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The Future of Cancer Detection

By Kelli Miller

FROM THE WEBMD ARCHIVES 

Sept. 26, 2014 -- Spotting cancer early is key, but trying to do that -- often when there are no
symptoms -- has been challenging.

Still, more and more evidence suggests that all cancers have a signature, or even a scent, that
can be detected early. Now, researchers worldwide are testing simpler methods to spot the
subtle signs of:

Breast cancer

Colorectal cancer

Lung cancer

Pancreatic cancer

Oral cancer

Other cancers

Some tests are already available.

"During the past couple of decades, scientists have learned a great deal about the cellular and
molecular changes that distinguish cancers from normal tissues," says Ted Gansler, MD. He's
the director of medical content at the American Cancer Society. "Most professionals who
follow the field of cancer screening and diagnosis are excited about the implication of this ... in
eventually reducing cancer deaths."

Here are a few cancer detection methods that experts say are worth watching.

Breath Tests for Cancer

Your breath can reveal many clues about your health, and not simply whether you brushed
recently. The air that you breathe out has hundreds of different chemicals, called volatile organic
compounds (VOCs).

Many studies have shown that exhaled breath from people with lung and breast cancers has a
distinctly different panel of "odors" or VOCs compared to the breath of people without such
cancers.

Detailed lab experiments and a robust knowledge of cancer's biochemistry helped fuel these
findings. But some say you could also give a bit of credit to dogs.

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Decades ago, there were a few word-of-mouth reports about dogs sniffing out cancer in their
owners. Since then, "a growing number of scientific studies support the accuracy of dogs in
detecting chemicals released by cancers," Gansler says. Those include colon, breast ,
bladder, ovary, prostate, and lung cancer , among others.

Today, clinical trials are underway to find out if breath sensors and artificial noses based on
dog-sniffing research can accurately detect certain lung cancers.

Peter Mazzone, MD, MPH, is director of the lung cancer program at Cleveland Clinic Respiratory
Institute. He has studied breath and urine tests for lung cancer with encouraging results. "Our
results have shown around 85% accuracy in distinguishing those with cancer in high-risk
patients," he says.

WebMD Health News | Reviewed by Michael W. Smith, MD on September 26, 2014

Sources 
SOURCES:
Bettegowda, C. Science Translational Medicine, February 2014.
Clinicaltrials.gov. "A Micro/Nano Device for Exhaled Breath Analysis," "Nanoscale Artificial Nose in Monitoring Response and Detecting Recurrence After
Surgery or Radiation Therapy in Patients With Stage I or Stage II Non-Small Cell Lung Cancer."
Crowley, E. Nature Reviews Clinical Oncology, August 2013.
Hossein Borghaei, DO, chief of thoracic medical oncology, Fox Chase Cancer Center, Philadelphia, PA.
J. David Beatty, MD, medical director of the clinical and bioinformatics program, Swedish Cancer Institute, Seattle, WA.
McCulloch M. Integrated Cancer Therapies, March 2006.
Michael Bouvet, MD, FACS, co-director of the GI cancer unit, University of California, San Diego (UCSD), Moores Cancer Center.
News release, FDA.
Peter Mazzone, MD, director of the lung cancer program at Cleveland Clinic Respiratory Institute.
Phillips, M. PLOS One, March 2014.
Science Daily, "Bacteria in mouth may diagnose pancreatic cancer," May 2014.
Shirasu M. The Journal of Biochemistry, September 2011.
Ten Gansler, MD, spokesperson, American Cancer Society, Atlanta, GA.  
Wang, Y. Cancer Biomarkers, November 2012.

© 2014 WebMD, LLC. All rights reserved.

The tests are fairly simple and pose no risk, according to Mazzone. You just breathe out, and
sensors in the equipment pick up your unique "breath print." The odors in the breath sample are
captured by the system and change colors when exposed to specific chemicals.

"Easy detection is the key,” says Hossein Borghaei, DO. He's the chief of thoracic medical
oncology at Fox Chase Cancer Center in Philadelphia, where a lung cancer breath test clinical
trial is being done. "Exhaled breath collection is cheap and can be applied to a wide population
relatively quickly and at low cost."

A breath test may also help spot early breast cancer or help confirm an abnormal
mammogram, according to research published online in the March 2014 issue of PLOS One.

Study co-author J. David Beatty, MD, says it's possible that checking for VOCs in women without
obvious symptoms "will help find breast cancer earlier and result in improved outcomes from
treatments." But he cautions that it's too early to consider such testing as a replacement for
mammograms. Beatty is the medical director of the clinical and bioinformatics program at the
Swedish Cancer Institute in Seattle.

Saliva Tests for Cancer

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Breath odor aside, the mouth itself has long been considered a gateway to a person's health.
Bacteria inside the mouth not only trigger cavities and gum disease -- they may also reveal
certain cancers, including pancreatic cancer , which often goes undetected until it has
progressed.

A simple swab of saliva might help better diagnose early pancreatic cancer. Research presented
at the American Society of Microbiology annual conference in spring 2014 found people with
pancreatic cancer have different types of bacteria in their saliva compared to those without
cancer or those with different pancreatic diseases.

