Improving Early Detection to Reduce the Burden of Cancer

Reliably detecting cancer at the earliest possible stage, regardless of where it occurs in the body, and accurately identifying people who are at increased risk of cancer are high-priority goals for NCI.

Research Priorities

More research is needed to understand how precancerous growths progress to cancer and how to translate this knowledge into new and improved technologies for early cancer detection.

Understand How Precancers Progress to Cancer

NCI supports studies to understand the molecular events that occur during the transition from precancerous growths to malignant tumors. This research will lead to new methods to detect cancer early, enable better treatment decisions, and improve cancer prevention. To address these goals, specific NCI programs include:

  • NCI’s Consortium for Molecular and Cellular Characterization of Screen-Detected Lesions, which supports multidisciplinary research at 15 different institutions across the country on the molecular and cellular features of cancerous and precancerous tumors that have been detected by a cancer screening test. This research, which was initiated in 2015, will provide information to help distinguish screen-detected tumors that are indolent (nongrowing or slow-growing) from those that are aggressive and, therefore, need immediate treatment. The ultimate goal of this research is to help doctors and patients decide whether treatment is warranted or whether regular monitoring, with the possibility of later treatment, is sufficient.
  • NCI is also launching a Pre-Cancer Atlas (PCA) program to systematically collect, catalogue, and analyze large numbers of precancerous growths and early cancers to understand how different types of cancer arise and progress. This effort will be greatly accelerated by the Cancer Moonshot℠. Information collected through the PCA program will enable the development of more sensitive early detection methods. In addition, PCA research will advance cancer prevention efforts.
  • NCI’s Early Detection Research Network (EDRN) brings together scientists from more than 30 different institutions and organizations across the country to accelerate the identification and clinical validation of biomarkers of cancer at its earliest stages and to evaluate new methods of testing for cancer risk and early cancers. EDRN-supported research has led to Food and Drug Administration approval of a urine-based test for the detection of prostate cancer and a molecular test for the early detection of lung cancer. (Read more about the lung cancer test developed by Avrum Spira, M.D., M.Sc., of Boston University.)
The Pre-Cancer Atlas initiative collects precancerous tissues for analysis.

Improve Current Detection Methods and Develop New Technologies

Our increased understanding of cancer and advanced technological capabilities are amplifying opportunities for noninvasive early detection. The development of the liquid biopsy and new or improved imaging methods are examples.

Liquid biopsies of blood, urine and sputum is a new, noninvasive technique to detect disease biomarkers.
  • Liquid biopsy: Imagine if a simple blood draw in a doctor’s office could be used to detect, stage, or monitor cancer. Perhaps one of the most rapidly evolving areas in cancer research is identifying and validating tumor biomarkers in blood, urine, sputum, or other bodily fluids. Investigators, including many supported by NCI, have discovered that cancer cells and molecules released from them (such as DNA and RNA) can be detected in these fluids. The process of collecting samples of bodily fluids, known as a liquid biopsy, is simple, minimally invasive, and can be repeated on a regular basis. This approach stands in stark contrast with standard biopsy procedures, in which a tumor is sampled directly, often with surgery. However, before this new approach can become broadly useful for early cancer detection, much more work needs to be done to develop standardized methods to maximize the sensitivity (true-positive rate), specificity (true-negative rate), and reproducibility of biomarker identification in specimens of bodily fluids. This effort will require improvements in both detection technologies and methods, in addition to identifying the most appropriate biomarkers in these fluids. To address these challenges, NCI is establishing a Precompetitive Collaboration on Liquid Biopsy for Early Cancer Assessment to facilitate public–private partnerships to advance this technology for early detection.
  • Cancer imaging: Biomedical imaging is important in cancer screening, diagnosis, staging, treatment, and the monitoring of disease response or recurrence. Many advances in cancer imaging have been made in recent decades, but more work remains to improve the sensitivity, specificity, and breadth of available imaging techniques. To expedite developments in this area, NCI is creating a Consortium for Imaging and Biomarkers, which will foster multidisciplinary collaborative research. NCI also sponsors clinical trials of new imaging methods. For example, in 2017, NCI launched the Tomosynthesis Mammography Imaging Screening Trial (TMIST) to compare the effectiveness of 3D digital mammography (breast tomosynthesis) and standard 2D digital mammography in detecting breast cancer and reducing the incidence of advanced tumors diagnosed.
  • Molecular analysis technologies: There are a variety of other approaches that can be used to study precancerous growths and early cancers and to detect biomarkers of these lesions. Optimizing the utility of these approaches involves the development of improved analytical methodologies and tools. NCI’s Innovative Molecular Analysis Technologies program has catalyzed and fostered the early-stage development of highly innovative analytical technologies and tools for nearly 20 years, and it continues to support the development of next-generation technologies that have the potential to revolutionize the way that precancerous growths and early cancers can be studied.

Stories of Impact

NCI support is improving the early detection of cancer and making new technologies available to doctors and patients.

Brushing the Airway to Detect Lung Cancer Earlier

More people die from lung cancer than from any other cancer type. In 2017 alone, the estimated number of lung cancer deaths in the United States will exceed 155,000. Tobacco smoking is the prime culprit underlying the development of most lung cancers. Sadly, most people are diagnosed with late-stage disease that has spread to other parts of the body and is difficult to treat.

Low-dose computed tomography (CT) screening can be used to detect lung cancer at earlier stages, but false-positive results, suggesting cancer is present when it is not, are common. False-positive results mean that many people who have benign lung nodules must undergo invasive and painful follow-up tests to see if they have cancer. Having experienced the limitations of low-dose CT screening firsthand in his pulmonary practice, Avrum Spira, a physician, researcher, and entrepreneur at Boston University, was determined to change that. With NCI funding, he is transforming the paradigm of early lung cancer detection and screening.

Key Takeaways

  • NCI is committed to identifying and validating biomarkers in liquid biopsy specimens that will allow cancers to be detected at the earliest possible stage, when treatment is likely to be most effective and patients have the greatest prospects for long-term survival.
  • NCI supports the development of new and improved technologies for the noninvasive detection of precancerous growths and early cancers.
  • NCI supports additional research to improve our understanding of how precancerous growths transition to cancer, which will increase opportunities for early detection and cancer prevention.