THECWORD

What if you had the opportunity to take a blood test to see if you had cancer before you had any symptoms? Would you take it? How would you prepare yourself ahead to time for the results? How might you react if you learned you have cancer? For cancer survivors, in retrospect, would you have taken a cancer blood test before your symptoms became apparent? Given your cancer journey, would you encourage family members to get a cancer blood test, if one is available? These are not hypothetical questions, because blood tests designed to detect multiple cancers before symptoms show up are on the horizon.

2. Schedule multiple appointments in advance. This is especially beneficial for treatments that require a series of visits, such as infusions over many weeks. Booking in advance can secure more convenient time slots for you.

3. Advocate for yourself. Don’t hesitate to ask how you can streamline the process. For example, I recently needed weekly infusions possible only if my white blood cell count was within certain limits. By arranging to have the required blood tests a couple of days before each infusion, I saved time and avoided unnecessary waiting on the day of the treatment.

4. Be prepared to wait. Bring something to pass the time, such as a book, emails to catch up on, or materials for upcoming meetings. Having a distraction can help make the waiting more bearable.

5. Understand medication side effects. Familiarize yourself with the potential side effects of any medications you are prescribed. Ensure you are taking only what is necessary and talk to your doctor if you experience any issues or discomfort.

6. Minimize medication side effects. Ask your health care provider for strategies to minimize any unwanted side effects of necessary medications. While some side effects are unavoidable, there may be ways to mitigate their impact.

7. Prepare a list of questions. Even if it’s just one question, having it written down ensures you won’t forget to discuss it. If you’re prone to misplacing physical lists, put it on your phone. Handing your list over to your doctor allows for a comprehensive discussion within the limited time available.

8. Maintain a positive mindset. Focus on keeping your spirits up. Find what works best for you. It could involve reaching out to friends or loved ones, engaging in exercise to the extent possible, treating yourself to something enjoyable like chocolate, or simply seeking out moments of beauty and inspiration in the world around you.

9. Cultivate emotional intelligence. Work to manage not only your own emotions but also those around you, including health care professionals. This can be challenging, but start by recognizing basic emotions like sadness or anger and gradually expand your emotional awareness.

10. Share your emotions with your doctor. I value a doctor who understands my concerns. Don’t hesitate to share your emotions and allow your doctor to genuinely care about your well-being.

I hope these tips prove helpful to you based on my own experiences. Remember to tailor these suggestions to your specific circumstances.

Christine J. Ko is a dermatopathologist.

Cancer Screening

Two major benefits from cancer screening tests are the “detection of abnormal cells that can be removed or treated before they become cancer (pre-cancers), and discovery of cancer at an earlier stage when it may be more treatable and lead to improved survival” according to the National Cancer Institute (NCI).1

Recommended specific cancer screening tests are done semi-regularly depending on age and family history of cancer. The NCI describes four major types of screening tests: physical (i.e. skin cancer mole check), imaging (breast mammogram or a low dose CT scan for lung cancer), observational (colonoscopy), and laboratory tests to examine tissue, blood, urine, or other bodily substances (for example, a Pap test to detect cell changes in the cervix or the prostate-specific antigen test (PSA)).

What is a Multi-cancer Detection Test?

First, we need to distinguish between cancer blood tests used after a cancer diagnosis to monitor treatmenteffectiveness, and those tests designed to detect the presence of cancer before symptoms show up. This edition of The C Word explores the latter, a type of laboratory liquid biopsy test also known as multi-cancer detection (MCD) tests or MCD assays that measure biological signals (molecules) that cancer cells shed in bodily fluids.1

Although the MCD tests target molecules (genes and proteins) released by cancer cells, they differ from genetic testing for cancer. The DNA targeted by the MCD test is “cellfree DNA” that is circulating in the blood. Genetic testing looks for “specific inherited patterns in a person’s genes, including healthy cells” according to NCI. While not widely available in the U.S., and lacking FDA approval, MCD tests are undergoing study in clinical trials research. The greatest utility of MCD tests is for people with high risk for cancer based on family history and their genomic predisposition, says Dr. Ravindra Kolhe, Professor of Pathology at the Medical College of Georgia. He states, “Once we have enough knowledge on high-risk patients the MCD technology will improve so that it can be used for the general population beyond those with high risk.”

One multi-cancer early detection test (MCED), Galleri, is available by prescription only for people 50 years of age and older with an elevated risk for cancer, who are immunocompromised, or who have a family history of cancer. Galleri identifies a augusta.edu/cancer/community

‘cancer signal’ to predict where in the body the signal originated.2 Galleri detects more than 50 types of cancer including cancers of the anus, breast, cervix, esophagus, kidney, and liver, and the more lethal ovarian and pancreatic cancers.2,3 Its accuracy varies depending on the cancer type, says Healthline 4 Cleveland Clinic reports Galleria found 51.5% of cancers and was 89% accurate in predicting where the cancer started. “It’s a great tool using amazing technology that will be refined,” says Dr. Kolhe.

A positive result from a MCD or MCED test is an indicator and does not mean you have cancer. “The MCD test only provides a signal for a possible cancer” and can indicate the likely organ site of the cancer.1 Follow-up protocols for a positive or negative MCD test fall within a grey zone – they are evolving and are not standardized. To be clear, MCD tests are not diagnostic but are considered screening. A cancer diagnosis is confirmed through tissue biopsy and analysis, imaging (such as scans), and/or surgery, not through screening.

The benefits and harms of MCD tests, whether they will improve survival, will result in fewer cancer deaths, and whether they can help reduce cancer disparities requires large-scale study which the NCI is facilitating.

“The C Word” is a news brief of the Georgia Cancer Center at Augusta University. For cancer information, visit: augusta.edu/cancer/community.To request exhibits or speaking engagements, contact Maryclaire Regan at mregan@augusta.edu or 706-721-4539. Arrange for virtual presentations in order to follow Coronavirus precautions.

Sources:

1. National Cancer Institute (NCI). Questions and answers about MCD Tests. https://prevention.cancer.gov/ major-programs/multi-cancer-detection-mcdresearch/ questions-and-answers-about-mcdtests#:~:text=Multi%2Dcancer%20detection%20(MCD)%20tests%2C%20also%20 referred%20to,may%20shed%20in%20body%20fluids.

2. GRAIL https://grail.com/galleri-test

3. Healthliine. healthline.com/health/cancer/galleri-cancer-test

4. Cleveland Clinic health.clevelandclinic.org/the-galleri-test/#:~:text=Galleri%20can%20detect%20these%20 cancers,your%20bloodstream%2C%20like%20brain%20 cancer

Do you have a retirement plan?

Not really.

Why not?

I don t need one. I should have all the money I will ever need

What do you mean should ?

Pearson

I ve got all the money I ll ever need - provided I don t live past next Tuesday.