A new blood test for cancer

Cancer cells can float in a person’s blood. But finding them, in the past, used to be like “looking for a needle in a haystack”.

But new smart technology promises to detect these cancer cells easily and much early before a person develops symptoms. Detection of cancer cells at an early stage may be helpful for some patients.

A recently published study in the journal “Annals of Oncology” reports exciting results.

A Californian company called Grail has developed a blood test which seems to have a high degree of accuracy for detection of multiple cancers.

Times newspaper reports that “The NHS will begin a pilot scheme of the test with 140,000 people this year. If that is successful it will be used for millions of patients by 2025”

A word of caution though.

Just because something could be diagnosed early does not always mean that it is a good thing.

The most important thing is whether the early diagnosis can lead to better cure rates and a better quality of life.

If a test detects a cancer early but has no meaningful effect on quantity or quality of life, then it is not a good thing.

For example. Up to 80% of men have prostate cancer which can now be detected by a simple blood test called PSA. There is a good reason why we are NOT using the simple PSA test in every 80 year old.

Most 80 year old men die WITH prostate cancer rather than DUE to prostate cancer.

So why diagnose a cancer that is not causing symptoms if it is not going to make person live longer !

REFERENCES

Times. New blood test, created by Californian company Grail, detects cancers among over-50s. Kat Lay, Health Editor. Friday June 25 2021, 12.01am, The Times.

Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. E A Klein et al. Ann Oncol. 2021.

Guardian. Blood test that finds 50 types of cancer is accurate enough to be rolled out.
Diagnostic tool being piloted by NHS England shows ‘impressive results’ in spotting tumours in early stages
Blood tests’ development could help the NHS further.
Nadeem Badshah and agency
Fri 25 Jun 2021 06.00 BST

Daily Mail. NHS trials ‘holy grail’ blood test that can spot 50 kinds of cancer: Ground-breaking check that can accurately detect two thirds of deadly cancers early in healthy people could save thousands of lives a year. By Victoria Allen Science Correspondent For The Daily Mail
00:00, 25 Jun 2021 , updated 10:04, 25 Jun 2021

NHS. Should I have a PSA test?

Disclaimer: Please note- This blog is NOT medical advice. This blog is NOT a expert medical opinion on various topics. This blog is purely for information only and do check the sources where cited. Please DO consult your own doctor to discuss concerns and options relevant to you. The views expressed in this blog represent the author’s views held at the time of drafting the blog and may change overtime, particularly when new evidence comes to light. The blog is not previewed, commissioned or otherwise endorsed by any organisation that the author is associated with. The views expressed in this blog are not, in way whatsoever, intended to be a substitute for professional advice.

Is the new variant of Coronavirus more dangerous?

Yes and No

The new mutant is more dangerous because it is more easily transmissible from person to person. The new variant is now spreading very rapidly in London and South East of England.

But, so far, the new variant has NOT been found to be more deadly than the original version. The new variant does NOT seem to have substantially increased the risk of hospitalisation and death anymore than the original version of coronavirus.

Emergence of this new mutant (called variant VUI-202012/01 fall) is a certainly a worrying development in this pandemic.

The mutations has made the new strain 70 per cent more transmissible but scientists do not expect these mutations to reduce the effectiveness of vaccines.

Tests are being carried out to confirm that the existing vaccines would still have a high degree of protective affect.

It is an evolving area and we have to hope that the new variant doesn’t make things worse than they are now !

Covid-19: New coronavirus variant is identified in UK. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4857 (Published 16 December 2020)
Cite this as: BMJ 2020;371:m4857

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Does intensive follow benefit Bowel cancer patients?

Photo by rawpixel.com on Pexels.com

The old adage “prevention is better than cure” is mostly true with regards to cancer if you can do it.

If you can’t prevent it , at least catch it early, has been the prime motive behind screening tests for breast, cervical, bowel, lung and prostate cancers. (“early is better”). Cancers that are detected at an early stage can offer a better chance of curative treatment.

So one might logically expect that intensive monitoring and early diagnosis of a cancer relapse or a secondary cancer after initial treatment can be immensely helpful.

But the evidence for intensive hospital follow-up visits and investigations is weak for most cancers except for some cancers such as Testicular Cancers which are highly curable.

Intensive monitoring after bowel cancer treatment can detect treatable cancers. To confirm the benefit of early detection of relapse by intensive monitoring , a trial was conducted comparing intensive follow up versus routine follow up ( in France and Belgium).

