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Recognizing Imaging’s Impact on World Cancer Day

February 4, 2022 – As we celebrate World Cancer Day, an initiative of the Union for International Cancer Control (UICC) to remind the world of our global fight against cancer, it is important to realize the impact of imaging sciences in the fight against cancer, since imaging has become absolutely essential as a partner in this effort to help humankind. Since the advent of cancer therapies that target specific molecular pathways, the need for sophisticated imaging to assess response to such therapies has grown tremendously. It is indeed no longer sufficient to rely exclusively on anatomic and sized-based measurements. The complexity of imaging for clinical trials in oncology does no longer rest on simple imaging, rather it requires the expertise and experience that science-based imaging core laboratories, such as Imaging Endpoints, provide.

World Cancer Day was born a winter day in the year 2000 in Paris, France when the Summit Against Cancer for the New Millennium took place leading to the creation of a Charter with specific goals to “prevent cancer, improve patient care, raise awareness, promote research, and mobilize the global community to make progress against cancer”. Given cancer’s universality and its impact on human suffering, the decision was made during the meeting to mark February 4th as “World Cancer Day”. It was a declaration of war against cancer, not unlike the one President Nixon made in the United States 30 years earlier, based on the realization that cancer “knows no boundaries” and requires every available weapon in the world to defeat it, from early detection to palliative care.

Since the concept of targeted drug therapy was first introduced to treat cancer a few decades ago, this form of therapy has become the standard of care for most if not all cancer types, either as a stand-alone therapy or in combination with standard chemotherapy or radiation. With that came the realization that determining response to such therapies was not going to be easy and at a minimum that the old reliance on size-based, anatomic measurement that had been so pervasive in the form of RECIST (and its latest alteration RECIST 1.1) had to be improved. Imaging Core Labs are at the forefront of determining the latest imaging methods that should be used to measure imaging endpoints in a cancer trial. The conduct of a clinical trial needs to incorporate new concepts in imaging such as pseudo-progression, hyper-progression and other characteristics of the agent’s mechanism-of-action that impact the quantitative assessment of efficacy in the trial. This is how Imaging Endpoints can advise and educate the imaging world about the utility of an imaging method, criterion, or need for criterion modification that may be incredibly important to the success of each clinical trial.

As we mark World Cancer Day, tremendous progress has been made in cancer therapy, but this explosion in new drugs has also led to an explosive growth in imaging methods being considered for various cancers, illustrating the perfect harmony between the role of imaging and that of drug therapies to win the war on cancer.

So how well have we done in our fight against cancer? One area where progress has been made is in the screening of certain cancers using imaging where early detection can mean the difference between life and death. The goal is to identify a cancer while it is still localized and the patient asymptomatic, so that it can be treated with curative intent, since the presence of symptoms typically signifies late-stage disease where treatments are no longer curative but rather palliative. Breast and lung cancer are two of the cancers where such strategies have had a significant impact on patient survival.

Since mammography was initially suggested as a potential screening tool for the early detection of breast cancer, and subsequently found to significantly impact the 5-year survival of women diagnosed with breast cancer, the actual recommendations for the use of mammography have undergone a few iterations and some finetuning, but the data is crystal clear; mammography helps detect breast cancer early. When compared to no screening, screening every 2 years decreases breast cancer death by 26% for every 1000 women screened, and significantly decreases the number of women diagnosed with late-stage breast cancer, which is the basis for the current recommendation and guidelines from the CDC for the use of mammography. Therefore, after more than 40 years of breast cancer screening using mammography, we know that imaging can detect cancer early leading to significant improvement in survival and reduction in health care costs…the only question now is to ensure that imaging is not over-utilized to minimize the rate of false positives, which can lead to over-detection, over-diagnosis and possibly over-treatment since these could seriously dampen any positive outcome resulting from screening programs in the first place. This is where artificial intelligence in the form of radiomics are expected to play a growing role; a field lead by Imaging Endpoints.

So, as Imaging Endpoints celebrates World Cancer Day in 2022, we greatly appreciate the healthcare workers, scientist, physicians, clinical trial industry professionals and clinical trial patients that have helped the world to start winning the war on cancer, and we also appreciate how long the journey remains until we win this war, one clinical trial and patient at a time.

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