Cancer of the cervix was the first cancer where early diagnosis was practiced and this changed reduced the mortality due to this cancer significantly.
When the Pap test was invented and used on a large scale, cervical cancer could be diagnosed at the earliest stage, which is “stage 0” or “cancer in situ” (the earliest local cancer). In 1943 Dr. Papanicolaou published the book “Diagnosis of Uterine Cancer by the Vaginal Smear” where he described in detail how to do the Pap test. This became the norm very quickly and the use of the Pap test spread all around the world following WWII.
This was important, because later it was detected that cure rates of close to 100% could be achieved by removing the tiny accumulation of local cancer cells, which are present with cancer in situ. This could be achieved by surgical removal (cone biopsy), radiation therapy, and cryotherapy or later also with laser treatment. The key to success in cancer treatment is early detection and early treatment.
Other cancer prevention and early detection
- With melanoma, a darkly pigmented skin cancer, the earliest stage, namely stage 0 or carcinoma in situ is treated by surgical excision leaving a wide margin of healthy skin around it. This is the cure, because it was detected early and had not yet invaded the surrounding tissues.
- The most common breast cancer type is ductal carcinoma in situ (DCIS), of which 80% are diagnosed by mammography. Treatment for this is usually by local surgical excision, called lumpectomy followed by radiation.
- Colon cancer typically arises out of colonic polyps. Colonoscopy in high-risk patients with a history of colon cancer in a first degree relative is typically done every three years. Any polyps that are found are removed during the procedure. My mother died at the age 59 of colon cancer. I had colonoscopies every three years since the age of 40 and on several occasions polyps were removed. Had I not had the colonoscopies, an unnoticed carcinoma in situ would have developed within one of the polyps and subsequently invasive colon cancer would have developed. Colonoscopies are a means of true colorectal cancer prevention.
The newest development: Oncoblot test to detect in situ cancers
At the 23rd Annual World Congress on Anti-Aging Medicine in Las Vegas (Dec. 11-13) Dr. Mark Rosenberg spoke about the universal cancer marker ENOX-2 that is only expressed during embryogenesis (the development of the fetus) and in adulthood only again when cancer develops. A test has been developed to check for the ENOX-2 gene, which becomes positive 5 to 7 years before cancer can be detected clinically. This is called Oncoblot test. Sensitivity of ENOX-2 is high and false positives are negligible, which makes the ENOX-2 marker ideal for cancer screening.
There are various isoelectric points for various cancer tissues, so the lab physician can tell the treating physician from which tissue a positive cancer test originates. The interesting aspect is that a combination of green tea and capsicum has been able to suppress the expression of the gene, and the cancer gene can be turned off. Corresponding biopsy samples showed that the cancer cells had disappeared. This is an entirely new concept and will have to be further investigated by clinicians for the various cancer types.
Here are the 25 cancers that are screened with the Oncoblot test: Bladder, Breast, Cervical, Colorectal, Endometrial, Esophageal, Gastric, Hepatocellular (liver), Kidney, Leukemia, Non-Small cell (lung), Lung Small cell, Lymphoma, Melanoma, Mesothelioma, Myeloma, Ovarian, Pancreatic, Prostate, Sarcoma, Squamous Cell, Follicular Thyroid, Papillary Thyroid, Testicular Germ Cell, Uterine. Considering that testing for all of these cancers is 1000 USD, this means that each specific cancer test is only 40 USD per test. I suspect that in future the price will come down as mass screening will be done. But the key is that this test is available right now; it is highly specific and highly sensitive.
But the important finding right now is that we have a very sensitive and very specific cancer screening test for over 25 various cancer types that can detect these cancers in the in situ stage (very early).
This has not been the case in the past except with the introduction of the Pap test for cervical cancer.
Change of treatment protocols may be required
The company producing the Oncoblot test states that the results need to be discussed between patient and treating physician. Although the treatment protocol does not change, there will be a lot more early diagnoses of cancer than in the past. In the past stage 1 and 2 stage cancers were considered to be early cancers and protocols to have these treated have been worked out. But with this very sensitive blood test (Oncoblot test) in situ cancers (stage 0) can be found. Mind you, it sets you back about 1000 USD, the cost for processing your blood and the test. But despite the monetary barrier I believe, that enough people will want this test done, because with the knowledge that cancer is diagnosed, it can be treated effectively with high cure rates.
The down site may be that those who have the test done and are found to be positive may have to undergo additional tests to locate and treat the tumor.
Suggested future approach to cancer detection and treatment
I envisage four steps to the future of cancer diagnosis and treatment.
- Screening for cancer using the Oncoblot test and other similar tests that likely will be developed in the future. This will give a tissue specific cancer diagnosis at the earliest possible point in time when clinically in most cases no tumor can be found for another 5 to 7 years.