Data presented at ESMO ( European Society of Medical Oncology) shows that the intensive follow with scans can detect cancer recurrences which can be treated by further surgery. But unfortunately the intensive follow up did NOT lead to longer life expectancy.

The results might be counterintuitive but after an average follow up more than six years, this trial demonstrates that intensive follow is NOT always best. Scans might be done for psychological reassurance but they could end up causing significant anxiety.

When there are resource constraints (e.g low economic countries) , one has to be careful about frequents routine scans for those without symptoms.

During COVID-19, even in rich countries such as UK where there might be huge waiting lists, one has to consider prioritising scans for those who need most.

References

1. ESMO Daily reporter: INTENSIVE FOLLOW-UP INCREASES FREQUENCY OF CURATIVE INTENT SECONDARY SURGERY IN COLORECTAL CANCER.

2. DRE is useless for follow up of prostate cancer patients. https://www.bmj.com/rapid-response/2011/11/03/dre-useless-follow-prostate-cancer-patients

3. Cancer patients follow up and a new role for GPs. https://www.bmj.com/rapid-response/2011/11/03/cancer-patients-follow-and-new-role-gps

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Once a week chemotherapy is not superior to Chemotherapy given once every 3-weeks

Advanced ovarian cancer is treated by chemotherapy. A pre ious study of Japanese ovarian cancer patients RT showed significantly increased survival in those treated with dose-dense weekly paclitaxel compared to the standard three-weekly schedule.

Data from an international trial called ICON8 was presented at the ESMO Virtual Congress 2020, this week.

The final analysis of ICON8 “provides conclusive evidence that although weekly dose-dense chemotherapy can be successfully administered as first-line treatment for ovarian cancer, it has no survival advantage over the standard chemotherapy given once every 3 weeks.

ICON8: Overall survival results in a GCIG phase III randomised controlled trial of weekly dose-dense chemotherapy in first line epithelial ovarian, fallopian tube or primary peritoneal carcinoma treatment. Citation. Annals of Oncology (2020) 31 (suppl_4): S551-S589. 10.1016/annonc/annonc276

ESMO Daily Reporter: OVARIAN CANCER: FIRST-LINE DOSE-DENSE CHEMOTHERAPY IS NOT SUPERIOR TO STANDARD 3-WEEKLY CHEMOTHERAPY.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Cancer and COVID-19

Cancer patients, as expected, did badly during the 1st wave of the COVID-19 pandemic

Data presented at ESMO ( European Society of Medical Oncology) shows that Cancers had – higher rates of Hospitalisation, higher risk of Complications and increased risk of Death.

Elderly cancer patients on the whole did very badly but surprisingly cancer patients under age of 50 did far worse than their peers without cancer.

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of drafting the blog and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.

Hope and incurable Cancer: does hope torment or does it help to cope?

A diagnosis of incurable and advanced cancer is often a massive shock to everyone.

Should we ask them to face reality , accept death and extinguish all hope.

Or should we be offering hope of living a bit longer with treatments while being honest with prognosis.

Hope can be tormenting to some.

Hope can be comforting to some.

What are you views?

Contribute your views at online rapid response @BMJ journal

Don’t torment me with hope. BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3016 (Published 09 September 2020)Cite this as: BMJ 2020;370:m3016

In defence of Hope: https://www.bmj.com/content/370/bmj.m3016/rr-3

Is weight loss a sign of cancer?

If you have been dieting and exercising to shed excess weight, then you can celebrate your success in achieving your goal.

But some poorly lose weight unintentionally . This type of weight loss that occurs without intention might be of concern in some people.

A recent article in BMJ advocates screening for cancer in some patients if they have weight loss and other symptoms in their chest and abdomen.

Male smokers over the age of 50 are one of the high risk groups !

Don’t ignore weight loss !

References

Prioritising primary care patients with unexpected weight loss for cancer investigation: diagnostic accuracy study

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2651 (Published 13 August 2020)

Cite this as: BMJ 2020;370:m2651

Disclaimer: Please note- This blog is NOT medical advice. This blog is purely for information only and do check the the sources where cited. Please consult your own doctor to discuss concerns and options relevant to you.

The views expressed in this blog represent the author’s views held at the time of publication and is likely to change overtime, particularly when new evidence comes to light. The blog is not necessarily endorsed by any organisation the author is associated with and views are not substitute for professional advice.