Page 4 Early cancer detection: challenges for implementation Prof Ian Cree CanTech Limited Detection of cancers at an early stage benefits patients, who have improved chance of survival, and healthcare systems, which have fewer costs to bear as a result. However, early cancer detection is not easy, despite the success of screening programmes for common cancer types. In the UK, current screening programmes for breast cancer (mammography), colorectal cancer (FIT), and cervical cancer (HPV) are successful, but have issues of coverage which remains just over 70% for breast and cervical cancer screening, but only 60% for colorectal cancer screening. There is interest in new programmes for lung and prostate cancers, but these have issues of cost effectiveness which are hard to overcome. A general blood test that would detect all (or even most) cancers at a stage when they are limited in size would be game-changing (1,2), but despite some progress, this remains a matter for research.While it may be feasible to develop a high sensitivity general test for cancer, using multiple biomarkers (2,3), there will be need to fit these into existing diagnostic pathways without over-stressing the existing service by potential over-diagnosis (4). 1. Cree IA. Improved blood tests for cancer screening: general or specific? BMC Cancer. 2011 Nov 30;11:499. PMID: 22128772 2. Uttley L,Whiteman BL,Woods HB, Harnan S, Philips ST, Cree IA; Early Cancer Detection Consortium. Building the Evidence Base of Blood-Based Biomarkers for Early Detection of Cancer:A Rapid Systematic Mapping Review. EBioMedicine. 2016 Aug;10:164-73. PMID: 27426280 3. Cree IA, Uttley L, Buckley Woods H, Kikuchi H, Reiman A, Harnan S,Whiteman BL, Philips ST, Messenger M, Cox A,Teare D, Sheils O, Shaw J; UK Early Cancer Detection Consortium.The evidence base for circulating tumour DNA blood-based biomarkers for the early detection of cancer: a systematic mapping review. BMC Cancer. 2017 Oct 23;17(1):697. PMID: 29061138 4.Yadav K, Cree I, Field A,Vielh P, Mehrotra R. Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries. JCO Glob Oncol. 2022 PMID: 35213215 Ian Cree MBChB, PhD, FRCPath Ian Cree is a pathologist, currently working as a consultant to the medical diagnostics industry. He is recently retired from his post as an international civil servant, based at the International Agency for Research on Cancer (IARC) in Lyon where he lead the WHO Classification of Tumours, responsible for the ‘WHO Blue Books’ and the Evidence Synthesis and Classification branch, responsible for the IARC Monographs and the IARC Handbooks. He is an Honorary Professor of Pathology at the Institute of Ophthalmology, part of University College London; and at the University of Coventry. He has previously held posts as the foundation Yvonne Carter Professor of Pathology at Warwick Medical School, Consultant Pathologist at University Hospital Coventry and Warwickshire, Professor of Histopathology at the University of Portsmouth and as the founding Director of the Efficacy and Mechanism Evaluation (EME) programme for the UK National Institute of Health Research (NIHR) Evaluation Trials and Studies Coordinating Centre. Until April 2015 he was a member of the UK National Institute of Clinical Excellence (NICE) Diagnostics Advisory Committee, joining at its inception. He was founding Chair of the Inter-specialty Committee on Molecular Pathology for the Royal College of Pathologists (2011 – 2015) and chaired its Research Committee (2015 – 2017).Trained as a general pathologist with a PhD in immunology, Ian’s research career has been based on investigating disease mechanisms to improve diagnosis and treatment, particularly for cancer. He has a developed a number of molecular diagnostics methods and led the UK Early Cancer Detection Consortium (2012 – 2017). He has a major interest in the management of translational research. He has published more than 300 papers, and 11 books.
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