Even with significant improvements in cancer therapy, the most important factor for survival remains the stage at diagnosis, and catching more cancers earlier requires more screening. That's the concept behind the Integrated Cancer Prevention Center (ICPC) at the Tel Aviv Medical Center in Israel. Everyone is eligible for comprehensive cancer screening regardless of symptoms.
In a proof-of-concept study, oncologists and researchers at the center recently reported data from the 13 years that the center has been operating and screening patients for cancer (J Clin Oncol 2023; doi: 10.1200/JCO.22.00938). All patients who underwent comprehensive screening during that time were included in the dataset. The study reported how many cancers were detected, how many were missed, and how many were caught early. Currently, costs for screening are paid for out of pocket by patients. The study's authors concluded in the paper: "We successfully detected cancers at an early stage, which has the potential to reduce morbidity and mortality, as well as offer substantial cost savings."
In an interview with Oncology Times, Ezra Bernstein, MD, MPH, a resident physician at NYU Langone Health, shared thoughts on the findings and how the screening works. Before joining NYU, Bernstein worked on research in the ICPC at the Tel Aviv Medical Center in Israel while doing a Fulbright fellowship.
1 What is an integrated cancer prevention center and how does comprehensive cancer screening work?
"Our program was the first of its kind where, in a single visit, many of the most common cancers are screened for. Patients see physicians from various specialties and undergo a series of tests. Participants fill out an epidemiologic questionnaire, including information regarding diet, physical activity, smoking status, and alcohol intake, as well as personal or family history of cancer. The questionnaire also includes a comprehensive systems-based assessment that covers symptoms and other relevant past medical history that could indicate an underlying malignancy, such as a change in bowel habits or a history of hepatitis.
"Additionally, each patient is interviewed and undergoes a medical examination by physicians specializing in internal medicine/oncology, plastic surgery, and oral surgery. All women are examined by a breast surgeon and gynecologist and undergo a transvaginal ultrasound and Pap smear. Men are examined by a urologist. Complete blood cell count; bone morphogenetic protein; inflammatory markers (CRP and fibrinogen); and thyroid, liver, and kidney function tests are evaluated in all participants.
"The screening tests also consist of PSA and free PSA for all men over age 40, colonoscopy for men and women older than 40 years, mammography for all women over age 40, and low-dose chest computed tomography in moderate to heavy smokers who are over 50 years old and 20 pack-years history, after a thorough discussion of the risks and benefits of such screening.
"An internist or oncologist orders further diagnostic tests (such as ultrasound, endoscopy, or CT) based on symptoms, family history, physical exam, abnormal laboratory tests, individual risk factors, or other abnormalities identified during the visit. In cases where there is a concern for malignancy, the center schedules follow-ups and referrals. These centers are becoming more common and some of the major cancer centers, like MD Anderson, now have them as well."
2 What were the key findings from this trial?
"The key findings were that more than 1 percent of the healthy asymptomatic subjects had a malignant lesion detected. Importantly, the majority of these cancers were found at an early stage with over 75 percent found at Stage 0, I, or II, some of which may have otherwise been diagnosed at a later stage with reduced treatment efficacy, increased morbidity and mortality, increased cost of treatment, and a worse chance for cure.
"As a result of early detection, only 31 cancers (12.5%) were found at a metastatic stage. When compared to the Israeli general public over the same time period, the percentage of cancers found at metastatic Stage IV at the ICPC was lower for all cancers. This tells us that the ICPC is a very successful cancer screening model as we found a great number of cancers at early stages. This research is a culmination of over 13 years that the Integrated Cancer Prevention Center has been open. At this point, we have collected data on over 17,000 patients who visited the ICPC and have sufficient data to publish and show the benefits of our program."
3 Is implementing this type of screening on a larger scale feasible?
"It is absolutely feasible on a large scale. In fact, if implemented on a large scale with government support and funding, screening costs will decrease as a function of economies of scale. The next steps for our work are to evaluate for a mortality benefit from our program, as well as the cost savings offered by a program such as the ICPC."