The Initiative for Prevention and Early Detection
A single observation that transcends disease type for nearly all cancers is that cancers are far more likely to be cured if detected early, while still localized to the primary site and before spreading. Early detection programs have proven successful for multiple cancers, including breast, colon, lung, and cervix cancer, where surgical removal of screen-detected cancers reduces cancer-specific mortality. By detecting small tumors, screening provides critical insights into the earliest steps of cancer development, which contributed to the development of a highly effective preventive vaccine in the case of cervical cancer. Unfortunately, only 1 in 7 diagnosed cancers in the US are found by a recommended screening test.
Cancer is a complex disease, and similar tumors can exhibit a broad range of behavior. Some cancers are highly aggressive and metastasize early, while others are slow-growing and rarely, if ever, spread. The goal of screening is to detect aggressive cancers that are destined to be lethal before they spread and avoid detecting cancers, precancers, and benign tumors that are unlikely to progress and harm the patient. Current strategies fall short of these goals, with “overdiagnosis” and “over-treatment” of cancers that would not cause harm a common problem.
IPED aims to improve population and individual health by developing, testing, and implementing early detection and prevention strategies that address the limitations of existing approaches and can be applied to cancers where programs do not currently exist. We also aim to address disparities that limit access to screening and preventive services.
These new strategies will help to reduce the cancer burden overall and decrease patient stress, anxiety, and discomfort associated with false positive tests and/or unnecessary treatment.
A pan-cancer registry and research platform for patients at high genetic cancer risk
Germline testing for mutations in cancer susceptibility genes allows for identifying patients at elevated cancer risk. Mutation carriers are often at elevated risk for multiple cancers arising in different sites. Current care delivery models are not optimal for addressing the needs of these high-risk individuals. Many at-risk individuals are not aware of their risk and are not offered genetic testing. Mutation carriers experience fragmented care that is spread across multiple providers and teams, each addressing a single at-risk site. We aim to change the current clinical paradigm and consolidate care for these high-risk patients within a single multidisciplinary group.
At-risk patients will be systematically identified, counseled extensively about their risk, offered genetic testing, carefully monitored, and offered participation in coordinated prevention and early detection services and research trials. The team will use innovative technologies, including online risk assessment tools and chatbots, to help guide patients in genetic testing and risk management decisions and reach patients with limited access to care. The potential impact is enormous, as data clearly demonstrate that even at academic centers, more than 50% of at-risk patients are not identified or receive sub-optimal care. Individuals will also be offered participation in novel research protocols with an initial focus on 1) circulating DNA multi-cancer early detection tests, 2) high dimensional, integrated multi-“omic” wellness monitoring, and 3) novel imaging tests for breast and pancreas cancer.
We look to bring new members into our team to ensure we remain at the forefront of cancer early detection and prevention research.
Immunologic monitoring and interventions to detect and prevent cancer
PARC investigators are already deeply engaged in understanding the host’s immune response to cancer. Our overall strategy includes deep molecular profiling to characterize critical features of the local and systemic immune response and factors that impact this response over time. Ongoing efforts are primarily focused on patients diagnosed with advanced cancer.
Our longer-term goal is to expand this work toward early cancer detection and prevention, where we anticipate the signals will be more challenging to detect. We are piloting new technologies to facilitate this work and collect the requisite biospecimens, including samples from asymptomatic patients with early-stage cancers and patients at high genetic risk. Our high-risk research platform facilitates the biospecimen collection process.
Molecular profiling of pre-malignant and early-stage lesions to identify targets for early detection and prevention
Comprehensive molecular analysis of precancerous change and early-stage cancers provides unique insights into the natural history of cancer development before clinical detection and the timeframe and type of interventions that can be effectively deployed to prevent or detect cancer before symptoms or spread. This work is highly synergistic with our immune-based studies.
Here, we expand our focus to include non-immunologic regulators of tumorigenesis, including molecular changes within the tumor epithelial and stromal compartments and changes in cell composition and structural organization that contribute to the early phases of cancer development.
Over the next several years, we will perform detailed molecular analysis of early cancer lesions, including precursor lesions from patients with ovarian and breast cancer.
Address barriers to participating in cancer screening and prevention to ensure equitable access for all.
Efforts to reduce disparities in cancer screening and prevention are essential for achieving health equity and improving overall population health outcomes. Disparities in cancer screening and prevention in the United States are significant and multifaceted, often influenced by socioeconomic status, race, ethnicity, geographic location, access to healthcare, health insurance coverage, provider bias, and cultural competency.
Addressing these disparities requires a multifaceted approach that includes the engagement of patients, community leaders, and individuals with expertise in care delivery models, behavioral health, and population science. We will work to identify existing barriers to screening participation and receiving care. We plan to develop research collaborations and recruit key personnel to help us address critical gaps.
