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Extraordinary Opportunities for Early Cancer Detection and Risk Assessment Research

Extraordinary Opportunities in Early Cancer Detection Research

Although a primary tumor can usually be successfully controlled with local therapy, most cancer deaths are caused by metastatic disease. Therefore, the goal of screening and early detection is to identify tumors at early stages of development. Unfortunately, clinically available screening and early detection modalities detect many tumors at a relatively late stage in their development. New technologies emerging from molecular and cellular biology have been shown to identify genetic alterations and antigenic changes during early stages of tumor progression, and some of these could show promise as markers of premalignant lesions.

Advances in understanding and clinically applying the molecular aspects of tumorigenesis have the potential to reduce mortality from cancer. The long-term benefits of early cancer detection, particularly decreased mortality from cancer, could be achieved with proven, early tumor screening markers that increase the window of therapeutic opportunity. Progress in biomarker development and success, however, depends on establishing a correlation between the biomarker and the morphologic or differentiation changes that occur in premalignant or early malignant lesions.

Molecular and genetic alterations in various types of cancer offer the opportunity to specifically detect early tumor-related changes in DNA. In colon cancer, for example, delineation of various stages of tumorprogression offers a wider window of opportunity to intervene in the process by detecting stage-specific molecular changes. An understanding of the biological basis of tumor progression, therefore, allows us to develop specific tests useful for the early detection of cancer. For instance, molecular probes could be used to detect altered DNA shed into the feces (colorectal cancer), into sputum (lung cancer), and in exfoliated cells in bladder washings (bladder cancer). In addition, correlation of the molecular alterations with the demographic data, risk factors, environmental exposure, family history, dietary habits, and follow-up events may provide important information on the biology of tumors.

Another area where the genetic alterations could contribute is in risk assessment. This is well-characterized for colorectal cancer. Adenomatous polyposis syndrome and hereditary nonpolyposis colorectal cancer, also called Lynch Syndrome, are two examples of autosomal dominant inheritance. The occurrence of colorectal cancer in first-degree relatives of patients with colorectal cancer is 3-4 times that of the general population in the absence of a recognizable syndrome. Molecular technology could significantly advance our understanding of inherited factors in risk assessment.

The CBRG has developed several funding opportunities to stimulate biomarker research for early cancer detection and risk assessment. Through grants and contracts, sponsored research is available for the following initiatives and in the specific research areas.

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