The 50-Cancer Test

Talk about depressing! The National Cancer Institute’s A-Z web site lists more than 157 variations starting with A (acute lymphoblastic leukemia) and ending with W (Wilms tumor).

While there are screening tests for six common cancers - breast, cervical, endometrial, colon, prostate, lung - the American Cancer Society says 71% of cancer deaths come from types such as liver, pancreas, brain and spinal cord tumors for which there is no screening, that is, no simple test for people with people with no symptoms. As a result, these cancers are likely to stay hidden until they hit the about-to-kill-you zone.

That may be about to change.

Last week, GRAIL Inc., the California-based medical tech company, released the latest summary of the results of clinical trials for Galleri, its blood test designed to track the DNA a cancer cell sheds into the bloodstream.

The test is predicted to identify 50, yes 50, different kinds of cancers, 45 of which have no other recommended types of screening. Your doctor draws two tubes of blood and sends them off to GRAIL whose lab guys will analyze them to look for any floating bits of tumor DNA that can tell you whether there’s a cancer present. Better yet, as Joshua Ofman, GRAIL’S chief medical officer, told the tech and science website Healthline, Galleri appears able to predict where in the body the tumor lurks.

So far, several clinical trials have been able to identify positive results. One big one, run by the Mayo Clinic with 2,482 known cancer patients and 4,207 healthy controls drawn all from a pool of more than 100,00 patients in earlier studies, identified 29. Even better, while no medical test is perfect, it’s worth noting that GRAIL correctly detected cancers across all stages with a margin of error (false positive, false negative) of 0.5 percent.

Clearly, Galleri is a game-changer but it’s not a stand-aloner. To the contrary, it designed to complement but not replace established cancer screening guidelines. Before the end of the year, it will be available at Mayo Clinic locations in a number of states including Arizona, Florida, Minnesota, and Wisconsin. It will also be available at many sites run by the regional health system Providence which, like Mayo, will offer it along with conventional techniques such as mammograms.

Across The Pond, the Brits already plan to run at least two major Galleri studies eventually reaching 1,000,000 patients and hope for similar results and follow-up strategies. As these studies roll out and on, Galleri, which hasn’t yet been approved by FDA, is available nationwide on prescription at a price approaching $1,000. That, too, may change. Last spring, Congressmembers Terri Sewell (D-AL) , Jodey Arrington (R-TX) and 112 co-sponsors re-introduced their Multi-Cancer Early Detection Screening Coverage Act (H.R. 1946) proposing to allow Medicare to cover multi-cancer screening tests once the tests have been approved by the FDA. Across the hall, Senators Mike Crapo (R-ID) and Michael Bennet (D-CO) introduced the Senate companion (S. 1873).

In short, sooner or later, once a year, along with your flu shot and maybe your latest COVID booster, you’ll give a little blood to get a lot of predictive protection.