Cancer prevention: What is available and what is being researched?

14 Jun 2021

In her Health Lecture, Julia Mayerle speaks about the options and latest in cancer screening research. The video is now available on YouTube.

Prof. Dr. med. Julia Mayerle | © Dominik Gierke

Cancer screening can save lives. Regular examinations for the early detection of breast, colon, cervical, skin and prostate cancer are already available. However, only a fraction of insured people take advantage of the offer. In Germany, the risk of dying from colorectal cancer is around ten times higher than the risk of being killed in a traffic accident.

How cancer mortality can be reduced through screening is explained by Prof. Dr. med. Julia Mayerle, Director of the Medical Clinic II, Interdisciplinary Center for Dietetics and Nutritional Medicine, LMU Hospital, in her lecture. Which methods for early detection already exist? What is currently being researched?

Three questions for Prof. Mayerle

Why is early diagnosis so important in combating cancers?

Cancers are second on the list of the world’s deadliest diseases. If diagnosed at an early stage, many types of tumors can be treated successfully. But the term ‘cancer’ – in the singular – is actually misleading. More than 100 distinct malignant cancers have been identified. Nationwide screening for the early diagnosis of four different forms – breast cancer, cancer of the cervix, skin cancers and colon cancer – are currently on offer in Germany. The greatest improvements in survival rates for adult cancer patients in the last 25 years have been achieved for breast cancers and colon cancers. These successes are largely attributable to the availability of screening programs for the two malignancies. Less progress has been made in the case of cancer of the cervix. Only 31% of 15-year-olds have been vaccinated, and the figure for 17-year-olds is 43%. In light of the fact that 4,500 women are diagnosed with cancer of the cervix each year, and 1,500 die of the disease, these are disappointing figures.

Other screening programs, such as the blood test used to detect prostate cancer in its early stages, are controversial. Is this skepticism justified?

Screening tests that are based on what are called tumor markers in the blood are problematic. This is because, with few exceptions, the incidence of each type of cancer in the population is relatively low, so the sensitivity and specificity of any such test for a single tumor must be extremely high. It’s like looking for a needle in the proverbial haystack. Often the test will signal the presence of a needle that’s not there – or fail to detect the only one that is there. As a result, rates of false positive and false negative diagnoses are relatively high. Such cases must nevertheless be investigated further, which may cause complications and even endanger the patient. Since patients can also die as a consequence of overzealous diagnosis, two large-scale studies in the US and Europe both concluded that there was no significant difference in the overall incidence of mortality from prostate cancer between subjects who had been screened for the prostate-specific antigen (PSA) and those who had not.

Your own research focuses on pancreatic cancer. What specific challenges does this form of carcinogenesis present?

At 18 cases per 100,000 of the population, the incidence of the disease is low, but the range of therapeutic options is extremely limited, and mortality is correspondingly very high. If the rate of progress remains at its present level, a reliable cure for the condition can be expected for the year 2190. Against this background, it seems sensible to find ways of defining groups who are at high risk of developing carcinoma of the pancreas, and offering them regular check-ups. Monitoring methods based on imaging procedures and blood-based tests are conceivable. Indeed, with funding from the Federal Ministry for Education and Research, we have developed a blood test (Meta-Pac) that is able to rule out the presence of an operable carcinoma of the pancreas, which would also be cost-effective. The test is now undergoing validation and is expected to be on the market by 2024.

Prof. Dr. med. Julia Mayerle is Director of the Medical Clinic II and Head of the Interdisciplinary Center for Dietetics and Nutritional Medicine at the LMU Hospital.

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62 Min. | 14 Jun 2021

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