- Staging of the cancer found: this requires confirmation of the cancer by doing imaging studies and possibly biopsies. An MRI scan of the affected area will likely be very useful, also to rule out early lymph gland metastases. Without being certain about the stage of the cancer the treating physician can not be certain what treatment schedule to follow as treatments differ for various stages of a cancer.
- Minimal invasive therapy like low-dose laser phototherapy using three different photosensitizers as shown in the example of end stage prostate cancer in this link under the heading “Photodynamic therapy of a group of inoperable prostate cancer patients”. The tragedy in this pilot study was that all of the men presented with end stage prostate cancer, which is difficult to cure. But early prostate cancer is easy to cure with the same method, simply because the cancer cells are local (in situ). Every cancer expert knows that cure rates are very high in the early stages of cancer, with the highest cure rates for cancer in situ (stage 0) and somewhat lower success rates for stages 1 and 2. Stages 3 and 4 have very poor cancer cure rates, as the cancer is already spread into the surrounding area in stage 3 and presents with distant metastases in stage 4. To make an impact in these latter cases requires toxic therapies like chemotherapy, radiotherapy and/or extensive surgery. Having said this, 20% of these end stage prostate cancers still experienced a cure with the triple photosensitizers and low-dose laser therapy (see link above), which conventional therapies would not have achieved.
- Retesting for residual cancer using Oncoblot test. Two months after the cancer treatment has been completed, the Oncoblot test should be repeated, which will reassure the patient and physician as well that all of the cancer cells have disappeared. As this test is so sensitive, any remaining cancer cells would shed tumor protein into the blood, which the Oncoblot test would immediately pick up. In the few cases that would remain positive this would enable the physician to do further tests, modify treatment and hopefully get rid of the last cancer cell that way.
Examples of two clinical scenarios
Two common cancers are prostate cancer in men and breast cancer in women.
1. Prostate cancer is very common in older men. From the age of 50 onwards the risk of getting prostate cancer is higher with every decade.
Another problem is that not every prostate cancer is invasive, some cancers are low grade and sit around for a long time and may never metastasize. A cancer expert discusses this here.
To attempt to distinguish between the aggressive form of prostate cancer and the slower “wait and see type”, a score has been developed, called the 4K score. This score combines the PSA test and a prostate specific kallikrein marker within one blood sample. Patients with a high 4K score are the ones who have an aggressive prostate cancer that needs urgent treatment. Patients with a low 4K score are the ones where many urologists recommend to wait and observe.
If I were the patient I would lean towards treating any kind of prostate cancer. Any cancer can do whatever it wants to, and you do not really know how these cancer cells will behave in the future. The only difference in prostate cancer is that the prostate has a tough capsule where the tumor stays localized for a long time, sometimes for decades, but it grows until it breaks out of this shell and metastasizes to the rest of the body. At that point it is often too late to rescue the patient, because it suddenly is a late stage. As stated earlier, late cancer stages are associated with poor treatment successes. Knowing this, I would suggest to use either a radical prostatectomy in a stage I cancer or low-dose laser phototherapy with three photosensitizers and three matching laser frequencies as indicated in the link to my blog mentioned above.
2. Breast cancer is common in women. Often early cancer is found on a routine mammography or else with the Oncoblot test. An MRI scan can localize the tumor when it has a certain size, but it may take 5 to 7 years following an Oncoblot test to be visualized. This may be a diagnostic dilemma, which has to be worked out in the future. But as most breast cancers develops from the epithelium of the breast ducts, low-dose laser phototherapy with photosensitizers could be given to treat this early cancer stage. If a repeat Oncoblot test 2 months later is negative, the treatment was successful. If not, the clinician will have to closely follow the patient with repeat MRI scans of the breasts. Compared to the present diagnostic system without utilizing the Oncoblot test, this method is still superior, until perhaps in the future another way to localize early cancer becomes available. The fundamental difference between breast cancer and prostate cancer is that breast tissue is very vascular and any cancer of the breast tends to metastasize very early. For this reason it is crucial to treat breast cancer very early to have optimal treatment successes.
The introduction of the Oncoblot cancer-screening test may revolutionize diagnosis and treatment of 26 or more cancers that can be screened with this test. I have only highlighted the possibilities with the example of two cancers and explained what this might mean in practical terms. The exciting news is that cancer can now be detected earlier. The confusing part is that it can be diagnosed 5 to 7 years before the cancer is clinical detectable, and many physicians will feel uncomfortable treating cancer that early. Having seen many cancer patients in their end stages in clinical practice, I can only state that you cannot be too early diagnosing cancer. Only stage O (cancer in situ) and stage 1 (and sometimes stage 2) can be treated successfully and guarantee a cure. Experience will teach us what the best way is in the future. In the meantime this is an approach to an early diagnosis without taking any risks.