Proteins in blood could provide early cancer warning 'by more than seven years'

223 points7
zero-sharp6 hours ago

The video makes the case that the early detection of cancers isn't always a good thing. See 6:30 and 7:00 for specific references to scientific studies. Some cancers (thyroid and skin) can be detected at a much higher rate, but the associated mortality remains constant (we are detecting benign cancers).

To be clear: obviously this is dependent on the cancer. Really my point is that we need studies that show that the screening improves outcomes.

brnt6 hours ago

This is how Dutch public healthcare motivates its general aversion to medical testing, as many a foreigner finds surprising and incongruent to the generally OK level of healthcare outcomes provided by the system. You can test and detect, but the error margins are often large (so many false positives and/or false negatives), would generate way too much workload to follow up and thereby cost time and money for better leads. Plus, as you say, knowing early doesn't always or even often mean you can actually change the outcomes.

Now, this is what they say... I have tried to find the actual literature they use to motivate their protocols, and apart from occasionally, have not been able to find that evidence. I'd love to have a resource that demonstrates these sorts of things.

mort965 hours ago

It's not just about keeping costs down, but also about increasing quality of life. If you detect a benign cancer in someone, and they then go on to receive chemotherapy, you've massively decreased that person's quality of life for a significant period with no upside.

iknowstuff4 hours ago

A benign tumor doesn’t spread and doesn’t warrant chemotherapy I believe? And if it’s actually cancer than I don’t understand how you would not want it gone as soon as possible to avoid metastasis?

canes1234564 hours ago
Fire-Dragon-DoL4 hours ago
dukeofdoom3 hours ago
dukeofdoom3 hours ago

My nurse friend said she only discharged 2 people after chemo in about 7 years of service. People have a misguided notion about the odds of survinvg a deadly cancer. They also found the diagnostic procedures for breast cancer was causing the cancer.

arcticbull59 minutes ago

> They also found the diagnostic procedures for breast cancer was causing the cancer.

I assume you're referring to mammograms. You do get exposed to a significant amount of ionizing radiation in mammography, about 0.4mSv, about 40% of the EPA's annual radiation limit for a member of the public.

That's one of the very good reasons why guidance is women wait until age 45 to get annual screenings and switch to biennial at 55.

At that point the rewards outweigh the risks.

whimsicalism3 hours ago

the scenario you're describing would never happen, you don't prescribe chemo based on a blood test of protein markers

fidotron5 hours ago

I am not sure that is unique to the Dutch, it is the line I have heard in several countries.

Heavy agreement on your last part - if there is substantial evidence to back this up I would like to see it.

As it stands I personally prefer the idea of constant mass testing in order that we learn as much as possible as quickly as possible, including improving the tests from the resulting feedback loop.

brnt5 hours ago

When I see the prices of some of that testing, I know that that cannot be the reason, and indeed, establishing personal baselines by regular testing can only be helpful. The aversion to it grounded on taking some average patient, I am convinced.

I really wish there was more transparency, because test aversion is exactly the same protocol you'd invent if you were trying to save money. I want to be able to see which of the two we're dealing with.

radicalbyte4 hours ago
pessimizer3 hours ago
leto_ii5 hours ago

> would generate way too much workload to follow up and thereby cost time and money for better leads

Having lived a decade in NL, my impression was that keeping costs down is the top priority. Unless you have a serious chronic condition or were in an accident, good luck getting somebody to take a look at you.

(irl, after a while you learn to push, exaggerate symptoms etc. or just go back home to get tests and treatment).

brnt5 hours ago

Yep, the loudest people get the most help. There's no good solution for that other than to become a bitchy 'client'. It's unfortunate that despite the promises, you still have to 'use it correctly' if you want those good outcomes as a patient.

epistasis6 hours ago

This is not about early detection in general, but rather a specific test of dubious utility, specifically full-body MRI, which often leads to tons of follow-on tests and invasive procedures that may have zero benefit.

For a test with high enough specificity and sensitivity for early detection, it's likely that it would be quickly adopted, and then studied to show that it actually improves outcomes without undue cost (not merely dollar cost but also health cost) to people in terms of treatment and its side effects.

zero-sharp6 hours ago

They specifically talk about using the fully body MRI for the purpose of detecting cancers. I'm not sure how you missed that. You literally had to watch 10 seconds of the clip.

