Dana-Farber’s Centers for Early Detection and Interception, founded in 2023, aim to detect cancer early, when there is a greater chance of treating and curing that cancer. The Centers also serve as a hub for research, with investigators seeking to better understand cancer risk and how it can be reduced.
“Dana-Farber has always been the place to go to have your cancer treated. As we move forward, it will also be the place to go to protect yourself from cancer,” says Sapna Syngal, MD, MPH, co-director of the Centers for Early Detection and Interception.
A key mission of the group has been to build in access to the centers from the start, so that anyone can benefit, regardless of their zip code, socioeconomic status, gender, race, or ethnicity.
Achieving this goal, however, requires a multipronged effort:
- Awareness: To help people in the community become familiar with this type of clinical service, which is new and different from the cancer care most people are used to.
- Pathways: To help patients and community physicians connect with Dana-Farber when needed, the team has hired patient navigators and is building relationships and clinical pathways between community health care providers and Dana-Farber.
- Interventions: In some cases, new types of clinical decisions, diagnostics, and interventions might be needed, and those approaches need to be tested and verified. Dana-Farber is running several studies to develop new approaches to early detection and intervention. Those studies are designed from the start to include diverse populations so that everyone can benefit from the findings.
To carry out these plans, the Dana-Farber Centers for Early Detection and Interception team is working collaboratively with Dana-Farber’s Community Health team and the Dana-Farber Cancer Care Equity Program to improve access to early detection and interception services across in the Boston area and beyond.
“We are working to bring awareness to the community and understand more about how we can partner with providers and services in the community so we can bring these new early detection and interception services to more people,” says Syngal.
The following efforts are underway to build access into the Centers for Early Detection and Interception thoughtfully and effectively:
Helping people understand early detection and interception of cancer
Dana-Farber’s Community Health team focuses on building awareness in the Boston area about cancer prevention, screening, and diagnosis. Their goal is to empower people with knowledge and to introduce them to new approaches that might help them reduce the risk of cancer for themselves and their families.
The field of early detection and interception is new and advancing rapidly. Dana-Farber recently hired a Community Outreach Specialist who is responsible for working with Dana-Farber’s many community partners to help people learn more about what kinds of approaches there are to early detection, and what Dana-Farber offers in terms of risk reduction, screening, and early detection.
- Try Dana-Farber’s AssessYourRisk tool to learn more about your personal risk of breast and ovarian cancer.
- Learn more about cancer screening and risk reduction programs offered by community health, including the Mammography Van and Tobacco Treatment Program.
Improving lung cancer screening for people of Asian and Hispanic descent
In the past 25 years, cases of lung cancer have been rising among people without previous tobacco use. These cancer cases are approximately 2.5 times more likely to be found in women than in men. These women tend to be younger, and cases are rising more rapidly in people of Asian or Hispanic/Latina descent.
To begin to address this lung cancer disparity, Narjust Florez, MD, FASCO, associate director of Dana-Farber’s Cancer Care Equity Program, has partnered with the Centers for Early Detection and Interception and the Robert and Renée Belfer Center for Applied Cancer Science to evaluate a blood test that could be used to screen more younger individuals of Asian or Hispanic/Latinx descent who are non-tobacco-users for EGFR-positive lung cancer. These historically marginalized groups are at an elevated risk for EGFR-mutated non-small-cell lung cancer.
Due to their young age and no previous tobacco use, they do not qualify for current lung cancer screening practices. As a result, many of them are diagnosed with lung cancer at advanced stages when treatment options are limited.
The blood test is being evaluated in a clinical trial called the EQUAL study to determine the feasibility of using it to identify early or locally advanced EGFR-positive non-small-cell lung cancer in non-tobacco-using healthy East Asian and Hispanic/Latinx individuals.
“Our hope is that we will be able to determine if this test helps us diagnose patients early, since they are at a high risk for lung cancer but don’t qualify for traditional lung cancer screening,” says Florez.
The study is expected to launch in by the end of 2024 and will include community outreach.
Learn more about clinical trials in lung cancer at Dana-Farber.
Helping more patients come to Dana-Farber for blood workups
Myelodysplastic Syndrome (MDS) is an asymptomatic blood disorder that can progress to acute myeloid leukemia (AML). It also frequently goes undiagnosed, according to Lachelle D. Weeks, MD, PhD, a physician-scientist and director of the CHIP clinic in the Center for Early Detection and Interception of Blood Cancers, especially in patients who have other diseases, such as chronic kidney disease. Weeks also suspects that it is more frequently missed in Black or Hispanic patients, as these groups are underrepresented in large cancer registries.
AML is a dire form of blood cancer, so identifying patients early, before cancer starts, is important. To increase detection of MDS and the MDS precursor clonal hematopoiesis (CH) in a broader population of people, Weeks has partnered with the CCEP, which has a strong patient navigation program in place in community hospitals to help patients find their way to Dana-Farber for a blood workup if needed.
For example, one sign of MDS is low blood counts. Most often, people with low blood counts do not have MDS. But to find those people who have undiagnosed MDS or higher risk forms of CH, more complex diagnostics may be needed. Weeks hopes that her program can help bring more patients with low blood counts to Dana-Farber for evaluation.
“If we establish a pathway where primary care providers don’t have to wait to get someone to see a hematologist, where they can have a clear algorithm that guides a patient to Dana-Farber, we might catch MDS more frequently,” says Weeks. “This is a gap that is easy to address.”
Weeks is also working to reach more people who might have CH that is at high risk of progressing to AML. She developed a risk calculator to identify patients with high-risk CH called the clonal hematopoiesis risk score (CHRS). A new clinical trial in the CHIP clinic will test potential treatments in high-risk CH to see if they prevent the development of MDS or AML.
Learn more about clinical trials in the Center for Early Detection and Interception of Blood Cancer.
Guiding people with an elevated risk of cancer to genetic testing
Syngal and her team, developed a cancer risk assessment screener called PREMMplus that helps people determine if they might be at a higher risk of developing cancer due to inherited genetic changes. These people would be good candidates for referral to genetic counseling and/or genetic testing to determine if they carry any cancer-related risk genes.
People who do carry risk genes are eligible for earlier, more frequent, or specialized screening that can help identify cancer early, when it is easier to treat.
PREMMplus was originally developed at Dana-Farber. Now, the team is rolling it out in three other places so it will reach more people:
- Kaiser Permanente Mid-Atlantic States, which serves a diverse population that includes many Black Americans.
- Logan Health in Montana, which serves many lower income individuals and a large population of Native Americans.
- Denver Health, which also serves a lower income community and a large Hispanic population.
The team is working to commercialize the tool so it can reach even more people. This research will help them learn more about how to improve the tool for a diverse population.
“We want to build a tool based on real world experience, based on real feedback from people of many backgrounds and ancestries,” says Chinedu Ukaegbu, MBBS, MPH, a senior scientist on the PREMM team who also is working on rolling out the tool to a wider population in the Boston area.
Including more people in early detection research
Researchers are still working to understand the factors that influence cancer risk and how to intervene early or to lower risk. To learn more about cancer risk, Syngal has launched a large study called InAdvance that aims to collect clinical information, samples, and survey data from individuals who have an elevated risk of cancer.
The samples and data will enable researchers to learn more about cancer risk and to develop strategies to improve prevention, early detection, and treatment of cancer.
Learn more about InAdvance and who is eligible to participate.