Biden wants blood tests for early detection of cancer, but it’s not that simple

Biotechnology is full of tantalizing promises, but few are as alluring as this: a test that can screen for any type of cancer early, so patients can start treatment earlier and have a better chance of survival.

These tests, often referred to as screening tests for multiple cancers, look for bits of DNA released from tumor cells into the bloodstream. This allows them to potentially catch cancer before people have symptoms. If tests identify potential cancer, biopsies could be taken to confirm where it is located.

But the scientists faced challenges with the technology. Detecting where a cancer is coming from is scientifically complicated, although at least one company is using machine learning to solve this problem. And while initial research shows some private companies are having success, many tests still have accuracy issues.

Last week, President Biden said He wants to fund research into these tests through his cancer initiative, Moonshot. He announced a federally funded clinical trial that will examine the effectiveness of several types of screening tests. The hope, Biden said, is that a tool will come out that can help halve cancer deaths in the United States within 25 years.

“Imagine a simple blood test during an annual checkup that could detect cancer early.” he said.

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According to the Centers for Disease Control and Prevention, nearly 600,000 people die from cancer in the United States each year. According to experts, early detection of cancer is one of the best ways to save lives. But few cancers have tests capable of doing this, except for a few in sites like the breast, prostate, and lungs.

A handful of companies have entered the space to detect more cancers. Among them, Grail, a Silicon Valley-based biotechnology start-up that developed the Galleri test, is one of the most advanced, biotechnology experts said.

The company’s test is based on the rationale of finding DNA that tumor cells release into the bloodstream as they die and replicate. The Galleri test detects markers on DNA shed by tumor cells and feeds that data into a machine learning algorithm that can detect if cancer is present and in which organ, said Josh Ofman, Grail president.

The company says its test can detect more than 50 types of cancer early. The tests aren’t approved by the Food and Drug Administration, although they’re actively seeking them, Ofman added. Most insurance companies won’t cover the test, but people can buy it for a whopping $949 if they have a prescription.

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Grail performed an initial study in which it screened more than 6,600 people over the age of 50 for cancer with its test. It developed cancer in 35 people, and 71 percent of those cases were not cancers for which routine screening exists. 56 healthy blood samples were incorrectly identified as cancerous.

That of the Biden administration initiative, run by the National Cancer Institute, plans to test how effective blood tests are in identifying cancer early. Starting in 2024, 24,000 patients aged 45 to 70 will be enrolled for a four-year pilot study. This will lay the groundwork for a larger process aimed at enrolling 225,000 people, the White House said.

What tests will be included in the study is ongoing, Ofman said, adding that Grail would like to work together.

Salil Garg, a clinical researcher at MIT’s Koch Institute for Integrative Cancer Research, said if tests could be perfected, they would become valuable as regular patient screening tools. He noted that despite the attention being given to space, there are several challenges to getting this technology ready for the masses.

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A positive result doesn’t necessarily mean cancer is present or that there is a mass that will turn into cancer, he added. Determining where the cancer came from is difficult because some cancers have similar DNA mutations or may not shed any DNA into the bloodstream at all, making it difficult for the tests to detect them.

“The open question is: in what context will this be useful information?” said Garg. “Very useful information versus less helpful.”

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