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Closer to the goal of early cancer screening

The 6th National Cancer Center Academic Annual Conference was recently held. Reporters learned from the conference that key national research and development program projects and several international cooperation projects are accelerating their layout in this field. At the same time, four national-level cancer screening projects that have been ongoing for more than a decade are also continuously adding new technological elements.

2018-11-22 21:28

　　The 6th National Cancer Center Academic Annual Conference was recently held. Journalists learned at the conference that national key R&D program projects and several international cooperation projects are accelerating their layout in this field. At the same time, four national-level cancer screening projects that have been ongoing for more than a decade are continuously adding new technological elements, relying on new generation tumor omics technology, biotechnology, and big data technology for cancer prevention and control monitoring.

　　Achieving "early detection" is challenging.

　　The earlier the diagnosis, the better the treatment outcomes for cancer patients. "Taking liver cancer as an example, the 5-year survival rate for early-stage patients can reach 50% to 70%, while it drops to 25% to 30% in the middle stage, and only 10% to 15% in the late stage. Unfortunately, the rate of early-stage patients seeking medical attention in China is less than 10%," said Professor Zhang Kang from the University of California, San Diego.

　　"Due to the insidious onset, about 80% of lung cancer and 60% of colorectal cancer patients in China are diagnosed at the middle or late stage," said Professor Wu Ning, director of the PET-CT center at the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences. The 5-year survival rate for lung cancer, the most common cancer in China, is only 15% to 18%, while if early lung cancer receives timely treatment, the 5-year survival rate can exceed 80%. The situation is similar for colorectal cancer.

　　Early diagnosis and treatment not only improve patient prognosis but also have significant economic benefits. Research shows that the treatment costs for early-stage and stage II and above cancer cases differ greatly: the cost for early-stage lung cancer treatment is 22,000 yuan, while for stage II and above it rises to 46,000 yuan; the cost for early-stage esophageal cancer treatment is 14,000 yuan, while for stage II and above it is 47,000 yuan; gastric cancer costs soar from 12,000 yuan to 43,000 yuan.

　　"It is worth noting that existing early screening programs have shortcomings such as a lack of high-level evidence-based medical evidence, insufficient evaluation of screening benefits, and the need to verify the effectiveness of new molecular markers," Wu Ning bluntly stated. "Although studies have shown that low-dose spiral CT can more effectively detect early lung cancer compared to regular chest X-rays, low-dose spiral CT screening has a problem of high false-positive rates. Questions such as which populations need screening and the optimal interval for screening have not been definitively answered. In the field of colorectal cancer, many people are unwilling to undergo colonoscopy due to its invasive nature, although fecal occult blood screening has high compliance, its sensitivity and specificity are low."

　　Optimize screening technologies and programs.

　　"Currently, the Ministry of Science and Technology has deployed the 'Precision Medicine Research' R&D plan, aiming to develop a series of precise application solutions and decision support systems for early screening, molecular typing, personalized treatment, efficacy prediction, and monitoring of major diseases such as cancer," said Tian Baoguo, deputy director of the Department of Social Development of the Ministry of Science and Technology. Another key R&D plan, 'Research on the Prevention and Control of Major Chronic Non-Communicable Diseases,' has also initiated research on liquid biopsy, optimization of cancer screening programs, and new oncolytic virus and cancer immunotherapy technologies.

　　"In the field of early cancer screening, liquid biopsy is very popular, and finding ideal early diagnostic markers is a global challenge that troubles clinical doctors," said Zhang Kang, who has long been dedicated to research in this field. Finding DNA methylation sites for different cancers is crucial for determining early diagnostic markers. Existing studies have confirmed that DNA methylation markers can be used for minimally invasive tissue biopsies of common cancers, and DNA methylation profiles can identify the primary site of metastatic cancers.

　　It is understood that optimizing existing screening programs is also one of the research objectives of the '13th Five-Year Plan' national key R&D special projects. For example, ongoing research on lung cancer screening and intervention technologies and programs, randomized controlled trials and prospective cohort studies of multi-center screening for lung cancer and colorectal cancer, and the integration and application system construction research of standardized early diagnosis and treatment key technologies for malignant tumors are all based on this objective.

