What advice do you have for researchers interested in making meaningful contributions to the field of cancer prevention and early detection?
Dream big. Collaborate with people you like. Be happy with making small advances. Don’t lose sight of the big picture. Have fun.
Whilst early detection research has yielded some incredible advances, there is still a long way to go to rule out late diagnosis of cancer… what areas of research give you the most encouragement that we will get there?
Visiting colleagues in low- and middle-income countries, you realise how far we have come. There it is common for cancers not to be diagnosed until they and fungating.
The low-hanging fruit is to educate the public regarding the symptoms of cancer and to empower them to seek help early from their GP. But that will only achieve so much. New technologies enable liquid biopsies (from blood and urine) and breath biopsies to detect signals from cancers. With advances, these non-invasive biopsies will be able to detect smaller and smaller cancers. The potential for screening programmes that will enable most cancers to be detected before they cause symptoms and whilst they can be easily and effectively treated is great. I really hope that such screening will be routine in 30 years’ time.
However, people are rightly concerned about screening leading to overdiagnosis of indolent cancers. My vision is that as we improve technologies to detect more microscopic cancers, so too will we expand our treatment options. Wouldn’t it be great if anyone screening positive could be given a well-tolerated therapeutic vaccine that would help clear any small foci of cancer including those that are too small to see on routine scans?
Are there specific populations that stand to benefit the most from advancements in cancer prevention, and how do you think we can ensure equitable access to these interventions?
There are a small number of people who have a strong genetic predisposition that makes it extremely likely they’ll develop certain types of cancer. We already consider prophylactic surgery for women with BRCA1 and BRCA2 mutations, and biennial screening colonoscopy from a young age in people with Lynch Syndrome. But, as we showed, approximately half of the population born since 1960 will get cancer. So, we would all benefit from prevention.
Society and politicians need to do more to create an environment in which it is easier for people not to smoke, eat healthily, exercise, and avoid air pollution. There are drugs that reduce the risk of some cancers. But they all have some side effects, so the benefits only clearly outweigh the risks in people who are at high risk of cancer. Perhaps the best way to prevent cancer is though detection and treatment of pre-cancer. This has been highly effective for prevention of cervical cancer and could be used to prevent many bowel cancer cases. But unfortunately, most cancers don’t have a clear pre-cancerous state.