Early Cancer Detection: Challenges and Opportunities

Cancer is the second leading cause of death both globally and in the United States [1]. Recent studies suggest that the detection of cancer at early, pre-clinical stages has the potential to reduce cancer-specific morbidity and mortality [2]. Yet, at present, more than 70% of cancer deaths occur in organ sites without approved early detection modalities [2] mainly due to cost-ineffectiveness caused by low disease prevalence in most organ sites, combined with the low sensitivity of detection at early stages, and the relatively high false positive rates that can lead to significant morbidities or mortality from unwarranted invasive diagnostic procedures, or to unnecessary financial toxicity. Currently, screening programs for early cancer detection in the general population in the United States are recommended only for a few organ sites with relatively high incidence, including colon, breast, and cervix [3], as well as for lung cancer in individuals with increased, smoking history-based risk [4], or for prostate cancer at an individualized basis [5]. Existing screening programs, such as colonoscopy for colorectal cancers, mammography for breast cancer, or low-dose computed tomography for lung cancer, require expensive infrastructure and highly trained technical and medical personnel. Hence, compliance with recommended screenings has remained poor [6], especially among historically and socioeconomically vulnerable populations, such as ethnic/racial minorities, under-insured or uninsured individuals, or those residing in rural areas with limited access to health care services.