It's interesting because they explicitly talk about follow up testing (@2:10) which is to say that multiple methods are used if the MRI indicates a problem. So yes, the initial MRI may produce a misdiagnosis and that is a defect of the test. But the commentary in the video obviously suggests that additional testing for early detection is done. That's partly a problem as you pointed out, but then it clearly also indicates the scope of the conversation is more broad.

ceejayoz6 hours ago

They didn't miss it at all.

You've misunderstood the comment's point, which is "just because prospective full-body MRI is bad doesn't mean all diagnostics are".

zero-sharp6 hours ago
Spooky235 hours ago

It’s a risk assessment like any other. Probability/impact.

My wife ultimately lost her life to metastatic melanoma, which was believed to be in remission. Had there been a way to detect the proteins associated with the mets that developed ahead of symptoms, the odds are she we be alive and thriving.

In other scenarios, say most prostate cancers, early knowledge has low or negative benefits.

Wowfunhappy6 hours ago

I can't watch a video at work but I have seen this argument before.

I just find it fundamentally hard to believe that having more data is a bad thing. What we choose to do with that data is a different story, and the actual source of these bad outcomes.

cityofdelusion4 hours ago

Data isn’t necessarily good because medicine and biology are messy and inaccurate. I just went through a scare myself with elevated markers on a typical blood panel. Lots of fuss, anxiety, and cost for zero gain. At the end, I learned that human bodies vary so much that we’re was just no way to know upfront if a finding was a concern or if my body was just on a tail end of a bell curve. Turns out, if you fully scan people, we all have lumps, bumps, and various anomalies. How much do you spend “treating” and investigating this stuff? I wasted my own time and precious time with doctors for nothing, increasing costs to society as a whole.

That kind of data, the costs, we have tons of. That’s why pretty much every medical association regardless of culture has limits on recommended screenings.

canes1234564 hours ago

If your are choosing not to do anything based on the data, gathering the data is objectively a net negative. There are financial costs related to taking the tests as well as emotion costs related to false positives and even with deciding not to act with possibly true positives.

There needs to be a net positive action on a subset of the cases to outweigh the costs of gathering and sharing the data.

mort965 hours ago

Are you prepared to make the decision, "I have cancer but statistically it has a relatively low likelihood of killing me before I would die of other causes, so I won't do anything about it"?

Are most people?

nick__m3 hours ago

There is a spectrum between invasive treatment and not doing anything.

You could have a scan 3 months later and if there is no progression the doctor schedule a scan 6 months later and then 12 months... If there is a progression he schedule an appointmentwith an oncologist.

thimkerbell4 hours ago

It might provide enough impetus for getting you to avoid sugar and processed meats though.

mort961 hour ago

Has avoiding those things been shown to stop existing cancer? I thought those foods just increased the chance of getting cancer in the first place. But I'm totally ignorant here, it sounds plausible that some carcinogens work by worsening cancer which would otherwise have been benign, I just haven't heard about that

brnt3 hours ago

Most data is crap, and you generally can't tell where the needle in the haystack is.

Having more consistency between doctors would already be a change needed to actually use data. You will find it matters more than you'd like. We can't all have the best doctors, but we could use data to level the outcomes.

siliconc0w5 hours ago

The problem with this is that they haven't done the long term studies (which they admit). They also don't consider that once these are cheap and regular enough you get the change over time which should get you a lot less false in positives.

Fire-Dragon-DoL4 hours ago

I don't understand how we don't consider benign cancers false positives? Acting against those cause serious damage to the body for no gain

mensetmanusman4 hours ago

The more data the better though. We need to train the models to understand what is worth doing over time.

zjp1 hour ago

It seems like every other day there's a new breakthrough. I watched my paternal grandmother succumb to lung cancer when I was 7. She was my favorite person on Earth at the time and watching her go was devastating. It gives me so much hope to watch the category "treatable and preventable cancers" expand over time.

tombert7 hours ago

This is cool, though I do wonder if the tests will be good enough to differentiate between “cancers that will be lethal in the next seven years” and “cancers that are technically there but will take so long to kill you that something else will beforehand anyway”.

snarf2141 minutes ago

I think we also should be looking more at change over time, not just results as a distinct value. A lot of these values have ranges and error margins but looking at changes over time can be quite informative, especially for cases where your body takes care of any potential issues. I think there are a lot of diseases we could treat in cheaper ways with improved QoL if detected early. Too often we try to fix a crashed car instead of checking the brakes once a year.

two_handfuls6 hours ago

Also “cancers that your body takes care of on its own”

Jedd6 hours ago

> .. though I do wonder if the tests will be good enough ..

