
In some cases, early detection of certain cancers can also have adverse effects on quality of life without improving survival, says Jamie Studts, PhD, co-leader of the Cancer Prevention and Control Program and a co-investigator on the Vanguard Study.
“Cancer screening is a process with many different outcomes. The reason we screen for cancer is help people live longer and better, which often requires detecting it earlier and treating it more effectively,” Studts says. “But for many cancers we might be able to detect early with multi-cancer detection tests, we may not be able to change the outcomes. We might just be detecting cancers earlier and not changing anything that really matters in terms of living longer and better. The only thing you change is that people live longer knowing they have cancer. That’s why this study is so important — to see if individuals who receive these blood tests live longer and better.”
Diversity and disparities
The Vanguard Study is a randomized control trial comparing MCDs with standard-of-care screening. It will measure everything from accuracy and cost to survival rates and patients’ anxiety levels around screening and results. Additionally, the network aims to reach diverse populations that receive routine care in a variety of health care settings, including rural areas.
Study sites are geographically diverse and include underserved populations, and the trial will examine whether a blood test offers easier access but equally accurate results for populations for whom traditional cancer screenings can be difficult to access.
“Important to Colorado, there are disparity issues in both access and adherence” when it comes to screening, Wood says. “It’s important that we look at rural populations and underserved populations that tend to have less insurance coverage and other barriers to screening.
Future investigation
Cook is excited that the CU Cancer Center is among the institutions looking to discover if MCDs are the future of cancer screening, but she cautions that the road will be a slow one. The Vanguard Study will lead to larger trials that study survival rates over a number of years.
In the more immediate future, she’s happy that the CU Cancer Center is part of the network that may end up evaluating many screening methods in the years to come, all with the goal of saving lives through early detection.
“Because we are establishing this network, it’s going to be involved in any sort of new screening test or screening technology,” Cook says. “Right now we’re looking at multi-cancer detection tests, but as science progresses over the next 10 years, we’re going to have new ways of identifying if somebody has cancer. This network is being established as a resource to do this type of investigation well into the future.”
