Are Current Methods for Cancer Diagnostics Effective?
Author: Holly Young
Cancer, one of the most prevalent diseases in the world today; with 14 million new cases identified each year. Until 2017, it was responsible for over 8.8 million deaths worldwide.
Cancer is the uncontrollable growth of cells in an area of the body, developing into a tumour: these cells can also detach from the tumour and travel to other parts of the body and grow into another tumour. (1).
In recent years, developments in treatment options available for differing cancer types has resulted in a vast improvement in prognosis: doubling cancer survival rate compared to the 1970s. However, cancer is still the leading cause of death in the UK and by 2035, is estimated to cause more than half a million deaths annually (2). Due to this, the demand for better cancer diagnosis, especially for early stage cancer, is increasing exponentially.
Early diagnosis is vital for survival, especially for lung, prostate, colon, pancreatic and liver cancer. There is a large variation in the survival rate and diagnosis rate between different types of cancer. Cancer diagnosed at later stages lack effective treatment options, highlighting the importance of detecting cancer at the earliest stage possible: current tests available are limited, expensive and invasive such as colonoscopies and mammography (3,4).
Point of care (POC) technology can offer numerous benefits including geographical and economic related issues associated with current cancer diagnostic methods (4). POC is highly attractive with great development opportunities to integrate novel technology. Lower cost, rapid results turnaround and portability are advantages of POC : this is ideal for areas of low-resource, low-mid income and where healthcare is not easily accessible (5).
Most currently used diagnostic tests for cancer
Presently, there are 3 main diagnostic methods used to detect cancer: Liquid biopsy, solid biopsy and imaging tests.
Liquid biopsies are laboratory tests that analyse circulating DNA from cells in blood, urine or other bodily fluids for cancer-associated biomarkers. Tumour markers are any substance produced by cancer cells or, healthy cells in response to cancer at a much higher rate than normal; it can give information about the aggression of cancer or the type of treatment that would be most effective. These test results alone cannot be used as a definitive diagnosis for cancer but can be used as an indicator in conjunction with other diagnostic methods such as tissue biopsies or mammographs.
Solid biopsies are the most definitive method to diagnose cancer. These methods take a sample of tissue directly from the tumour to be analysed in a laboratory. Solid Biopsies are invasive can involve extended periods of hospitalisation for the procedure and recovery. In some cases, patients will go into surgery to obtain a tissue sample and other times These methods are time-consuming, require highly trained personnel and expensive laboratory-based equipment but are effective for diagnostics.
Imaging tests are usually used in conjunction with one of the methods mentioned above in the detection of cancer. They create detailed images of different areas inside the body to identify abnormalities or if a tumour is present and the location. Examples include CT scans and MRI scans. Imaging tests are useful to identify and find abnormalities however, they are limited to only finding large groups of cancer cells: this test also exposes patients to high concentrations of radiation (6).
A traditional process for the detection of breast cancer uses the ELISA test along with mammography. ELISA testing involves costly and large equipment in a hospital or laboratory environment. In low-income countries, access to such services is limited. Accuracy of mammography ranges between 45%-90%, relying on the expertise of medical personnel. The process itself is also invasive and can expose the patient to dangerous levels of radiation.
Current diagnostic tests are effective in diagnosing cancer however, they are invasive, time-consuming and costly. There is great scope for the integration of novel technology into POC devices that are cost-effective, accurate and have rapid result turnaround.
How can novel technology improve current cancer diagnostics?
For novel technologies and POC devices to be successful and widely used it must be “portable, easy-to-use and reduce the overall cost burden” (4). POC technology has numerous benefits over currently used diagnostic methods.
Imaging Technology
Recent developments in the imaging technology field include the miniaturisation of already well-used diagnostic equipment. Portable ultrasounds are now available by GE and Siemens, these are not costly and less bulky diagnostic methods in the hospital setting.
Figure 1: GE’s portable ultrasound VSCAN AIR. It is small, lightweight and wireless. Easily portable and utilises modern smart device technology to allow early diagnosis.
Pocket Colposcope developed by Duke University’s Tissue Optical Spectroscopy Lab is effective as a portable tool to examine the cervix without the need for a high-resolution viewing system. When connected to a smart device it can produce quality real-time analysis that is comparable to the standard of lab-based results.