Sure .. but ..

a) knowing that cancer is there, but you may get hit by a bus before it kills you, can still inform some medical care decisions

b) the 12 authors of that paper have probably put a bit of thought into the usefulness and efficacy of this kind of very early detection, and concluded it was worth reporting on their research

tombert6 hours ago

I don't dispute either of your points. It was a genuine mere curiosity on my end, not a rhetorical "gotcha!".

I've just heard that for stuff like prostate cancer, a diagnosis can be misleading, because sometimes it can take 20+ years to kill you. If you get it when you're 70, it's probably not worth going through surgery or chemo because you'll likely die of heart disease or another cancer before that anyway.

thfuran53 minutes ago

That sort of issue crops up all the time in medicine. Screening for conditions will always produce some false positives, and the ramifications can vary from scaring the shit out of someone for a few weeks before you determine they don't have cancer after all to them dying as a result of further testing/treatment that wouldn't have happened without that initial screening. That and the potential adverse outcomes of the screening itself (and its costs) always has to be weighed against the value of the true positives.

EspadaV97 hours ago

I donated some blood a couple of years back and they came back saying there were proteins present. Having follow up tests at the moment, but none of the other markers are present that would normally be there if there was cancer. Still waiting to get further follow up tests, but no one seems to be worried enough to rush things along.

HappyJoy6 hours ago

Where did you donate? The only feedback I usually get is a certificate every 8 trips.

Symmetry5 hours ago

I donate platelets with the Red Cross every month and I've got an app where they give me the blood pressure and hemoglobin level, and which used to tell me if I had Covid-19 antibodies before everybody did via vaccine or infection.

Before I donate I have to sign something that says, among other things "We're going to test your blood for AIDS and tell you if you have it, so if you don't want to know don't donate". I hadn't thought about the other things they test for but of course they don't want blood with Leukemia in it either.

frontman19884 hours ago

Why wouldn't someone not want to know they have AIDS? Given the disease is not a death sentence anymore and the earlier you know better your chances of survival. The warning probably deters a lot of people who could have otherwise been saved by timely treatment.

krisoft5 hours ago

> Still waiting to get further follow up tests,

I hope all will turn out good for you, and wishing you the best of luck.

> they came back saying there were proteins present.

I think probably there is a bit of a Chinese whisper kind of misunderstanding here. Your blood will contain proteins. It must. Everyone's blood does. For example hemoglobin is a type of protein which makes your red blood cells able to carry oxygen.

What they probably told you is that they found the wrong quantity or the wrong kind of proteins.

Wishing you the best!

dogtorwoof7 hours ago

Which proteins?

unsupp0rted7 hours ago

Oh boy, I hope one of those markers is for Pancreatic. That's the/a silent killer.

adamors7 hours ago

It isn't unfortunately

> Little evidence for protein associations was observed in these data for cancers of the pancreas, thyroid, lip and oral cavity, or melanoma after correcting for multiple tests

From the study

anotherpaulg2 hours ago

The Galleri blood test claims to pick up pancreatic cancer early. Which I agree, is one which would be great to find early.

> More aggressive cancers, such as pancreatic cancer, tend to release more cell-free DNA into the bloodstream at early stages and are more likely to be detected by the Galleri test.

andrewmutz2 hours ago

You can get these sorts of tests already. Last year I used this company's product and it was a smooth experience:

ak2172 hours ago

Grail's test is a cfDNA test. It detects DNA fragments in blood that are indicative of specific methylation patterns that are in turn indicative of possible cancerous growth. While a good approach, there are continued sensitivity challenges with cfDNA tests.

This research is a high quality longitudinal retrospective study of protein cancer biomarkers, not cfDNA. Protein biomarkers are a complementary signal that has the potential to boost the sensitivity and precision of these tests, especially when the signals are combined together.

ekanes7 hours ago

Compared to most cancer-related findings, this seems clear, simple and easy to replicate / disprove. Hopefully quickly, as it'd be a huge win for humanity.

macawfish5 hours ago

So you can get seven years more of nocebo effect, anxiety, stress and worry?

kazinator6 hours ago

Say we find some proteins in the blood that hint at cancer 7 years away. How is that actionable, and will it make a difference?

