Options for early detection of cancer

When we talk longevity, we must address the basics before discussing sophisticated methods and medications to promote longer lives. It is imperative to adopt early detection strategies of the 4 major killers of humans today- heart attacks, strokes, dementia and cancers.

Early detection of cancers has seen major strides over the last decade with more data emerging on certain blood tests like cell free cancer DNA, in addition to certain imaging modalities like whole body MRIs and low dose radiation CT scans, and beyond that genetic testing for high risk individuals.

Adopting early screening modalities is crucial to master in the era of information overload as it could be a dual edge sword, where it could lead to over diagnosis, which in turn can cause unnecessary health anxiety and unnecessary interventions. It is important to always remember that the human body is designed to defend itself, especially if healthy otherwise, metabolically fit and free of significant inflammatory conditions it can and should eliminate or stabilize certain cancers if they are smaller than a certain size. Some of the new testing modalities are capable of detecting cancers at the stages where the body is still in a window where it could handle it. Cancer screening should be done carefully, under strict supervision and knowledge, putting all variables in context.

In this blog we will explore different cancer screening modalities for different forms of cancer.

Whole Body MRIs:

Whole body MRIs have been adopted by many health care professional as a tool to detect tumors in very early stages. It is estimated that out of those screened with a whole body MRI, 1.5% of them where found to have detectable cancers, and they were in the subclinical stages and this in turn lead to life saving measures.

A negative whole body MRI is somewhat reassuring and although data is not robust, but MRIs missed only 2% of solid tumors (False negative value). This rate can be much higher with high risk individuals who have certain mutations that lead to cancer development.

Drawbacks of whole body MRIs are numerous. They are expensive, and are not capable of detecting blood cancers like Leukemias, and can not detect very small tumors.

Cell free DNA blood tests:

This modality of cancer screening is gaining more attention, It is a fairly new method of detection . It detects DNA fragments of cancer cells that could be small enough for an MRI to detect.

A cell free DNA cancer detection test is capable of detecting different forms of cancers, but not all of them. For example, as of now, they are not capable of detecting cancers like thyroid cancer and have a very poor yield when it comes to cancers like kidney and prostate cancers.

A positive test should always be followed by a confirmatory imaging study to further determine site and size. But sometimes a positive test can indicate a very small cancer clump, that the body is still able to neutralize naturally, which in turn leads to over diagnosis and significant health anxiety. 

Genetic testing:

Certain gene mutations can help detect cancers early, especially in the presence of a strong family history of certain cancers. These should be done selectively, in individuals with a personal history of cancer, or a stong family history of cancer. And example is a rare genetic disorder called Li-Fraumeni syndrome and BRCA1/2 that leads to breast cancer. This is not a widely use method as a large majority of cancers are a result of environmental exposure, dietary habits, life style rather than genetic disorders.

Traditional Medicines approach to cancer:

Traditional medicine recommends screening for certain common cancers, mainly colon cancer, breast cancer, prostate cancer and lung cancer. Below is an overview of the current medical recommendations for these cancers.

Breast cancer: I will dedicated a separate blog that talks about modalities for breast cancer screening, but in general terms there are now 4 generally available modalities: Mammograms, Ultrasounds, MRIs and Thermography. They are have pros and cons, and the modality should be based on different variables, including breast tissue density, age and risk factors. In todays medical world, the first line of screening is always a mammogram.

Colon cancer:

Colon cancer is one of the most common cancers that is on the rise over the last few decades, it is important to consider a form of screening at least at the age of 45 even younger in certain high risk individuals.

Colonoscopy remains the gold standard with the highest detection rate, but the superiority of colonoscopies comes from the ability to detect precancerous lesions and remove them during the procedure, that is lacking in all other modalities of screening.

Cologuard is a stool DNA analysis that is very sensitive in detecting cancer, but not very sensitive in detecting precancerous lesions. It is recommended to repeat cologaurd every three years if negative, and if  positive should be followed by a colonoscopy.

Another upcoming option is a blood cell free DNA test, very similar to what I discussed above. It is less sensitive than both the cologuard and the colonoscopy, but because many people do not get screening for colon cancer due to the inconvenience of colonoscopies or stool tests, this can be a great option to help reduce incidence of advanced colon cancers.

Prostate cancer: This area remains controversial, as prostate cancer for the most part is a very slow growing tumor with a few exceptions. Rectal examination is a poorly sensitive method, but when coupled with a PSA level, it could be helpful in early detection. False positive results can lead to MRIs and possibly biopsies, that could lead to complications, thats why a lot of people differ from screening.

Lung cancer:

Recently the medical society started recommending low dose CT scan of the lung for individuals who are older than 50 years of age and were smokers, and that has shown to be superior to MRIs in detecting lung nodules. Many lung cancer cases occur in people younger than 50 or have never smoked, so it is reasonable to consider lung cancer screening even if a person does not satisfy the above criteria.

In My opinion, the we will see massive strides in the area of cancer detection, and Cell free DNA blood tests will continue to improve in sensitivity which I think will result in adopting them as gold standards for screening in the future.

What is more important than screening is prevention. I am a firm believer than metabolic dysfunction could be the root cause of developing a lot of cancers, and addressing it early on will inevitably reduce the incidence of cancer occurrence and deaths.