Home Simplifying Cancer Detection using point-of-care Technologies

Current Scenario & Challenges in Cancer Detection

Approximately 1 in 6 people die of cancer. Multiple factors are expected to fuel the demand for innovative diagnostic solutions in cancer diagnosis. These factors are listed in Exhibit 1 below:

Growing incidence and economic burden:

As per WHO estimates, there were ~17 million newly diagnosed cases of cancer and 9.5 million deaths around the globe in 2018. In 2010, the estimated annual cost for cancer care was ~USD 1.6 trillion. By 2040, the global burden is expected to reach 27.5 million new cases and 16.3 million cancer deaths, primarily due to the aging population. According to the Institute of Health Metrics and Evaluation (IHME) statistics, the prevalence of cancer was found to be comparatively high in the United States (refer to Exhibit 2). Additionally, the prevalence of cancer is on the rise in developing countries.

Need for early diagnosis for the betterment of survival rates:

There exists variation in the survival rate and ease of diagnosis among different cancer types. The need for early diagnosis is evident from the fact that survival rates decrease by ~30-40% after cancer spreads from the site/organ of origin to other body parts. In cancers with low survival rates such as lung, prostate, colon, pancreas, and liver, early diagnosis becomes much more critical. Additionally, some cancers such as brain cancer and Non-Hodgkin lymphoma are fatal and at the same time hard to diagnose. Exhibit 3 given below shows estimated cancer deaths in both males and females in the US, in 2019.

Heterogeneous nature of cancer:

Multiple factors such as the aging population, unhealthy habits, and carcinogenic environmental exposure are expected to contribute to the rising incidence of cancer. There exists a huge disparity in causes for different types of cancers and individual occurrences.

As per the American Cancer Society Surveillance report, variation in cancer prevalence is observed on the basis of age, gender, and ethnicity, thereby making the diagnosis of cancer complex and propelling the need for dynamic and personalized tests. For e.g., i) in the US, cancer prevalence is comparatively high for the middle-aged group (55-80 years). ii) Pre-existing co-morbidities often complicate the diagnosis and treatment of cancer at older ages (refer to Exhibit 4).

Limitations to existing cancer detection techniques:

  • Most of the current cancer detection methods are lab-based, invasive, time-consuming, and expensive. There are several instances wherein patients forgo basic screening on account of the impact on the quality of life due to the current diagnostic test characteristics.
  • In lab-based tests, due to the involvement of multiple and separate pre and post-analytical stages, such as sampling, labeling, etc., there are high chances of manual errors.
  • According to WHO, 70% of deaths from cancer occur in low- and middle-income countries. In addition, there is a lack of access to healthcare infrastructure having the required diagnostic capabilities in these areas.
  • The requirement of highly trained lab practitioners for cancer detection and a shortage of the same may impact the implementation of improvised diagnostic measures.

The development of effective Point-of-Care (POC) diagnostic solutions can play a significant role in addressing the above-mentioned challenges.

Leveraging Multiple Technologies from POC Application

Transitioning of diagnostics from centralized or hospital-based laboratories towards POC can only be facilitated, if the developed POC solution is portable, easy-to-use, and reduces the overall cost burden. In the review article, ‘The Role of Affordable, Point-of-Care Technologies for Cancer Care in Low- and Middle-Income Countries’, Karen Haney (National Cancer Institute) and her team points out that the need for POC solutions has resulted in the exploration and commercialization of molecular diagnostic tools and innovative technologies in optical imaging (refer Exhibit 5).

Additionally, with the advancement of separation and sequencing technologies, the concept of liquid biopsy is gaining significance. In a liquid biopsy, only a few drops of the liquid sample (blood, urine, saliva, etc.) is taken in place of tissue for cancer detection.

Imaging technology:

Imaging plays a central role in the comprehensive cancer care continuum, right from the screening stage – diagnosis to treatment cycles and follow-ups. On account of its very nature, imaging technology-based solutions are well-suited for providing rapid results. Both in-vitro and in-vivo portable imaging solutions are under research/commercial development. Miniaturization of the imaging device and price reduction are supported by the adoption of innovative technologies, such as optical Micro-electromechanical Systems (MEMS), optical fibers, etc. In addition, advancement in smartphone technology fitted with high-resolution optical lenses has provided a ubiquitous platform for cost-effective and easy-to-use POC solution development.

  • Ultrasounds that were initially considered bulky and costly are presently made portable for ready availability and cost-effectiveness. Established players such as GE and Siemens have portable ultrasound products in their portfolio. For e.g., GE Healthcare introduced VSCAN in 2010, and MobiSante introduced MobiUS TC2 in 2013.
  • Portable Microscopy: Presently, hardware modifications are allowing for a compact design. Ultra-compact objectives and thin filters are enabling the development of advanced, field-portable microscopy systems. For e.g., in 2014, Edmund Optics launched TECHSPEC assemblies. Market players are leveraging Light-emitting Diodes (LEDs) for fluorescence microscopy, providing the ease of switch between fluorescence excitation and Brightfield (BF) illumination. While special eyecups on the microscope eliminate the need for a dark room, these microscopes can also run on battery packs facilitating their use in the areas where there is no main power supply. In 2014, ZEISS and the Foundation for Innovative New Diagnostics (FIND) developed PrimoStar iLED. Researchers at MIT developed diffraction diagnosis systems to convert smartphone camera into a powerful microscope in 2015.

  • The Pocket Colposcope: Duke University’s Tissue Optical Spectroscopy Lab and 3rd Stone Design developed a pocket colposcope in 2017; this instrument has a unique portable design, allowing it to reach closest to the cervix point, without the need of a high-resolution viewing system. It can also be attached to a laptop for real-time analysis and provides results at par with lab-based tests.

 

Molecular Diagnostics

The discovery of new bio-markers has propelled the need for POC detection in oncology indication. Still, the major challenge lies in purifying/concentrating the required biomarkers in limited samples, without the use of lab centrifuge. Technologies such as liquid biopsy, portable sequencing, and implantable biosensors are contributing to the development of POC diagnostic solutions for cancer.

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