Laura Nuttall was diagnosed with deadly brain cancer at the age of 18 after going for a routine eye exam. She completed an incredible bucket list, which included meeting Michelle Obama, driving a monster truck, and commanding a Royal Navy warship before ultimately succumbing to her cancer this past Monday at the age of 23.
What if her cancer had been discovered earlier through a simple blood test? Could it have been cured?
While still futuristic, multi-cancer early-detection blood tests, also known as liquid biopsies, are on the verge of revolutionizing medicine as we know it. They have the potential to screen for dozens of cancers from a single blood draw. As a radiation oncologist and the liquid biopsy working group leader at Siteman Cancer Center at Washington University School of Medicine, I have witnessed firsthand the power and potential of this technology to detect cancer and improve patient outcomes.
Current leaders in this multi-cancer early detection space include Grail, Exact Sciences, Freenome, and Delfi Diagnostics. Already, anyone with $1,000 to spare and a referral from their primary care physician can order a Grail Galleri test and screen for over 50 cancers. However, these tests are not yet ready for prime time and still have high false negative rates for most cancer types. Nevertheless, there have been several success stories, with these tests identifying cancers early, leading to prompt diagnoses and successful cures. It is truly an exciting time, and the future of cancer screening appears to lie in the realm of these blood-based multi-cancer early detection tests.
But as these tests take center stage, one wonders who will have access to them. Currently, minority and underserved populations are less likely to undergo standard cancer screening tests, such as colonoscopy, mammography, Pap smear, and low-dose CT scanning. They are less likely to see primary care physicians regularly and are more likely to seek medical assistance in the emergency room for unaddressed medical issues. Moreover, they tend to have less trust in health care providers and the health care system as a whole. They may also view clinical trials with apprehension, suspicious that they will be subjected to human experimentation with nefarious motives.
Therefore, I worry that as we become increasingly precise in our ability to detect and treat cancer, we are inadvertently widening the health care divide. While the United States is a behemoth in biotechnology innovation, supplying drugs and tests worldwide, it also leads the world in health care disparities. A high percentage of uninsured or under-insured individuals and communities lacking basic health care needs contribute to preventable health issues and increased mortality rates.
Addressing these disparities head-on is imperative. Firstly, clinical trials need to make a greater effort to include underserved populations. They should extend beyond prestigious academic cancer centers to include community practice centers. This way, our least-served populations can be better integrated into the clinical trials engine that drives game-changing cancer care in the United States.
Secondly, we need comprehensive health care awareness campaigns that target community centers in underserved communities. These campaigns should encourage regular visits to primary care physicians and provide information about upcoming technologies, including these multi-cancer early-detection blood tests.
Thirdly, we must build trust within these communities. This can be achieved by educating more doctors and nurses who come from underrepresented minorities and convincing them to practice within these communities. This approach will contribute to trust growing from within.
Finally, biotechnology companies themselves need to make a concerted effort to democratize their tests. They should lower price points and work with regulators to advocate for Medicare and insurance coverage. This will ensure that multi-cancer early detection tests are accessible to everyone when they are ready for prime time, rather than being limited to the wealthy and educated.
The future looks bright, and America remains a powerful force in health care innovation, investing billions of taxpayer dollars into these efforts. These innovations have been game-changing, as we witnessed during the pandemic, with American innovation leading the way in developing Covid detection tests and vaccines, ultimately turning the tide in our favor. However, just as the Covid pandemic exposed, there is a significant divide in this country when it comes to access to life-saving technology.
With cancer being a leading cause of mortality in the United States, affecting even young individuals like Laura Nuttall, and with blood-based multi-cancer early detection tests on the horizon, we must remain aware of and address these health care disparities head-on. Otherwise, we risk creating a medical caste system and a future reminiscent of the movie Gattaca, something we must work hard to avoid.
Aadel Chaudhuri is a radiation oncologist.
