Big (b)ounce of prevention
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.
Stein: For Big pharma companies, prevention is all about the target—precisely, what do we go after? Our understanding of the viral
etiology of cancer—the hepatitis and human papiloma viruses come to mind—has led to some very important vaccines to slow the
progression of liver and cervical cancer. But defining those endpoints is a complex task. In addition, the regulatory hurdle
in getting a drug approved as a preventive is very high. We must demonstrate close to zero toxicity in this setting.
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.