Abstract

Screening Technologies for the Early Detection of Cancer: Current Challenges and Opportunities

Steve Soper, Foundation Distinguished Professor; Director, Center of BioModular Multi-scale System for Precision Medicine, Adjunct Professor, Ulsan National Institute of Science & Technology, The University of Kansas

Regardless of the significant improvement in treatment, cancer remains the leading cause of death worldwide accounting for nearly 10 million deaths in 2020. Other than the effects on patients and families, cancer has a tremendous impact on the economy of a country as well. Both mortality and healthcare costs for cancer care could be greatly reduced by early detection of large populations as once cancer has metastasized treatments become difficult and costly and survival rates drop precipitously. Although there is a one-in-three chance of being diagnosed with cancer in one’s lifetime, the screening of cancer in the general population is limited. Screening tests if designed properly can help find the disease early, which here is defined as a pre-metastatic state, when the disease outcome for a patient is more optimistic. Currently, only a few cancers including breast, cervical, colon, lung, and prostate cancers are screened among the general population. But, the current screening tests are not without challenges including modest clinical figures-of-merit, poor compliance, and high complexity in terms of assay format and the need for specialized operators. Thus, improvements in screening strategies will enable more of the general population to be tested resulting in reduced mortality rates. Current screening tests are limited by several factors such as lack of easily accessible markers, suboptimal compliance, low sensitivity for early-stage disease, high false positive rates, varied cost-effectiveness, and the need for complex clinical workflows. For instance, to date there is no screening test for the early detection of ovarian cancer. Although CA-125 blood tests are the most widely used test for ovarian cancer screening, it is not without significant challenges as CA-125 is also often elevated in the blood of people with other conditions such as endometriosis, fibroids, and liver cirrhosis. Thus, the CA-125 test is FDA approved only for assessing treatment efficiency after ovarian cancer diagnosis, as well as for monitoring recurrence. Hence, there is a large societal need to develop new screening technologies to address these drawbacks. We discuss the challenges in currently available screening technologies for cancer and the prospects for developing new screening tests including accessible biomarkers (i.e., liquid biopsy markers) and the associated hardware that would be of keen interest to the bioanalytical community.