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Challenge 4: Lethal v non-Lethal cancers
Our methods for detecting cancer simply aren’t good enough. We need to detect the disease at an early stage, but the diagnosis needs to be more sensitive and accurate too, otherwise we risk missing cancers that cause serious harm, and over-treating those that won’t.
So our Grand Challenge is to:
DISTINGUISH BETWEEN LETHAL CANCERS THAT NEED TREATING, AND NON-LETHAL CANCERS THAT DON'T
Read our science blog all about this challenge
It’s a hard concept to imagine, but not all of the things we call ‘cancer’ need to be treated. Some ‘cancers’ are temporary changes to cells that will reverse or disappear with time, and others are so slow-growing they’ll never cause any problems.
For some cancers, over-diagnosis leads to unnecessary treatment and avoidable side effects. In others, we desperately need to be able to detect the disease earlier – but do so in a more accurate way.
In lung cancer, for example, X-ray scans can’t distinguish between spots where there is nothing to worry about, or the early stages of an aggressive cancer that needs prompt treatment.
This is a Grand Challenge that would both save lives and improve quality of life – for millions of people worldwide.
Current screening methods in breast and prostate cancer pick up cancers at an early stage, but lead to over-diagnosis and subsequent over-treatment.
Paradoxically, we don’t as yet have any tools to accurately diagnose other cancers at an early stage, leading to a high cancer-specific mortality (such as for cancers of the pancreas, brain, lung and oesophagus).
The premise of this challenge is that we need a thorough understanding of features that can distinguish a non-lethal growth from a potentially lethal malignant growth, to allow methods to be developed to specifically detect the cancers that require intervention.
There are two aspects to this challenge: identifying changes that distinguish a non-lethal from a potentially lethal tumour and then determining how these changes would be detected accurately.
This might include (but would not be limited to) defining what distinguishing materials are shed from tumours into the bloodstream or bodily fluids that could be detected, working out how blood-based markers can be traced to a specific organ and determining how to detect the specific abnormalities that would then require intervention.
This is a challenge that requires discovery and translational research into the biology of lethal versus non-lethal cancers, rather than one that spans behavioural or public health approaches to early diagnosis.
We would anticipate that a multitude of approaches would be necessary to achieve success. These might include genomic, epigenomic, proteomic, metabolomic, immunologic and other studies, and one or more technology components focused on how to detect the features established as key indicators that the tumour requires treatment.
Applications are welcomed in disease-specific areas or for broader studies; the key criterion for consideration by the panel is that the work focuses on identifying the distinguishing features to facilitate accurate diagnosis of potentially lethal vs non-lethal cancers rather than new methods to detect any/all cancers earlier.
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