COMPASS Research Report | Page 12

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Cervical and bowel cancer screening continues to be effective The nature of cervical screening has changed to an HPV-focused screening program in the UK and continues to be effective . Screening programs are standardised starting for women around the age of 25 and if HPV is present with any cellular changes , then a follow-up colposcopy is organised . Bowel cancer screening is similarly effective with screening programs changing to the FIT or faecal occult blood (“ FOB ”) test and , if positive , a follow-up colonoscopy . Both these follow-up tests are relatively simple and accurate and reduce the financial and clinical burden of overdiagnosis . They have reduced mortality and incidence in both cancers and are effective .

Targeted H . Pylori eradication should reduce gastric cancers

Introduction of more screening programs Gastric cancer has now been added to the recommended screening list for countries with a high incidence of gastric cancer in Europe- notably Portugal , Slovenia , and eastern European countries . This will be based on a widespread H . pylori breath test and H . pylori eradication therapy if found . Rather than treating early cancers , this aims to remove the main risk factor and prevent cancer from developing . For H . pylori , both the test and treatment are simple , inexpensive , and with few side effects . The success of these screening programs relies on the accuracy of the tests and follow-up procedures and is an essential part of future early diagnosis markers . Cancer-associated bacteria and viruses represent a group of potential future screening program targets and there are many different examples of these ( Table 2 ). One such company looking at this outside of cervical cancer is Adenoprevent Co . Ltd with Colibactin in colorectal cancer . Investors should be aware of the increasing number of screening programs and that tests adopted in these programs are likely to have high revenues with the global cervical cancer diagnostics market estimated at $ 10bn , in our view .

CT scans are a source of radiation and can lead to cancers themselves

CT scanning and unnecessary radiation are still used in lung cancer Lung cancer screening is targeted at high-risk groups , usually older individuals with significant smoking histories . This involves a low-dose CT scan and has been recommended across the UK and Europe although the particulars of how it will work has not been decided yet . While this screening reduces mortality many of the nodules identified are often benign and pose little risk to a patient ’ s life . Overdiagnosis is a frequent problem and unlike cervical and colon cancer interventions and follow-ups are more invasive and have long-term sequelae . Future early detection methods for lung cancer need to be more accurate in picking up high-risk lesions and non-invasive . Alternatively , biopsy methods are improving with the introduction of the Ion Endoluminal system for lung biopsies by Intuitive Surgical as will be discussed later in the surgical chapter .

The challenges to overcome for future tests

Importance in risk assessment of lesions Not all premalignant lesions will become malignant and the risk that these progress varies drastically between cancers . For example , the risk that a monoclonal gammopathy of unknown significance develops into multiple myeloma is 1 % per year . However , fast-growing cancers may be missed between screening visits , and these are the malignancies that are most important to diagnose early . Future tests need to identify lesions but be able to stratify the risk of identified lesions or have sensible non-invasive follow-up tests to confirm this .

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