Liquid Biopsies
Identification of new cancer biomarkers has come with advancements in the field of molecular diagnostics. Liquid biopsies are much less invasive than the extraction of solid biopsies, requiring only a small sample of body fluid to be analysed. Grail and Guardance Health are major companies in liquid biopsy development.
Implantable Biosensors
Implantable biosensors are anticipated to play a vital role in monitoring vitals both during the detection of cancer and the recovery stage. One example is the measurement of body temperature: important for monitoring the effects of chemotherapy treatments. For this, an implantable biosensor would be helpful to provide continuous real-time updates.
Figure 2: This image shows qualities of the ideal implantable biosensor that is easy to use and reliable. As technology advances, this can change the game for precision medicine and cancer diagnostics.
Microfluidics
Multiplex POC detection involves microfluidics used to develop efficient lab-on-chip solutions, these can detect analytes/biomarkers in the blood which could indicate cancer. This process is time-efficient and low cost.
In 2017, the POC Medical Incorporation released a microfluidic rapid POC test known as the Pandora CDx-MammoAlert. This test can detect the presence of 48 serum biomarkers, aiming to replace the lab-based test originally used. The process is rapid; capable of producing results within 30 minutes and data can be stored in the computer system and accessed in any location (4).
Figure 3: Image illustrating some of the main benefits of Point-of-Care Technologies (4).
Current diagnostic methods are unable to overcome some of the points outlined in figure 1, including not requiring highly trained personnel, accessibility in remote locations, the cost being much lower, providing rapid results and they reduce radiation exposure.
There have also been advances in the use of colorimetric paper-based and lateral flow assays (LFAs) along with electrochemical equipment for diagnostic and screening methods of POC technologies. Electrochemical equipment tends to be low cost; highly sensitive; can be miniaturised; only require a small volume sample, and only need a low power supply. With these advantages, it is ideal for POC technologies (7).
Conclusion
It is clear that a fast and early cancer diagnosis is critical to broadening patient treatment and increasing the chance of survival. Late diagnosis can result in limited and less effective treatment options. Early stage diagnosis correlates to an average 5-year survival being relatively high at 91%, whereas in the later stage diagnosis it is much lower at 26% (3). This emphasises the need for the advancement of novel technologies and POC devices. These advancements may not improve the currently available treatment options for cancer, but they could improve the patient prognosis.
The opportunities for novel technology and POC devices can provide the ability to identify patients into a priority list can help in low- and middle-income countries with restricted access to good healthcare: lessening the gap in survival rate between low- and high-income countries. In general, POC development can benefit all cancer patients as it can provide a faster and all-round diagnosis to facilitate better treatment plans and prognoses.
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References:
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Crosby, D., Lyons, N., Greenwood, E., Harrison, S., Him, S., Moffat, J, et al. 2020. A roadmap for the early detection and diagnosis of cancer. The Lancet Oncology. Volume 21, Issue 11, 1397-1399. DOI: https://doi.org/10.1016/S1470-2045(20)30593-3
Chen, X., Gole, J., Gore, A. et al.Non-invasive early detection of cancer four years before conventional diagnosis using a blood test. Nat Commun 11, 3475 (2020). https://doi.org/10.1038/s41467-020-17316-z
2021. Simplifying Cancer Detection using point-of-care Technologies - FutureBridge. DOI : https://www.futurebridge.com/industry/perspectives-life-sciences/simplifying-cancer-detection-using-point-of-care-technology
Haney K, Tandon P, Divi R, Ossandon MR, Baker H, Pearlman PC. The Role of Affordable, Point-of-Care Technologies for Cancer Care in Low- and Middle-Income Countries: A Review and Commentary. IEEE J Transl Eng Health Med. 2017; 5:2800514. Published 2017 Nov 23. doi:10.1109/JTEHM.2017.2761764
How Cancer Is Diagnosed. (2019, July 17). National Cancer Institute. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis
Mohammadniaei M, Nguyen HV, Tieu MV, Lee MH. 2D Materials in Development of Electrochemical Point-of-Care Cancer Screening Devices. Micromachines (Basel). 2019;10(10):662. Published 2019 Sep 30. doi:10.3390/mi10100662