How low is the false positive rate?

tomoyoirl5 hours ago

A key benefit is that it might be able to perform follow up screenings that make sense for that type of cancer, rather than expecting absolutely everyone to take all the tests ever at the same rate, at significant inconvenience and expense.

njarboe4 hours ago

Does this mean we can get the 5 year cancer survival rate to 100%?

stuff4ben7 hours ago

How long before that becomes a mandatory test to get health insurance? Or somehow the data is bought by insurers who then use it to jack up the rates for those who will eventually get cancer. God I hate the US healthcare system!

DennisP7 hours ago

Insurance companies haven't been allowed to deny coverage for preexisting conditions since 2014, due to Obamacare. They can't even raise premiums. The only variables are age, sex, smoking, and where you live.

This applies both to employer plans and the ACA plans on, where you can get a quote without giving them any health data at all.

Koala_ice6 hours ago

But, you can get absolutely destroyed on life insurance and, just as critically, long-term care insurance. Genetic discrimination is perfectly legal in those domains.

qclibre226 hours ago

You can be denied some kinds of health insurance :

DennisP6 hours ago

Only if you miss the open enrollment period, and even then, you still have Medicare regardless.

It seems reasonable not to let people over 65 wait until they have cancer before purchasing supplemental insurance.

bonton897 hours ago

Is there anything stopping an employer from pretesting you to avoid adding a potentially expensive employee to their roster?

zamadatix6 hours ago

Generally it runs aground with things like the ADA because you can't just "accidentally" find out the person has a covered condition, you're just never allowed to ask or require it be told. Exceptions for something like an airline pilot on matters related to the job like sight notwithstanding. This is why you always see things like "can lift up to 40 lbs" type requirements instead.

Tenoke7 hours ago

This is such an odd take for me. If the test works and insurance makes the test mandatory (which seems pretty unlikely, what other comparable tests are mandatory?) then more people will get an early diagnosis, and less people will die! The incentives are aligned, the system works!

anonzzzies7 hours ago

Hope we found a lot of these type of things. 7 years is a big win.

blindriver7 hours ago

How does this differ from the GRAIL blood tests?

epistasis6 hours ago

Grail is looking at DNA methylation sites, this is looking at proteins.

GRAIL is available today, this test will need to be validated and commercialized

forinti7 hours ago

And how are you going to find the source?

_xerces_7 hours ago

You're right, these proteins could be associated with conditions that can later lead to mutations that cause cells to become cancerous, but they don't point to a specific cancer. Interestingly they hint at modifying the proteins to reduce the likelihood of getting something, but that could be risk in itself. A lifestyle change could be helpful in some cases.

I suppose if you have enough of these markers they could schedule routine testing earlier than usual, say 40 instead of 45 for colonoscopy, mammogram, etc.

nerdjon7 hours ago

Am I crazy in thinking that we heard about this several years ago? Is this just a continuation of that study or am I mis-remembering/my timeline way off?

This is really exciting though, especially when mixed with other cancer treatments the ability to catch and deal with this is fascinating. How long until a theoretical, "Oh we detected some cancer cells in your regular blood work, here is a shot to deal with it" like we treat many other things.

nextos1 hour ago

You've been hearing about ctDNA. Which is really interesting and predictive.

But it is hard to tune so that it is practical enough to be deployed in routine healthcare. Efforts so far have not been sensitive or specific enough.

graywh7 hours ago

we've been searching for blood biomarkers for cancer for decades -- I'm sure we've found several by now

jemmyw7 hours ago

You're not crazy, I recall a similar story too.

yieldcrv6 hours ago

with the addition of an mRNA treatment approach I'm willing to think 8 years off from at least a dozen cancers that currently only get detected after they've metastasized.

m3kw94 hours ago

You detect it and then what? You get depressed and there is no treatment for something that early. Better to test for obvious signs every year based on susceptiblility.

Maybe the depression and stress can make you more sick, let alone the effect on your family should you announce it

goda904 hours ago

Improve your health with better diet, exercise, sleep. Find and reduce carcinogen exposures. Give your immune system a chance to nip it in the bud before you even need treatment.