Advances in Cancer Prevention and Screening

As researchers discover new and better ways to target cancer, more people who get the disease are living longer and being cured.

Still, the goal is not just to treat cancer, but to stop it before it starts, or at least spot it before it spreads. Scientists are making great strides in those areas.

Personalized Care

These days, many doctors help you lower your odds of getting cancer and screen you for the disease based on your unique risks.

Genes play a role. So does your environment. Things like obesity, diet, smoking, and exercise habits also play parts.

"If we could identify individuals who are at very high risk... we could be more pointed about how we use screening," says Kala Visvanathan, MBBS, from the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.

For example, instead of every woman having a yearly mammogram, doctors could focus more on screening women who have a higher risk of getting breast cancer.

More Precise Screening

Sooner is always better when it comes to spotting cancer. If doctors find it before it spreads, it’s easier to treat. Finding it hasn't been simple, though.

"Early detection or screening is incredibly complicated. It's been very hard to move the needle in this field," says Scott Lippman, MD, director of the Moores Cancer Center at the University of California, San Diego.

Cancer screening tests come with risks. Mammograms and CT scans expose folks to small amounts of radiation. Biopsies and colonoscopies can have side effects. Sometimes, screening tests report a disease that isn't really there (called a false positive). And sometimes they pick up a cancer that isn’t likely to grow. Both can lead to unnecessary tests or treatments.

Genomic tests. These are the new frontier in cancer screening. They look for DNA changes that only happen to cancer cells.

In 2014, the FDA approved a new at-home test, Cologuard, that spots colon cancer DNA changes in stool. The test is more likely to find the disease than tests that just check for blood in the stool. But a colonoscopy is still more accurate at picking up colon cancer. Cologuard can have more false-positives than other tests, too.

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A new lung cancer test looks for gene changes in cells from a person’s upper airway with a scope and a small brush. Researchers say the test is more than 96% accurate at finding the disease in smokers. And it doesn't require a needle or surgery to remove tissue from the lungs, like biopsies do.

Biomarkers. These find things in blood, urine, and other body fluids that signal trouble. The well-known PSA test is a biomarker that's been used for years to screen for prostate cancer. It checks the blood for higher levels of a protein made by prostate cells.

The problem is, the PSA test isn't very precise because other things that aren’t linked to cancer can also boost PSA levels.

So, the goal for researchers is to find better biomarkers for many cancers.

One test that's being studied is for ovarian cancer, which is often found late. It uses a Pap test, which normally screens for cervical cancer, to find DNA from cancerous cells that reach the cervix. It’s still being developed, but it could be "a game changer," Lippman says.

Liquid biopsies. Researchers are looking intoa blood test that could pick up many different cancers in otherwise healthy people. Called a liquid biopsy, the test finds cancer DNA circulating in the blood. It could be on the market as soon as 2019.

Cancer Prevention Drugs

What if you could avoid getting the disease by taking a daily medicine? We're not there yet, but some drugs are showing promise.

A pill many people already take might also prevent colorectal cancer. In 2015, the U.S. Preventive Services Task Force (USPSTF) proposed a recommendation of a daily aspirin to help prevent this type of cancer (and heart disease) in adults ages 50 to 69. A final recommendation will be made after all the research and comments have been reviewed.

While evidence shows daily aspirin use can lower colorectal cancer risk by more than 20%, it also shows you’d need to take high doses of it for many years to make that happen. Taking that much aspirin could cause serious side effects for some people.

The drugs tamoxifen (Nolvadex) and raloxifene (Evista) are already approved to lower breast cancer risk. A group of drugs called “aromatase inhibitors” are also showing promise at preventing the disease. They stop the production of estrogen in women who've already gone through menopause. They also can cut the growth of breast cancer cells.

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Cancer Vaccines

These use the body's own immune system to prevent cancer. The HPV vaccine works much like those used to prevent measles and chickenpox. It trains the immune system to attack the HPV virus.

Since this vaccine was approved in 2006, it has lowered HPV infection rates in young women by 56%.

So why aren't there more cancer prevention vaccines?

"HPV is clear, because we know it causes cervical cancer. So we can target that," Visvanathan says. "Most cancers have more than one cause."

Scientists are also working on a colon cancer vaccine that teaches the immune system to spot precancerous colon cells and destroy them before they turn into the disease. Vaccines are also in the works to help women at higher risk for breast and ovarian cancers.

What You Can Do

One of the best things you can do right now to lower your odds of getting cancer is to know your risks.

"Learn your family history and then talk to your doctor," Visvanathan says.

Together you can set up a plan that uses the latest prevention and screening techniques.

WebMD Feature Reviewed by Melinda Ratini, DO, MS on January 22, 2016

Sources

SOURCES:

National Cancer Institute: "Cancer Statistics."

American Institute for Cancer Research: "The AICR 2015 Cancer Risk Awareness Survey Report."

Kala Visvanathan, MD, professor of epidemiology and oncology; member of the Cancer Prevention & Control Program, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.

Scott Lippman, MD, professor of medicine; director, Moores Cancer Center at the University of California, San Diego.

Imperiale, Thomas F. The New England Journal of Medicine, April 2014.

Silvestri, Gerard. The New England Journal of Medicine, July 2015.

News release, Medical University of South Carolina.

American Cancer Society: "What tests can detect prostate cancer early?" "Can ovarian cancer be found early?"

News release, Illumina.

MIT Technology Review: "Illumina's Bid to Beat Cancer with DNA Tests."

U.S. Preventive Services Task Force: "Draft Recommendation Statement--Aspirin to Prevent Cardiovascular Disease and Cancer," "Evidence Summary: Aspirin," “Draft Recommendation Statement: Aspirin to Prevent Cardiovascular Disease and Cancer.”

News Release, CDC.

National Cancer Institute: "HPV and Cancer."

Kimura, Takashi. Cancer Prevention Research, December 2012.

PennMedicine: "Breakthrough Science Team Awards."

News release, Johns Hopkins.

American Cancer Society: "What drugs are used to reduce the risk of breast cancer?"

New England Journal of Medicine: “Multitarget Stool DNA Testing for Colorectal-Cancer Screening”

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