Big (b)ounce of prevention

Looney: What progress can industry point to on the topic of cancer prevention? What advances are taking place in screening and early detection? Is industry committed to investing more in this area?

Paterson: We are slowly beginning to see genetic tests as a practical alternative to invasive screening procedures, at least for some cancers. Questions about cost effectiveness continue to plague screening for breast and prostate cancer, where the benefits can be outweighed by the morbidity associated with false positives. Nevertheless, more test options will lead to greater accuracy in determining who needs a biopsy. There is an incentive question in opening the door to new screening approaches, since specialist physicians often rely on invasive procedures for a disproportionate share of their incomes.

Puente: Early detection has seen some real advances. I saw recently in Canada two such instances, using state of the art technology: an exhaling device that can pick up traces of cancer cells in the lungs, and a circulating antigen test that can detect cancer cells in the bloodstream. This technology is exciting because it could allow scaled-down treatment over a long-term, with the aim of preventing a cancer from expanding.

Creighton: Patient information is a critical factor in prevention, yet in all but a few countries the industry is barred from communicating with this audience. That has to change if we are to move the needle on early detection.

Geipel: Lilly started a policy outreach effort called PACE [Patient Access to Cancer care Excellence] that surveyed the public in six countries. The findings show there are some fundamental misconceptions about cancer as a disease. For example, fully half of all the respondents believe that cancer is one disease—the implication being that it might be tackled with one cure. This is fundamentally wrong. On the encouraging side, another finding is that the public expresses a great willingness to participate in clinical trials, which at least challenges the notion that cancer patients are hard to recruit for clinical trials.