February 10, 2021

The Truth About Cancer: Debunking Five Myths about the Big C

This piece originally appeared on katiecouric.com.

From the efficacy of home screenings to the rise of telehealth, we’re setting the record straight on some common misconceptions about cancer.

Almost everyone has been touched by cancer— whether personally, or through a friend or loved one— and it’s a topic that Katie and all of us here at KCM are always eager to learn more about. KCM has teamed up with Exact Sciences, a company on the cutting edge of early cancer detection. Katie recently sat down with their CEO Kevin Conroy along with Dr. Paul Limburg, Chief Medical Officer for Screening for Exact Sciences to discuss crucial breakthroughs in early detection, treatment options, and screenings.

Their conversation helped us debunk some of the most common myths about cancer, which we’re sharing here so you can stay informed about the latest advancements in cancer screening and technology.

Myth Number 1: A colonoscopy is the only way to get screened for colorectal cancer

Colorectal cancer is the second deadliest cancer in men and women, but if caught early, the survival rate is 90%, and regular screening is the best way to detect colorectal cancer early. While colonoscopies are still the most common for colon cancer screening, they can be time consuming and invasive. Unfortunately for a long time, they were the only way to detect this type of cancer. 

Fortunately in 2014, the FDA approved an at home screening test called Cologuard®, which detects colorectal cancer including early-stage colorectal cancer and precancerous polyps by testing DNA taken from a stool sample. You may remember seeing their commercials which feature a particularly cheerful cartoon stool sample box: “I’m as easy as get, go, gone!”  Cologuard is intended to screen adults 45 and older at average risk for colorectal cancer. Rx only. For full Indications and Important Risk Information see Cologuard.com/risk-information.

Since it first arrived on the scene, Cologuard has been used by more than 5 million people. This type of easy access screening has proved to be particularly crucial over the past year. In a three-month period ending June 5th 2020, an estimated 1.7 million colonoscopies were missed, as many Americans pushed off their regular screenings amid the Covid-19 pandemic. Some people are slowly returning to the doctor’s office and while others remain at home, physicians with a backlog of colonoscopies are turning more and more to products like Cologuard. Conroy reports that in the spring of 2020, thousands of doctors prescribed Cologuard for the first time.

According to Dr. Limburg, “Having a test like Cologuard, where the test can be shipped to someone’s home, the sample can be collected at home, and can be mailed back from home is a great way to meet patients where they are, rather than having to make them travel to where clinicians are.”

Myth Number 2: All forms of breast cancer require chemotherapy treatment

Not all breast cancer is the same— and we shouldn’t treat it that way. That’s why it’s crucial for people living with breast cancer to understand what type of treatment their cancer is going to best respond to. Kevin Conroy, CEO of Exact Sciences, explained to Katie how technology can save some breast cancer patients from the physical and emotional toll of undergoing chemotherapy, while identifying the important minority for whom chemotherapy can be potentially life-saving*: “Most people with early stage breast cancer don’t benefit from chemotherapy, yet many go through with it. The Oncotype DX® test is a great example of how we can avoid over or under treatment of breast cancer. Prior to the test, most women with early stage breast cancer went on to receive chemotherapy. Today, as a standard of care in this country, there is a test that can provide a patient with estrogen receptor-positive early breast cancer insight as to whether or not they will benefit from chemotherapy by looking at the RNA of their cancer cells.”

The hope is that in the not so distant future, this type of test will be available for other cancers, so nobody with cancer will have to endure chemo treatment if they won’t benefit from it. Unfortunately, you still can’t get a mammogram from the comfort of your own home, so women should make sure to talk to their healthcare provider about when to schedule an annual mammogram.

 *Sparano JA et al. N Engl J Med. 2018.

Myth Number 3: The best way to see a doctor is in person 

If you’re a fan of the Netflix docuseries Diagnosis, where medical professionals from all over the world crowdsource diagnoses for people with rare or bewildering medical issues, you’ll know that sometimes, the doctor with the right answer isn’t necessarily the one in your hometown. That said, of course not everything can be done virtually. According to Dr. Limburg, “There will never be a replacement for the core elements of in-person medicine like a dedicated physical exam. But in order to establish an initial relationship, to understand what my patient is experiencing or what is highest priority for them, we can have that initial conversation through telehealth so we can then be much more targeted and efficient if we need that patient to come into the office.” 

This is great news, especially for people who can’t get to major cancer research or treatment centers. If you live somewhere rural and experience symptoms that may be indicative of a rare cancer, your local doctor may not have the specific expertise to know what course of action to take, or you may want a second opinion. With the rise of telehealth, patients have the option of meeting virtually with specialists from the leading cancer institutes in the country to figure out what action they should take. During their conversation, Dr. Limburg offered Katie a good example: “We had a patient who lived on the East Coast and wanted to come to Mayo Clinic after a new diagnosis of colorectal cancer. We were able to organize a special consultation to go over the diagnosis, review the treatment options, and actually confirm the care plan that had been arranged with her local provider was what we would have recommended here. So that was a nice example of a patient being able to avoid having to travel to Minnesota in December!”

Myth Number 4: The number of people whose cancer is detected early is going up every year

While the science of early detection is constantly evolving and this should be the case, one of the major collateral issues of the Covid-19 pandemic was that many people couldn’t get into the doctor for their annual cancer screenings. The National Cancer Institute predicts that from a three month period last year, COVID-19 related reductions in screenings could result in more than 10,000 deaths from colon and breast cancer alone over the next 10 years. According to Dr. Limburg, “A very sobering statistic with colorectal cancer is that nearly 19,000 colorectal cancer diagnoses will be delayed or even missed because of the reduced number of cancer screenings during the pandemic.”

So, is there anything that can be done about this? 

Dr. Limburg says the only way is by making screenings a priority: “Cancer screening can and should still happen. There are safe and effective home-based options to meet those needs.”

The pandemic has gotten many of us used to the idea of doing things from the comfort of our own homes: from working, to ordering groceries, to catching up with friends. So why should cancer screenings be any different, especially when there’s now such a backlog of people who haven’t been able to be screened? As Conroy explained to Katie, “This shift to at home healthcare, and in our case, at home colon cancer screenings is part of the solution to deal with the backlog, and to deal with the future.”

Myth Number 5: There is no one simple test that can easily detect multiple types of cancers

This is technically true… for now. But sometime in the not so distant future, you may be able to get a non-invasive screening for ten of the most common types of cancer right from your primary care physician. Exact Sciences recently acquired Thrive Earlier Detection, which created a blood test called CancerSEEK. While it’s currently not available to patients, early results from clinical studies are very promising.

A recent study out of Johns Hopkins showed that the results of this test can help doctors make diagnoses which may lead to surgery with intent to cure individuals with cancer who are asymptomatic and may never have been screened otherwise. In fact, in the study the test detected seven cancer types including ovarian, kidney and appendix in which there are no screening modalities today.*

So how exactly does this test work? Dr. Limburg explains: “The traditional [screening] approach was to focus on a single organ— someone would go in for a breast cancer or colon cancer screening. But as CancerSEEK develops, we may now have the ability to test for multiple cancers using a single specimen. We would use a blood-based approach to look for signals of cancer or precancer in a patient’s blood sample with a multi-organ focus. We would then hopefully be able to point to what the appropriate diagnostic follow-up assessment should be.”

While this type of technology sounds almost too good to be true, Dr. Limburg says that if the early trials continue to go well, we may be seeing this technology widely available within the next several years: “We believe that the promising early data will extend into a clinically available test in the near term.”

*Lennon et al., Science 28 Apr 2020: eabb9601. doi: 10.1126/science.abb9601