THE FIRST TIME he had cancer, John Hemmingsen didn’t find out about it until it was almost too late.
It was back in 2006, and he began to notice that he felt winded after climbing stairs. He was in his mid-60s but in good shape, thanks to all the walking he did in his job as vice-president of foundry operations for a global steel company.
It took his doctors seven years to sleuth out the source of his trouble: He was diagnosed with autoimmune hemolytic anemia, a precursor to acute myeloid leukemia. This blood cancer is so serious and its treatment so intense that the five-year survival rate is only 26 percent (and that drops to 11 percent in people ages 65 to 74).
Luckily, he was able to enroll in a clinical trial that offered hope. He stayed in the hospital for 31 days, undergoing two rounds of intense chemotherapy followed by a bone-marrow transplant. “I called it the Lazarus approach, because they put me near death and then brought me back,” he says. He survived, and his cancer went into remission.
Seven years later, in 2020, with his cancer still in remission, he got an invitation from the hospital where he had been treated, the Oregon Health & Science University’s Knight Cancer Institute, to join a clinical trial. The scientists were evaluating a new test that could supposedly find traces of many different types of cancer in a patient’s blood. Hemmingsen signed up.
His instincts were wise. The test came back positive, meaning he had cancer somewhere in his body. Further rounds of imaging scans and blood tests located the source: an early-stage leukemia that was growing at the base of his spine. While he was undergoing additional testing to search for the source, the doctors discovered that he also had a slow-growing prostate cancer, which was not unusual in a man of 80. This time around, his cancers were easily treated with radiation because of the early diagnosis. His latest scan showed that he is now cancer-free. End of story for Hemmingsen, but the beginning of a revolution in how cancer is detected.
There are only five cancers (breast, cervical, lung, colon, and prostate) for which somewhat reliable screening methods exist. There’s no screening for many kinds, which is why they are diagnosed late, when they are harder to treat. More broadly, cancer is the leading killer of Americans ages 45 to 64. If it’s caught earlier, it can be removed via surgery or zapped with radiation, with a higher success rate. If it’s in stage 3 or 4, it is much more difficult to deal with and more often fatal. “Early detection is a major challenge in cancer today,” says Tomasz Beer, M.D., a researcher at OHSU who participated in the study. “Nearly seven out of ten cancer deaths are due to cancers for which there is no early detection recommended at all. We’re flying blind.”
The test Hemmingsen took, called Galleri, may solve that problem. Dr. Beer and his colleagues took Hemmingsen’s blood and ran it through the protocol, which employs innovative sequencing technology to search the blood for genetic traces of cancer. (Galleri is owned by a company called Grail.) Because evidence of cancer was found, Hemmingsen’s results were then run through an artificial-intelligence analysis to determine the likely source of the disease.
Hemmingsen was one of more than 6,500 participants in the study. Ninety-two tests came back positive for cancer; 65 people went for further testing; and 29, including Hemmingsen, turned out to have cancer. The data is preliminary, Dr. Beer notes, but it suggests a positive predictive value of about 44 percent. (It delivers true positive results about 44 percent of the time.) Josh Ofman, M.D., president and chief medical officer of Grail, says that as more people take the test and as the company collects more data and continues to train its algorithms, the results will become more and more accurate.
Adding the blood test to existing screenings could reduce late-stage-cancer diagnoses by more than half among patients ages 50 to 79, which would translate into a 26 percent overall reduction in five-year cancer mortality, saving 100,000 lives annually, according to Grail. However, critics such as Eleftherios Diamandis, M.D., Ph.D., of Toronto’s Mount Sinai Hospital, a biochemist who has studied cancer detection for decades, say Grail is overpromising in terms of accuracy. Last fall, it partnered with the UK’s National Health Service to look for cancer markers in 140,000 patients. Dr. Ofman hopes this larger data set will further validate the test.
Grail is a leader in the rapidly growing field of “liquid biopsies” for cancer—a blood test used in cancer diagnoses. Originally, liquid biopsies were used to help doctors determine the best treatment for an existing tumor in patients who had already been diagnosed. A smaller number of such tests have been developed to diagnose different cancers. One of the best known is Cologuard, which came to market in 2014 and looks for signs of colon cancer in a sample of your, well, colon products.
Galleri is a multicancer early-detection test—that is, it looks for many different kinds of cancer at the same time. Scientists have known for decades that cancer leaves various signs of its presence in the blood, in the form of DNA from dead tumor cells and other by-products. PSA is one of them: The presence of cancer causes the prostate to produce more of this protein in response. Apart from a few well-known markers, however, these traces have been difficult to detect—and almost useless for screening healthy people. That began to change just within the past few years, with new technology such as advanced sequencing that enables the detection and analysis of very small amounts of DNA and other stuff in the blood.
Various companies are devising tests to find slightly different markers of cancer. Thrive, part of Exact Sciences, is developing a test that scans the blood for DNA markers as well as specific proteins associated with cancers. The company plans to launch a large clinical-validation study later this year.
Meanwhile, Freenome is working on a blood test for colon cancer, looking at changes to a much wider array of markers than Grail does; it hopes to broaden out to multiple types of cancer. C. Jimmy Lin, M.D., Ph.D., chief science officer for Freenome, thinks these blood tests for cancers are game changers. “The goal is eventually you’ll go to your annual physical, you’ll just have blood drawn, and we will search for all cancers. We’ll be able to definitively tell you there’s a signal for colorectal cancer, or a signal for prostate cancer, and we’ll go and follow up on it.” He adds, “I’m really optimistic that cancer will be a disease that will be completely treatable, like HIV, within our lifetime.”
This story appears in the April 2022 issue of Men’s Health.
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