　　The randomized controlled study on lung cancer and colorectal cancer screening led by the team of He Jie, director of the National Cancer Center and president of the Cancer Hospital of the Chinese Academy of Medical Sciences, is currently the largest randomized controlled study in China. This study will first be conducted in Hunan, Jiangsu, Gansu, and Zhejiang in October this year, with plans to complete subject enrollment within three years. Wu Ning, one of the research leaders, detailed the five specific goals of the project: updating the definition standards for high-risk populations of lung cancer in China; evaluating the screening effects of different screening intervals for low-dose spiral CT; comparing the screening effects of single colonoscopy versus annual fecal occult blood tests for colorectal cancer; exploring the application value of molecular markers in lung cancer and colorectal cancer screening; and establishing screening technology programs suitable for the Chinese population and national conditions. "We will initially formulate guidelines for lung cancer and colorectal cancer screening within this year. The project also collaborates with the National Cancer Institute of the United States and has invited experts from the International Lung Cancer Early Action Program as overseas consultants."

　　What is exciting is that the research team plans to leverage new technologies such as radiomics, big data, and internet platforms to compare the effects of different screening programs and improve screening efficiency. According to Wu Ning, for example, applying new radiomics technology to lung cancer screening, combining computer analysis technology of imaging features, clinical and molecular marker information to construct risk prediction models; using 'Internet + new technology' to complete behavioral interventions and health management for high-risk populations of lung cancer, exploring the optimal surgical intervention timing and the best surgical methods for early lung cancer; and developing and validating the effectiveness of imaging artificial intelligence endoscopy-assisted early diagnosis systems through big data platforms.

　　More investment is needed in screening.

　　From 2005 to 2012, the country successively launched four early diagnosis and treatment projects for cancer, targeting rural areas, cities, the Huai River basin, and cervical and breast cancer in rural women, with the screening scope continuously expanding and initial results emerging. Zhang Yong, deputy director of the Disease Control Bureau of the National Health Commission, introduced that by 2017, the rural cancer early diagnosis and treatment project launched in 2005 had established 252 screening points, including 188 for upper gastrointestinal cancer, 33 for colorectal cancer, 13 for liver cancer, 7 for nasopharyngeal cancer, and 11 for lung cancer. The suitable technology for early diagnosis and treatment of upper gastrointestinal cancer is being widely promoted, with significant results: a basic detection rate of 2.05%, an early diagnosis rate of 81.99%, and a treatment rate of 89.89%.

　　According to Chen Wanqing, director of the Cancer Early Diagnosis and Treatment Office of the National Cancer Center and the Cancer Hospital of the Chinese Academy of Medical Sciences, the urban cancer early diagnosis and treatment project launched in 2012 has expanded to 20 provinces this year, targeting lung cancer, breast cancer, colorectal cancer, upper gastrointestinal cancer, and liver cancer, completing cancer risk assessments for 3 million people. The early diagnosis and treatment project launched in 2007 in the Huai River basin has conducted comprehensive prevention and control for esophageal cancer, gastric cancer, and liver cancer, covering 32 counties. In addition, local governments are also actively participating, such as in Beijing, Shanghai, and Haining, Zhejiang, where government funding is used to carry out cancer screening projects.

　　Chen Wanqing stated that the next step for the urban project is to address the follow-up issue, and efforts are being made to improve the follow-up platform and data reporting information platform. At the same time, there are plans to establish a supporting biobank to leave valuable resources for disease research. "During the screening process, the national team is also conducting technical training in areas such as endoscopy, pathology, and testing, bringing advanced technology and experience to grassroots levels, with the ultimate goal of improving the diagnostic and treatment capabilities of grassroots healthcare providers."

　　Although the cancer incidence rate in our country is lower than the world average, the large population base results in a heavy disease burden. Screening work still requires more attention and investment from the state. Chen Wanqing pointed out that currently, screening is not reimbursed by health insurance and is mostly carried out in the form of public welfare projects, which cannot ensure the sustainability of the work. It is hoped that there will be breakthroughs in policy.

Source: Health News

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Health Report,Cancer