According to a recent report from the American Cancer Society, cancer survival rates in the United States are climbing. While this welcome trend is a result of a combination of scientific, technological and medical advances, there is no doubt that innovations in medical imaging and radiation therapy technologies play a critical role in the fight against cancer.
In just 20 years, medical imaging has provided physicians and researchers with unprecedented insight, facilitating the development of new approaches to detect, diagnose and treat deadly cancers.
Detection and Diagnosis
In its early stages, cancer is harder to detect but, if caught, is easier to treat. Medical imaging allows physicians to peer deep inside the human body to detect these elusive, early signs of cancer when symptoms may not have even appeared.
Low-dose lung computed tomography (LDCT) can detect tumors as small as a grain of rice and has been shown to reduce lung cancer deaths by 20 percent compared to chest X-ray in high-risk patients. The National Lung Screening Trial (NLST) recently demonstrated that 12,000 deaths could be avoided every year if high-risk patients underwent LDCT. Indeed, this test is so valuable that the Veteran’s Administration has adopted it, private insurers cover it and several cancer organizations recommend it. The Centers for Medicare and Medicaid Services (CMS) is currently evaluating (registration required) whether to cover and pay for lung LDCT among Medicare beneficiaries.
Another dramatic example is CT colonography (also referred to as “virtual colonoscopy”), which uses a low-dose CT scan to detect polyps and tumors in the colon and is faster to perform than traditional colonoscopy. It eliminates the need for sedation, is less invasive and allows patients to return to normal activities immediately. Not only do data prove that CT colonography is as effective as standard colonoscopy, it also may encourage patients to undergo this recommended screening. According to Dr. Brooks Cash, Integrated Chief of Medicine and Staff Gastroenterologist at the National Naval Medical Center/Walter Reed Army Medical Center, 40 percent of patients chose CT colonography over traditional colonoscopy. Moreover, 37 percent of patients who underwent colon cancer screening said they would not have been screened without CT colonography. A similar effect has been seen at the University of Wisconsin, where overall screening rates for colorectal cancer more than doubled after CT colonography was introduced as an additional screening option.
When it comes to breast cancer detection, traditional X-ray mammography used to screen recommended populations correctly identifies cancer in about 78 percent of women who have breast cancer overall and 83 percent in women over 50. For women whose mammogram detected an abnormality, an ultrasound can help prevent unnecessary biopsies. And for women with dense breasts who are at higher risk of developing breast cancer, magnetic resonance imaging (MRI) can detect early tumors.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Staging and monitoring
Medical imaging is an equally essential tool in determining cancer staging. Accurate staging is a prerequisite for prescribing an effective treatment. At the cellular level, molecular imaging detects disease before any symptoms or signs are noticeable. For example, positron emission tomography (PET) combined with CT (PET/CT) provides detailed images of internal structures as well as signs of abnormal activity, enabling better detection of tumors and more accurate staging of cancer. Patients have benefited from PET/CT when used to stage for therapy planning or to monitor therapy as abnormal activity can occur in areas that appear normal on traditional anatomic imaging, such as CT. This has been particularly useful for lymphomas, lung cancer, gynecological cancer, esophageal cancer and colorectal cancer, to name a few.
In addition, PET is one of the most powerful tools in the management and treatment planning of many cancers. In one study, PET imaging enabled physicians to avoid unnecessary tests or procedures 77 percent of the time and, in 36 percent of cases, PET scanning resulted in a change in the decision whether or not to treat.
More precise, targeted treatment
Advances in medical imaging and radiation therapy lead to far more precise cancer treatment while avoiding damage to surrounding cells.
Intensity-modulated radiation therapy (IMRT) uses imaging to target tumors with great precision, limiting the harm to healthy cells. When compared to standard radiotherapy, IMRT allows radiation oncologists to use stronger radiation doses since IMRT spares the surrounding healthy tissue from unnecessary exposure.
Stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT) use robotic positioning and real-time, continuous imaging to guide radiation therapy with sub-millimeter precision. Because the real-time image guidance allows the radiation therapy to follow the body as it moves, SRS and SBRT are especially useful in treating moving organs, such as the lungs, or tumors located near critical organs like the heart.
In addition to revolutionizing patient care, imaging has become a critical tool for scientists to understand cancer and its progression at a molecular level and to develop effective treatments. Researchers at the Cedars-Sinai Maxine Dunitz Neurosurgical Institute’s Department of Neurosurgery are investigating the use of a new, targeted imaging agent to guide removal of malignant brain tumors and other cancers without damaging healthy tissue.
Whether improving public health or enhancing a patient’s quality of life, innovations in medical imaging and radiation therapy have given clinicians dramatic new options for care. We can expect cancer survival rates to continue to grow as new technologies become available for the early detection, staging and treatment response monitoring of cancer.
