A new way to detect more cancers earlier | Anne Marie Lennon | TEDxMidAtlantic

Dr. Anne Marie Lennon of The Johns Hopkins University School of Medicine in Baltimore, Maryland, describes a new way to detect eight common types of cancer (esophagus, stomach, colon, pancreas, liver, breast, lung, and ovarian) using a simple blood test. The technique combines genetic indicators with blood protein markers to identify these cancers earlier than ever before, while avoiding false positives.

Dr. Lennon is an Associate Professor of Medicine at the Johns Hopkins University School of Medicine in Baltimore, Maryland, USA. After receiving a medical degree from the Royal College of Surgeons in Ireland and a PhD from University College Dublin, Dr. Lennon completed her residency training in internal medicine in Ireland and at the Cleveland Clinic. She then completed a Fellowship in Gastroenterology in Edinburgh, United Kingdom, followed by an Advanced Endoscopy Fellowship at Johns Hopkins.

Dr. Lennon joined the faculty at Johns Hopkins in 2010. She is a Fellow of the American Society of Gastrointestinal Endoscopy, the American Gastrointestinal Association, the American College of Gastroenterology, and the Royal College of Physicians of Ireland.

Dr. Lennon has authored over 100 peer-reviewed papers and 21 book chapters and is the co-editor of the textbook "Gastrointestinal Endoscopy in Practice." Dr. Lennon’s research is centered on early cancer detection and prevention.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

I'm a doctor.

And one of the hardest things
that I have to do in my profession

is when I have to tell a patient,
"You have cancer."

Raise your hand if someone close to you
has been diagnosed with cancer.

Cancer is something
that touches all of us.

I've personally lost

both of my grandmothers
and three of my aunts to cancer.

The most recent member of my family
to be diagnosed with cancer

is my wonderful mother-in-law,
Norma, seen here with my husband.

Norma was visiting us
in Baltimore last year,

and she was feeling
something wasn't quite right.

A couple of weeks later,
life changed completely for Norma:

She was diagnosed
with advanced ovarian cancer.

Norma's not alone.

This very day,

4,828 people will be diagnosed
with cancer in the United States.

And if we look globally,

17 million people will be diagnosed
with cancer this year,

and 9.6 million of them will die.

How can we change this?

One of the most important ways
of improving survival

is detecting cancer earlier.

The reason for that
is that the later you pick up a cancer,

the smaller your chances of curing it.

If we look at colon cancer,

it starts in the bowel,
then it moves to the lymph nodes,

and ultimately it metastasizes
to the lungs and the liver.

If your patients are diagnosed

when the cancer has spread
to the lungs and the liver,

they have a 14% chance of surviving.

But if you could catch it
just a little bit earlier,

when it was still in the lymph nodes,

their survival goes from 14% to 71%.

And if you could pick it up even earlier,
when it was still in the colon,

your patients have
a 90% chance of surviving.

So how can we detect cancer earlier?

Well, I'd like to share some research
that our group is doing,

which I think is really exciting.

We know that tumors
release tumor DNA into the blood.

Imagine if we could detect
that cancer DNA -

we could potentially
detect cancers earlier.

What a simple concept -

detecting tumor DNA in the blood.

But of course, science and life
is never that simple.

And for great endeavors,

there are always multiple challenges
that you need to overcome.

And whether you're climbing Everest
or trying to diagnose cancer earlier,

you have to overcome these challenges.

The first challenge that we faced
in trying to diagnose cancer earlier

was a technical one.

And that is that the amount
of tumor DNA in the blood is tiny:

one to five mutant fragments
among a sea of 10,000 normal fragments.

I'm part of a team
at Johns Hopkins University

led by Bert Vogelstein, Ken Kinsler,
and Nick Papadopoulos,

and our goal is to detect cancers earlier.

The team has worked on this
for many, many years

and ultimately came up
with a novel technique

which we call "safe sequencing."

And using this technique,
what we do is we take DNA

and we attach a unique identifier
or barcode to the DNA

before it's sequenced.

Using this technology,

we're now able to identify
a single mutant template in the blood

when it's surrounded
by 10,000 normal templates.

So we've overcome our first challenge.

But can it actually detect cancer?

And we looked at 220 patients
with pancreatic cancer.

Now, pancreatic cancer
is a devastating disease.

It has the worst survival of any cancer,

with just over 8% of patients
diagnosed with it ultimately surviving.

Imagine if we could identify
pancreatic cancer earlier -

what an incredible difference
this could make to those patients.

So did it work?

The answer is yes.

We were able to identify tumor DNA
in the bloodstream

in 30% of the patients
with pancreatic cancer.

So we thought, "That's good."

But the question we asked
is "How can we do better?"

Another challenge
that we need to overcome.

So we went back to the drawing board,
and we came up with a novel concept,

which was to combine tumor DNA
with other tumor markers

in such a way that we were able
to greatly increase

the number of patients with
pancreatic cancer that we could identify

from 30% to 64%,

while still ensuring that healthy patients
were not misdiagnosed as having cancer.

One of the really exciting things

about tumor DNA

is that the mutations
that are present in pancreatic cancer

are also present
in multiple other cancers.

So what does this mean?

It means that potentially,

you could identify many different types
of cancers with a single blood test.

And that's what we try to do.

So building on this concept,
our group developed a test

which would screen
for eight common types of cancers:

cancer of the esophagus,

cancer of the stomach,
the colon, the pancreas, the liver,

breast cancer, lung cancer,
and ovarian cancer.

We called it CancerSEEK.

And we evaluated it
in just over 1,000 individuals

who had one of those
eight different types of cancers

as well as 800 healthy individuals.

And it worked.

We were able to identify
every cancer type.

The number of patients
that we were able to identify

depended on the type
of cancer that they had.

So we were able to identify
33% of the patients with breast cancer,

72% of the patients with cancer
of the pancreas or stomach cancer,

and 98% of the patients
who had liver cancer or ovarian cancer.

Overall,

CancerSEEK identified a median of 70%
of the eight different types of cancers.

One of the most important findings

in this study

is that five of the eight cancers
have no screening test.

CancerSEEK identified
between 69% to 98%

of these five cancers.

(Applause)

If we look at these eight common cancers,

they account for 60% of the deaths
due to cancer in the United States.

Identifying them earlier will save lives.

We're currently evaluating

how good CancerSEEK is
at identifying cancer earlier

in 10,000 healthy individuals

who have no symptoms
and no history of cancer.

There will be more challenges ahead.

But our hope is that in the future,

we'll have a single blood test
which can identify multiple cancers,

and we'll save lives
by detecting cancers earlier,

ultimately helping ensure
people such as Norma

have the very best chance of surviving
and enjoying life to the full.

Thank you.

(Applause)