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Imagine a loved one being diagnosed with cancer when it is too late for effective treatment. Now, imagine if that cancer had been detected on time – when it was treatable, when hope was still alive. This is today’s reality, where timely detection, diagnosis and prevention are not only crucial but also life-saving. With 1 in 9 Indians likely to develop cancer in their lifetime, the urgent need to address the growing public health burden in India cannot be underestimated.
What is the role of cancer screening?
Cancer is responsible for this 18% of deaths are due to non-communicable diseasesWhich has made it the second leading cause of mortality in the country. In 2022 alone, according to an estimate 14 lakh new There are more than 100 million cases of cancer reported in India, with this number expected to increase by 12% by 2025. GlobocanBreast, cervical, ovarian, and colorectal cancers are the most common in women, while lung, esophageal, colorectal, and stomach cancers are the most common in men.
When cancer is detected late, survival rates plummet while the cost of care skyrockets, often requiring invasive and expensive treatments. Early detection of cancer makes its treatment easier, This reduces suffering and significantly prolongs life. This is why many countries have aligned with the United Nations Sustainable Development Goals (SDGs), and set ambitious targets to ensure that no cancer is ever diagnosed. For example, National Health Service in England It aims to increase the proportion of people diagnosed at an early stage from 50% to 75% by 2028. Early detection through screening is the cornerstone of any effective national cancer strategy.
there is Strong evidence Organized cancer screening can reduce mortality. As a result, many countries have established national screening programs for breast, cervical and colorectal cancer. Lung cancer screening is spreading worldwide, while prostate cancer screening is available but is not widely recommended as a formal program. Most European countries, North America, Australia and parts of Asia have adopted organized cancer screening, but in low- and middle-income countries such as India, such programs are still uncommon. According to the recent National Family Health Survey (NFHS), the number of cancer cases in the world has reached 100.NFHS-5, 2019-21), Cancer screening in India is limited to cervical, breast and oral cancers, and only 0.2–2% of people undergo any kind of screening.
How effective is cancer screening?
The success of any cancer screening programme depends on Quick—the percentage of people who complete a screening test and receive their results within a specified time after being invited. High levels of participation in early detection of cancer are essential to reduce mortality and ensure the cost-effectiveness of the program. However, barriers such as anxiety, embarrassment, and especially being told the results of the test are still prevalent. Women’s cancersLack of support from family members can significantly reduce its acceptability.
Additionally, structural barriers such as limited health infrastructure and access to screening facilities further hamper the reach and effectiveness of cancer screening programmes. These challenges are further compounded by disruptions such as the COVID-19 pandemic, when limited access led to a sharp decline in cancer screening. The drive to increase access has only shown that Minor effects Over time, the need for more innovative solutions was highlighted.
How do blood-based tests work?
Blood-based tests offer a promising way forward. Already a key element in annual preventive health checkups, these tests can be adapted for cancer screening at an affordable cost with high specificity and reasonable sensitivity. Early detection of multiple cancers (MCED) test, a type of Liquid BiopsyDetects signs of cancer – such as circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) – released by cancer cells into the blood at an early stage, when treatment is most effective. If a signal is found, the test can often precisely identify the location of the cancer, helping doctors plan the appropriate care pathway.
This test can detect 50 types of cancer, including ovarian, liver, stomach, pancreatic, and esophageal cancers, for which there is currently a lack of recommended early detection tests. It can also alert individuals to hard-to-detect and aggressive cancers and is especially recommended for adults and those at high risk. However, it is important to understand that the MCED test is different from genetic testing, which looks for inherited genes that may increase the risk of cancer throughout life. The MCED test does not assess genetic predispositions or inherited genetic changes related to cancer.
MCED tests are not yet approved US FDA. Some tests have received Breakthrough Device designation, but that does not mean they have gone through the FDA’s rigorous premarket review process. In India, the CDSCO is responsible for drugs, medical devices, and diagnostic kits. While liquid biopsy for diagnostic purposes is gaining popularity in India, MCED tests are still new and not in accepted standards CDSCO List Until now. But some companies are now offering these tests to doctors and consumers as laboratory-developed tests (LDTs) and cost up to Rs 15,000 per instance. LDTs are designed, manufactured and used in a single laboratory. While laboratories must prove that these tests can accurately measure what they claim to measure, federal rules do not require them to show that the tests actually benefit patients, such as by diagnosing cancer early.
Are there any negative aspects of MCED tests?
MCED tests are not without their challenges. A significant risk is false positivity, where a test indicates cancer when there is none. When multiple tests are used for screening, the false positivity rate can be as follows: Up to 50% higher. But combining traditional screening with the MCED test could have significant benefits Reduce this rate. A 2021 study in the British Journal of Cancer estimated that such a combination could reduce the false-positive rate for breast, lung, cervical, and colorectal cancers from 1:43 (i.e. 43 false positives for every true positive) to 1:14.
Studies have shown that MCED testing can detect efficiencies ranging from 25-100%. 400,000 additional cancer cases This may be missed by conventional methods. It is also important to note that MCED tests generally report high specificity (>96%), but their sensitivity was variable and affected by study design, population, reference standard test used, and follow-up period.
Despite their potential, MCED tests are not a magic bullet. They carry a risk of overdiagnosis and overtreatment, which can lead to unnecessary physical, psychological, and financial stress. Therefore, the US FDA recommends that after a positive MCED result, patients and physicians should receive prompt, comprehensive instructions on the diagnostic evaluation needed to confirm and understand the suspected cancer after a positive test.
Why are post trial procedures important?
As MCED tests are still new in India (as are most LDTs), post-test support is important to reduce the anxiety of a positive result. To address this, both patients and clinicians need a comprehensive range of educational tools and resources. Clear patient information guides should be provided to interpret results, outline next steps, and set expectations for further diagnostic procedures. Decision support tools can help evaluate the benefits and risks of additional testing or treatment, particularly considering the potential for overdiagnosis and overtreatment.
Access to counselling services such as a genetic counsellor or oncologist is crucial to help patients understand their results and manage the emotional and psychological impact. Interactive digital platforms can provide personalised education, track patient progress and send reminders for follow-up appointments. Healthcare providers will also benefit from specialised training modules focused on interpreting MCED results, effective patient communication and managing the diagnostic process.
Vid Karmarkar is the Founder and CEO of CanSeva Foundation, a Section 8 nonprofit with a mission to reduce financial toxicity in cancer care in India.
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