Revolutionary test could save the lives of thousands of smokers
Published 25 Apr 2016
Shirley Dolan wasn't worried when her GP invited her to take part in a trial of a new blood test that screens for lung cancer.
Despite having smoked up to 20 cigarettes a day for 45 years, the 57-year-old healthcare assistant from Dundee was 'very fit and always have been - I've never even had a cough or anything'.
Shirley, who is married to non-smoker James, was still smoking when she signed up for the trial in March 2014.
She gave a single blood sample in the University of Dundee medical school's cancer research centre at Ninewells Hospital, where she works, and didn't give it another thought.
But four weeks later she got the result - and everything changed.
'I got a letter saying I needed to go for an X-ray and I knew right away that something must be wrong,' she says.
After the X-ray she was called back, 'and that's when the doctor told me. He showed me the X-ray on a computer and there was my lung, with a black spot on the upper-right side'. It was a tumour, about 3cm across. Shirley, who knew that the majority of cases of lung cancer are incurable, was devastated.
'I just thought: "This is it. There's no cure. I'm going to die." ' But thanks to taking part in the trial, Shirley had just had the luckiest escape of her life.
The grim reality is that 70 per cent of lung cancer cases in the UK aren't spotted until the final stages of the disease, when it is far too late to do anything. By the time a patient starts experiencing symptoms, such as chronic coughing, breathlessness and bringing up blood, there is little that can be done.
Typically, these symptoms don't appear until the cancer has spread to other parts of the body, explains Neal Navani, a consultant in thoracic medicine and clinical lead for lung cancer at University College London Hospitals. Fewer than 20 per cent of cases are caught when they are still in the early, treatable stage.
Dr Navani says these are nearly always 'accidental catches', when an early tumour is spotted on an X-ray or CT scan carried out for another reason.
Because the new blood test detected Shirley's tumour in the early stages of its growth, doctors were able to operate on her successfully, preventing the cancer from spreading.
Two years on, she remains clear of the disease and says she has turned her back on cigarettes for good.
'I have had the luckiest of escapes,' she says.
Lung cancer is by far the biggest cause of cancer deaths in the UK. It claimed more than 35,000 lives in 2012, but until now there hasn't been an effective way of screening high-risk patients for the disease.
The new blood test, EarlyCDT-Lung, was developed by a company called Oncimmune, a spin-off from Nottingham University.
It works by detecting a group of seven proteins, known as autoantibodies, produced by the body's immune system in response to the abnormal proteins, or antigens, present in the earliest stages of lung cancer.
Crucially, these autoantibodies can be detected by the test long before a tumour grows to the point where a patient starts to suffer the telltale symptoms - which occur as a tumour grows and starts to irritate and block airways.
'Encouraging' early results from the trial, unveiled last September at a major cancer conference in the U.S., showed that 9.7 per cent of the smokers or ex-smokers given the test were found to have the autoantibodies.
I got a letter saying I needed to go for an X-ray and I knew right away that something must be wrong
When these people were then given X-rays and CT scans, the tests confirmed cancer in about 75 per cent of cases. The other 25 per cent continue to be monitored in case they also go on to develop tumours.
If the final results of the trial prove that the test saves lives, it could be 'a complete game-changer, opening up a new era in lung cancer management', says Dr Navani.
The test, being trialled by the NHS in Scotland, could eventually be used to screen smokers and ex-smokers for lung cancer.
However, such a national screening programme could be years away. Researchers won't be able to properly evaluate the test until after the trial ends in Christmas 2018, by which time all 12,000 participants will have been monitored for two years.
In fact, the test is already available privately in the UK. Good Health has learned that in the past three years, 4,920 tests have been carried out in England, both on private individuals and through company health schemes.
Some 2,270 tests were carried out by Lifescan, part of the Spire Healthcare group.
A spokesperson for the company says 6 per cent of the tests have come back positive for lung cancer. This raises the possibility that of the 4,920 people tested nationwide, as many as 295 lives may have been saved.
Lifescan charges £320 for the test - including a follow-up CT scan for positive patients and the first appointment with a consultant if the result is positive.
Although the blood test is not yet recognised by the NHS, armed with a CT scan confirming a suspicion of lung cancer a patient could opt to be treated within the health service.
But although doctors running the trial for NHS Scotland say interim results are encouraging, they can't yet advise high-risk smokers to take the test privately.
Professor Frank Sullivan, one of the two chief investigators in the study at the University of Dundee, urges caution in interpreting the early results.
'We don't have enough evidence yet to refute or recommend the test,' he says. 'It's a trial and we will know by the end of 2018.'
But there is little doubt that a screening test for lung cancer could make a huge difference, says Dr Stuart Schembri, a consultant chest physician and the other chief investigator.
He is reminded of the desperate need for this at every clinic he holds.
'It's very hard seeing people in the clinic - they have their hopes and their families, but you've seen their scan and know that realistically half of them will be dead by Christmas,' he says.
During his career he has seen life expectancy improve for victims of some cancers, but not for lung cancer.
'I am frustrated that I have no better options for patients than the people who taught me more than 20 years ago,' he says.
He adds that the figures from the study so far are 'hopeful' - 'but I have to be very cautious until the final results are in.
'If I knew with certainty that the test worked, rather than encouraging people to go into the study, I would be pushing the Government to introduce the tests.'
For now, his advice to any smoker considering paying to have the test would be to quit smoking first.
'It is never too late. Whenever you quit, your risk of cancer, cardiovascular disease and stroke will come down from whichever baseline you start at.'
Meanwhile, thanks to the blood test, Shirley had surgery to remove part of her lung in July 2014, just two months after her diagnosis, and by November she was back at work. It may have saved her life.
Subsequent tests confirmed that the cancer had not spread, and she has not had to undergo radiotherapy or chemotherapy.
Shirley - who is celebrating her 60th birthday on May 3 with her family, including her two sons, daughter and three grandchildren - is in no doubt: 'Without the trial, it would have been too late for me.'
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