Nikolas Papadopoulos has never met the cancer patients his work is designed to help, even though the lab where he works is just across the street from Johns Hopkins Hospital. Though he doesn’t know their names or faces, they were his motivation to do the work he does. Papadopoulos is the senior author for a study of what some are calling a “miracle test,” a test that can tell a seemingly healthy patient if he or she is actually suffering from early stages of cancer.
“I cannot see patients myself, so this is a way to contribute to medicine by developing things like this test. I know it’s not preventing cancer completely, I don’t know if we can ever do that, but it is at least preventing cancer from becoming metastatic. … In the end, that’s better [than what we do now],” says Papadopoulos, who is a professor of oncology and pathology.
The test pinpoints eight cancer types: breast, lung, ovary, liver, stomach, pancreas, esophagus and colorectal. As it turns out, these eight cancers collectively make up more than 60 percent of cancer deaths in the United States and five have no other screening test. These cancers are also known to go undetected for a long time before showing symptoms, which can then be too late to cure.
“The idea behind it is to try and find the cancers early,” Papadopoulos says. “The norm now is to treat cancer in later stages.”
Basically, it works like this: The test looks for cancer proteins and genetic mutations from floating pieces of DNA in the bloodstream. What exactly does that mean? DNA is in our bloodstream; DNA, in fact, is in every cell of our bodies. But pieces of cancer DNA would only be in the bloodstream for one of the eight tested types of cancer if that malignancy itself was present in the body.
But why test for only eight types of cancer when there are hundreds? After exploring several hundred genes and 40 protein markers, investigators chose to focus on 16 genes and eight proteins with the highest specificity, giving accurate results even in the earliest stages of the cancers. The team wanted to stay away from false positives to prevent patients from having to go for unnecessary invasive and time-consuming follow up screenings. These genes and proteins they selected are associated with the eight cancers.
The goal then was to ensure minimal false positives while keeping the test cost effective. Obviously, the more DNA studied, the more mutations found. But eventually you reach a point of diminishing returns and they designed the test to reflect this point, Papadopoulos says.
In their trial run, the test proved to have a detection rate of 70 percent, with a 98 percent detection for ovarian cancer and a 33 percent detection rate for breast cancer in 1,005 patients with stages I-III non-metastatic cancer in eight regions.
OK, so how is the miracle test administered? It’s a routine blood screening. Papadopoulos envisions a future in which patients will take this test regularly, likely starting around age 50, the current age that patients begin other cancer screenings, or earlier for patients with high risk. He and the other researchers expect the cost to be similar to that of other yearly routine tests; under $500 was their goal.
Looking forward, assuming all goes well in the current stage of their research — a clinical trial with 10,000 healthy patients — they will enter stage two, which brings a larger clinical trial. Papadopoulos says this test won’t be on the market for at least five years, since they have to follow up with clinical trial participants to make sure every aspect of the test runs smoothly.
“We will continue trying to come up with a breakthrough in a shorter time; that’s the goal,” he says.