Early Detection and Diagnosis of Cancer in the Primary Care Setting

Primary care physicians are at the forefront of screening for major cancers like breast cancer, colorectal cancer, and lung cancer. Therefore, the primary care setting may be a better place to bring new diagnostic tests, like multi-cancer early detection (MCED) tests, according to Christopher Chambers, MD.

At the Association of American Cancer Centers (ACCC) 49th Annual Meeting and & Cancer Center Business Summit, Chambers, professor, director of clinical trial, and department advisory chair at Thomas Jefferson University, gave a presentation on the role of primary care in multi-cancer early detection. The presentation was a collaboration with Tomasz M. Beer, MD, FACP who discussed the oncologists’ role.

Although colonoscopies, mammography tests, and CT scans are making doctors aware of some cancers, the are no standard screening tests for most cancers. Chambers, professor, director of Clinical Trials, and department advisory chairs at Thomas Jefferson University, explained that this may be an opportunity to bring MCED tests into primary care. To implement the use of MCED tests in primary care, Chambers believes that there must be a wider understanding of how to use the tests and how helpful the information coming from them will be.

In an interview with Targeted Oncology™, Chambers discussed how primary care physicians are involved with the diagnosis of cancer and the challenges faced with early detection.

TARGETED ONCOLOGY: Can you explain the role of primary care in multi-cancer early detection?

Chambers:Almost all cancer screening occurs in primary care, yet the focus of these new diagnostic tests, called MCEDs, is primarily targeting oncologists. Oncologists will be consultants to patients who are diagnosed with or who have positive MCED testing, but testing will occur in primary care. It's important for primary care physicians to adopt MCED testing so that we experienced the full benefit of these testing practices.

What new diagnostic tools have become available in recent years to help with early detection?

There's standard testing that we all know about and readily used in our practices, because there's good scientific evidence that they are helpful. Those are routinely colorectal cancer screening, which includes colonoscopy and some other modalities, mammography for breast cancer screening, and pap smears for cervical cancer screening. We do lung cancer screening using low dose CT scans in appropriate patients. That leaves the majority of all cancers that have no routinely recommended screening test. That is hopefully where MCEDs might fit in. MCEDs might help us patients diagnose some of the other cancers for which there are no current recommended screening tests.

What are your thoughts on the importance of early detection?

For most cancers, the opportunity to treat them effectively and potentially cure them is if they're diagnosed in the early stages before they metasitisize. Once cancer is metastasized, it's very difficult control them, and there are remote chances of cure. Early detection offers the opportunity to allow patients to receive potentially curative therapies.

We must figure out what's the appropriate use of these MCED tests. This is an example of where the technology may be ahead of our understanding of how best to apply. We can't automatically assume that doing MCED testing will have an overall benefit. There are potential downsides to early detection or positive tests.

Can you explain some of the potential cons to early detection?

For instance, it may be that there are a lot of tests that are positive without an identified source. That will lead to a huge increase in anxiety among patients who have a positive cancer test without knowing where the cancer is. That's one of the greatest concerns. There's also a concern that we might be spending a fortune to evaluate these patients and not changing many outcomes. The science of applying this has to catch up to the technology that's been developed.