27th November 2020 // Ira Laketic-Ljubojevic
On today’s news, NHS chief executive, Sir Simon Stevens, announced there was a new blood test referred to as the ‘Galleri blood test’ in the media, which might detect more than 50 types of cancer and that it would be piloted by the NHS over the coming years, starting in 2021.
Research on patients with signs of cancer has already found that the test, which checks for molecular changes, can identify many types of cancer that are difficult to diagnose early, such as ovarian, pancreatic and some blood cancers. This is exciting news for us, as myeloma and related conditions are notoriously difficult to suspect due to the non-specific nature of the symptoms. The scientific paper on the test, which has been published in the peer-reviewed journal, the Annals of Oncology, describes the large study run by the authors to assess this test’s ability to detect and localise multiple cancer types across all stages. It concludes that the potential value of early detection in deadly malignancies justifies further evaluation of this test in prospective population-level studies. As a screening technique, it is based on solid science although there is a line of discussion questioning how clear the efficacy of the screening test is. What does appear to be unique about this test, however, is its sensitivity to identify site of origin.
The paper does not mention myeloma, but it does talk about plasma cell neoplasm. Plasma cell neoplasms are a family of disorders featuring a large production of abnormal plasm cells that multiply fast and produce paraprotein or excess of free light chains which have no useful function. Plasma cell neoplasms include myeloma and its precursor states, MGUS, smouldering myeloma, solitary plasmacytoma, POEMS syndrome and systemic AL amyloidosis.
The GRAIL pilot, which is due to start in mid-2021, will involve 165,000 people and will include 140,000 participants aged 50 to 79 who have no symptoms but will have annual blood tests for three years. People will be identified through NHS records and approached to take part. Anyone with a positive test will be referred for investigation in the NHS. Another 25,000 people with possible cancer symptoms will also be offered testing to speed up their diagnosis after being referred to hospital in the normal way. Results of the pilot are expected by 2023 and, if the outcomes are positive, then the pilot will be expanded to involve around one million participants across 2024 and 2025.
We don’t know at this very early stage whether this test or the pilot will encompass myeloma or related conditions, but any push to accelerate the early diagnosis of cancer is important. We know that a cancer diagnosis can be life changing and a delayed diagnosis can have a devastating impact on both length and quality of life. Catching myeloma early is a persistent challenge due to the non-specific nature of the symptoms. A third of myeloma patients are only diagnosed after presenting through an emergency route and most patients have to wait over five months before receiving the right diagnosis. Post COVID-19 pandemic, we believe that early diagnosis will be the biggest challenge for myeloma patients in the coming years. That is why, whilst still waiting for more details about the efficacy and about precise types of plasma cell neoplasms this blood test can detect, we at Myeloma UK very much welcome the news that early detection of hard-to-diagnose cancers is in sharp focus. We will be working to ensure that myeloma is part of that longer-term vision.