By Michael Zinner, MD
In 2020, we predicted that delayed cancer screenings due to COVID-19 were a ticking time bomb with a 10-year fuse. We now have evidence to confirm that this ticking time bomb is starting to slowly explode, as we see more and more patients presenting with later-stage disease.
At Baptist Health Miami Cancer Institute, in collaboration with Florida International University’s Herbert Wertheim College of Medicine, we looked at approximately 1,200 patients before and an equal number after the COVID-19 time period. In two areas in particular – breast cancer and colorectal cancer – we saw that patients were presenting with more advanced disease after the pandemic. We saw a 12 to 13 percent rise in the number of colorectal cancer patients presenting with stage 4 or more advanced disease, and a similar increase in the number of breast cancer patients presenting with stage 2 disease.
What accounts for these increases? During the pandemic there were virtually no screening colonoscopies, and there was also a dramatic decrease in the number of mammograms. Without those screenings, we’re not going to catch patients early before their cancer has had a chance to spread.
Minimizing racial disparities in cancer care
As part of our ongoing effort to address disparities in both cancer care and clinical trial enrollment, Miami Cancer Institute recently launched the Center for Equity in Cancer Care & Research. Funded through the generous support of donors in our community, the Center allows us to tackle the social determinants of health both on the research side and on the care side.
Nationwide, of the hundreds of thousands of patients treated at cancer centers every year, only about six percent are invited to participate in clinical trials. Clinical trials are notoriously expensive and difficult to successfully run, which is why we’re directing much of the philanthropic funding received by Miami Cancer Institute to broaden the clinical trials we’re leading or participating in. It’s a crucial part of cancer care delivery.
Trends and predictions for 2023
As another year comes to a close, what are we excited about at Miami Cancer Institute, and what can we expect for cancer care in the year to come? Here are a few highlights:
- Detecting cancer through blood tests: There are four major areas of cancer screenings currently available – colonoscopy for colorectal cancer, mammograms for breast cancer, PSA tests for prostate cancer and low-dose CT scans for lung cancer (in patients who have a history of smoking). A new screening area on the near horizon is the liquid biopsy test for patients who have had no symptoms or history of cancer. With this new diagnostic tool, which has been in development and testing for more than a decade but is only now beginning to be used more widely, we could potentially detect cancer through something as non-invasive as a blood sample.
Liquid biopsies are not yet FDA-approved so the cost isn’t covered by insurance, but we know that the test is accurate and very good at detecting stage 3-4 disease. The question now is how sensitive it is for detecting stage 1-2 disease. I believe liquid biopsies will become more common as we accumulate more data and the tests improve. Our goal is to be able to eventually use liquid biopsies to detect all types of cancer.
- Starting cancer screenings even earlier: We are continuing to revise cancer screening guidelines to apply a personalized approach. For example, 10 years ago, the screening guideline for colorectal cancer was age 50 but if you had a family history, the recommendation was to start at age 40. Over the past decade, however, we’ve noticed that younger and younger patients are presenting with colon cancer – some as early as their late 20s and early 30s. So the recommended age to begin screenings has moved from age 50 to 45.
We’re seeing the same thing happen with breast cancer, which is affecting an increasing number of younger women, even in their 20s. As a result, screening guidelines have now moved from age 50 to 40. My guess is that we’ll continue to see those guidelines move even earlier until we can better understand why these cancers are showing up earlier in life.
- Leveraging the body’s own defense system to treat cancer: We’re continuing to discover and provide new treatments for cancer care. If we look historically at how we treated cancer for most of the 20th century and the early part of the 21st century, our only options were limited to surgery to remove the tumor, radiation to burn it or chemotherapy to poison it. But then, roughly 25 years ago, we began to see the rise of targeted therapies. By that, I mean we figured out that certain cancers have certain mechanisms that can be targeted with a specific drug, with few if any side effects.
Targeted therapy eventually became personalized cancer care and spurred the next great development in cancer care, immunotherapy, which allows us to turn the body’s own immune system on the tumor. It’s been in development for nearly 50 years and we’re just beginning to realize its promise to improve patient outcomes. Cellular therapy is a type of immunotherapy used primarily to treat blood cancers like multiple myeloma, lymphoma and leukemia, as well as other liquid tumors. Now, we’re beginning to see immunotherapy and cellular therapy used to treat solid tumors like breast cancer, pancreas cancer and colon cancer. We’re not quite there yet but we’re moving in that direction.
- Declining cancer death rates: If we look at the treatment of neurodegenerative diseases such as Alzheimer’s over the past 10 years, there have been only one or two FDA-approved drugs that have made it to market. On the other hand, in cancer treatment, we’ve seen the FDA approve 10 to 15 drugs a year. We’re definitely improving the way we treat cancer, which is why cancer death rates are going down.
- New technologies on the horizon: A new paradigm-shifting technology in the field of cancer care is CRISPR, which is gene editing, essentially. With CRISPR, we can remove part of a broken gene and insert a new gene to fix the gene that’s causing the tumor. It’s still highly experimental but it could very well represent the future of cancer care.
As part of Baptist Health Cancer Care, Miami Cancer Institute is at the forefront of these and many other innovations. We’re learning more and more about cancer every day, and we’re getting better and better at developing highly targeted and effective therapies that offer improved outcomes for patients. I hope you share the collective sense of optimism and excitement we have at Miami Cancer Institute for what the future holds for cancer diagnosis, treatment and prevention.
Dr. Michael Zinner is CEO and executive medical director for Miami Cancer Institute and Baptist Health Cancer Care, part of Baptist Health South Florida.