Michael Bouvet, MD, FACS, is co-director of the GI cancer unit at the University of California San
Diego (UCSD) Moores Cancer Center. He's been involved in clinical trials of a saliva test for
pancreatic cancer, and he hopes the research will lead to an easier way to track people at risk for
pancreatic cancer.

"We're getting some results that look very promising," he says. "Our preliminary data has found
that the saliva of patients with pancreatic cancer has lower levels of certain bacteria and higher
levels of other ones."

Clinical trials have also been done or are underway to find out if saliva tests could be used to
diagnose or detect someone's risk of oral cancer.

WebMD Health News | Reviewed by Michael W. Smith, MD on September 26, 2014

Sources 
SOURCES:
Bettegowda, C. Science Translational Medicine, February 2014.
Clinicaltrials.gov. "A Micro/Nano Device for Exhaled Breath Analysis," "Nanoscale Artificial Nose in Monitoring Response and Detecting Recurrence After
Surgery or Radiation Therapy in Patients With Stage I or Stage II Non-Small Cell Lung Cancer."
Crowley, E. Nature Reviews Clinical Oncology, August 2013.
Hossein Borghaei, DO, chief of thoracic medical oncology, Fox Chase Cancer Center, Philadelphia, PA.
J. David Beatty, MD, medical director of the clinical and bioinformatics program, Swedish Cancer Institute, Seattle, WA.
McCulloch M. Integrated Cancer Therapies, March 2006.
Michael Bouvet, MD, FACS, co-director of the GI cancer unit, University of California, San Diego (UCSD), Moores Cancer Center.
News release, FDA.
Peter Mazzone, MD, director of the lung cancer program at Cleveland Clinic Respiratory Institute.
Phillips, M. PLOS One, March 2014.
Science Daily, "Bacteria in mouth may diagnose pancreatic cancer," May 2014.
Shirasu M. The Journal of Biochemistry, September 2011.
Ten Gansler, MD, spokesperson, American Cancer Society, Atlanta, GA.  
Wang, Y. Cancer Biomarkers, November 2012.

© 2014 WebMD, LLC. All rights reserved.

Blood, Stool Tests for Cancer

All cancers shed DNA into the bloodstream. Many different blood tests, or "liquid biopsies,"
are being developed to spot these genetic pieces, as well as proteins, tumor fragments, and
other biomarkers, specifically linked to cancer.

"Much of the basic cancer research of the past few decades has focused on identifying the DNA,
RNA, and protein changes that distinguish cancer cells from normal cells," Gansler says.
"Technology has allowed scientists to detect these changes in samples of blood, urine, and
feces."

Recent studies have found that circulating tumor DNA (ctDNA) was successfully detected in

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people with early-stage:

Breast cancer

Colorectal cancer

Gastroesophageal cancer

Pancreatic cancer

Some biomarker blood tests for cancer are already available.

Red blood cells and DNA changes related to colorectal cancer also shed into the GI tract as stool
passes out of the body. Now, an easy-to-use test is available to detect these abnormal signs long
before colorectal cancer changes show up in the bloodstream.

In August 2014, the FDA approved Cologuard, the first fecal DNA test. Current screening
recommendations do not include the use of Cologuard, but experts say it expands the options
available for colorectal cancer detection.

Improving Technology
Imaging tests, such as mammography and CT scans, also play an important role in cancer
diagnosis and tracking.

As technology improves and scientists learn more about the makeup of cancer, screening
tests will continue to evolve to detect earlier and smaller cancers, even pre-cancers -- some that
may never become life-threatening.

"It is important to develop methods that accurately predict which of these early cancers are
genuinely serious, and which patients can safely avoid side effects of surgery, radiation, and/or
chemotherapy," Gansler says.

WebMD Health News | Reviewed by Michael W. Smith, MD on September 26, 2014

Sources 
SOURCES:
Bettegowda, C. Science Translational Medicine, February 2014.
Clinicaltrials.gov. "A Micro/Nano Device for Exhaled Breath Analysis," "Nanoscale Artificial Nose in Monitoring Response and Detecting Recurrence After
Surgery or Radiation Therapy in Patients With Stage I or Stage II Non-Small Cell Lung Cancer."
Crowley, E. Nature Reviews Clinical Oncology, August 2013.
Hossein Borghaei, DO, chief of thoracic medical oncology, Fox Chase Cancer Center, Philadelphia, PA.
J. David Beatty, MD, medical director of the clinical and bioinformatics program, Swedish Cancer Institute, Seattle, WA.
McCulloch M. Integrated Cancer Therapies, March 2006.
Michael Bouvet, MD, FACS, co-director of the GI cancer unit, University of California, San Diego (UCSD), Moores Cancer Center.
News release, FDA.
Peter Mazzone, MD, director of the lung cancer program at Cleveland Clinic Respiratory Institute.
Phillips, M. PLOS One, March 2014.
Science Daily, "Bacteria in mouth may diagnose pancreatic cancer," May 2014.
Shirasu M. The Journal of Biochemistry, September 2011.
Ten Gansler, MD, spokesperson, American Cancer Society, Atlanta, GA.  
Wang, Y. Cancer Biomarkers, November 2012.

© 2014 WebMD, LLC. All rights reserved.

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