Scott Menta describes himself as someone who “likes to stay on top of my health.” So, when he read about a new test that screens for cancer based on tumor cell DNA within the blood, he sprang for the cost of two tests — one for him and one for his wife.
His wife’s test can back negative, but his showed signs of cancer. “I thought, ‘Oh, this is pretty interesting,'” Menta says, little anticipating the quandary in which he would soon find himself.
The test, called Galleri®, is a blood test that usually isn’t covered by insurance. It can detect DNA from a variety of cancers but doesn’t deliver a diagnosis. When it returns a positive result, further tests are needed to determine if cancer is indeed present, what type of cancer it is, and how advanced it is. The relative newness of the test, and the unfamiliarity of many doctors with it, mean that people like Menta who test positive often have difficulty finding a center to guide them on next steps.
When Menta did identify such centers — such as the Multi-Cancer Early Detection (MCED) Clinic in the Centers for Early Detection and Interception at Dana-Farber — he was able to receive a full evaluation and learned that the cancer, though present, is essentially dormant, best dealt with by monitoring rather than immediate treatment. Today, he has reason to be grateful that he followed his instincts in getting tested. Knowing where his cancer is and that it’s currently idle, he and his doctors are keeping a close watch on it through blood tests, and if it does begin to advance, they can act quickly to stop it.
Facing uncertainty
Menta’s story exemplifies the obstacles faced by many people using Galleri or other “liquid biopsy” screening tests — and of the role specialized early-detection clinics can play in helping them understand, and act on, the test results.
When Menta learned his test had found signs of cancer, he immediately contacted his primary care physician. “She had vaguely heard of Galleri, but she said she couldn’t refer me to an oncologist because I hadn’t actually been diagnosed with cancer,” Menta relates. “I said, ‘Doc, these cancer markers are in me. The early-detection test says I do have cancer. What do I do?'”
The primary care doctor referred Menta to a geneticist, who scheduled a Zoom meeting. The geneticist asked him to fill out a form to see if there was a history of cancer in his family.
“The next day, she called me back and said she’d been Googling early-detection centers and the only two in this area are at Dana-Farber and [one other],” Menta says. “I was kind of taken aback because I live right outside Manhattan, but her search hadn’t found any centers in the city.”
Menta scheduled appointments at both Dana-Farber and another clinic. “I wanted to be tested at both of them,” he remarks. “I needed as many people as possible to be working on this.”
At Dana-Farber, Elizabeth O’Donnell, MD, director of the Institute’s MCED clinic, scheduled a PET scan for Menta in January and met with him before and after the scan.
“We walked Scott through everything,” O’Donnell comments. “We explained that early-detection tests like Galleri have a positive predictive value of about 40-43% and that those were his odds of the test results being accurate. We discussed the tests that we needed to do to resolve that. We did the tests and uncovered two areas of cancer, near his upper left clavicle and lower abdomen.”
“Dr. O’Donnell explained that these were very, very small areas of cancer, but they were indications of cancer and a biopsy would need to be done,” Menta comments.
O’Donnell and her team arranged for Menta to have the biopsy done in New York City. The test revealed the precise type of cancer Menta had, and O’Donnell referred him to a local oncologist, who he met with a week later to discuss the results.
“The oncologist said, ‘Scott, it’s there but is so small and non-aggressive that I’m going to recommend a watch-and-monitor approach,'” Menta relates. The oncologist indicated that the cancers might have been old — that they’d been there for many years without ever advancing. “Realistically,” the oncologist told Menta, “I may never have to treat you.”
In line with that approach, Menta had a follow-up MRI test in August. It showed one of the cancers had decreased in size substantially and the other had increased a little. The plan is for Menta to have blood tests every few months to keep tabs on the cancer in the event it does begin to advance.
“For people like Scott, who have a positive result on an early-detection test but have no local providers to guide them afterward, we’re here to help,” O’Donnell says. “As one of the only programs of its kind in the country, we provide the kind of individualized, seamless care people need to understand their test results and to get the treatment they need where they live.”
She adds that while Galleri and similar tests are expensive, some companies are beginning to offer free testing to their employees, making it available to a broader segment of the population.