In this article, Dr. Barry Kramer, director of the Division of Cancer Prevention, is discussing a new research program funded by NCI to help guide treatment decisions for people diagnosed with cancer after a screening test.
Investigating cancer prevention and early detection is entering a new era. We, by better understanding how cancers form and all too often flourish-and by having powerful new technologies-our approach is now more refined to prevent cancer, to screen for and manage disease in A very early state.
As illustrated in an Outcome Notification report published last week in Cancer Prevention Research, this evolution is rapid and broad in scope. Recent studies, for example, have shown the possibility of using a genomic classifier to identify early lung cancer and precision medicine methods to reduce the risk of cancer in those at high risk.
As described in the Annual Plan and Budget Proposal for 2017 , NCI supports many promising pathways for prevention and early detection, including studies that focus on extending the use of immune-based cancer therapies to prevent cancer in those who Are at increased risk, and studies to investigate whether aspirin and metformin , which are already used to safely and effectively treat other conditions and are known to affect the molecular pathways involved in cancer, may be able to halt the formation or The progression of various types of cancer.
One particularly exciting initiative led by the NCI that is opening a new field is the Consortium for Molecular Characterization of Examined Injuries. The consortium is a joint program of the DCP and NCI Division of Cancer Biology that will help address an area of critical need: determining the risk of progression of early cancers detected by screening.
The identification of cancer in the earliest stages has long been a critical area of research. However, our success in achieving this goal has been uneven. Effective screening-where the benefits outweigh possible harm-are available only for a handful of cancers, and in many cases, it is still unclear whether it is always necessary to treat cancers found by screening (or those detected as a result Of an unrelated medical examination).
There is ample evidence for prostate cancer, for example, that routine screening has led to many cases of overdiagnosis and overtreatment in which men were diagnosed and treated for a cancer that would probably never have harmed them.
The focus of this new consortium will be to analyze the cellular and molecular composition of precancerous lesions and tumors detected by screening tests (and of the cells and other components in their immediate vicinity, the “tumor microenvironment”) and identify characteristics such as Altered genes, or the expression of specific proteins that distinguish slow-growing cancers that may not need to be treated immediately, if they need it, for cancers that are aggressive or likely to become aggressive and need a treatment righ now.
The consortium was established in October 2015, when NCI awarded grants to support seven multidisciplinary research teams and a center to coordinate the consortium’s programs. Each research team will focus on one type of cancer of the following four cancers: lung, breast, prostate or pancreas.
As with almost all cancer research today, advanced technologies and tools, such as powerful imaging modalities, single cell analysis, and next generation cancer models, will be a critical part of the research Carried out by the members of the consortium. Each research group participating in the consortium will be composed of a multidisciplinary team with expertise in patient care, pathology, imaging and genomics, among others.
And while each team will manage its own research projects, teams will share data and expertise and create collaborative research projects.
This innovative company builds on NCI programs to bring more precision to how we treat and control cancer. Each patient’s cancer may have its own unique molecular composition and clinical presentation. Our job is to use the best understanding of the biology of pre-malignant states and new technologies not only to reduce the risk of cancer but to ensure that we are providing treatment only when it is necessary and more likely to benefit patients.