Update: Tackling #Cancer is not just playing to the gallery

The Mona Lisa in a face mask as the Louvre is closed due to the coronavirus? Not such an enigmatic smile on her face today, perhaps, writes European Alliance for Personalised Medicine (EAPm) Executive Director Denis Horgan. 

La Gioconda, which means 'jocund' - ‘happy' or ‘jovial’ - may look a little less chirpy in the internet memes at the moment, but we can perhaps cheer her up by explaining that one piece of good news is that EAPM’s end-of-March conference in Brussels is scheduled to go ahead as planned.

The Alliance is following all guidelines and recommendations, so hopefully you’ll all be there with us. You can register here.

COVID-19 aside, EAPM is currently putting focus on biomarker testing and early diagnosis. Not the idea of it, per se, but the actual implementation. We already know it’s a good idea.

One of the ongoing goals of the European Alliance for Personalised Medicine is improving biomarker access and high-quality testing.

To this end, EAPM has been (and will be) hosting events calling on relevant stakeholders to develop a road map, and act upon it to achieve much-needed progress in these areas.

Also up for discussion will be the current limitations of biomarkers, the use of centralized databases, and advice that is, or should be, given to patients prior to biomarker testing.

As is stands, molecular diagnostic testing plays a key role in personalised medicine as it is embedded at every stage of the treatment pathway - from providing reliable information that informs the optimal treatment for the individual patient, to precise monitoring of its effectiveness.   Such diagnostics identify particular biological traits, often within the genome of the disease tissue of individuals, that can underpin diagnosis, prognosis or prediction of disease recurrence.

Part of what is required is a policy framework for biomarkers in the European Union. This would guide Member States and facilitate consistent decision making, in order that molecular diagnostics and biomarkers can be integrated into the EU’s divergent healthcare systems. 

Updating what’s gone before - 'It's just *so* 2003'

A core focus of the Alliance’s ask in this arena is the revision of the existing 2003 European Commission recommendation and optimal testing/minimum testing.

The explanatory statement from 17 years ago acknowledged that “The possibility of treating cancer undeniably depends on how early it is diagnosed.

“The inexorable development of the disease would otherwise require aggressive and invasive forms of treatment, which are costly and traumatic.

“The only sure weapon we now have to prevent this happening is secondary prevention, consisting of predictive clinical tests, since primary prevention is subject to less controllable variables, such as environmental factors, eating habits and lifestyle, which differ from country to country.”

Five years later, in 2008, we had a further explanatory statement, part of which read: “Europe is still characterized by unacceptable inequalities in cancer control. For this reason the EU as well as national states have launched several projects including Cancer Screening Programmes and National Cancer Plans. 

“A well-conceived, well-managed national cancer control programme lowers cancer incidence and improves the life of cancer patients, no matter what resource constraints a country faces. 

“Therefore, one of the most important partnership actions should be to call on all governments in the EU to develop, implement and, where already existing, improve national cancer plans. Such plans should tackle the disease on all fronts - from prevention, screening and early detection to top-quality diagnostics and treatment and care, psychosocial and palliative care and include cancer research.”

Big stuff. And it’s still big because not enough has been done, for all the words and ideas. The lack of what EAPM would call substantial progress has been tacitly acknowledged and reflected in the new Commission’s Beating Cancer Plan, which is a major project for the Ursula von der Leyen executive.

Hence, the time is ripe for EAPM to renew its calls for the EU executive to take a long, hard look at preventative measures, and the relatively new opportunities provided by biomarkers.

Making health care sustainable

EAPM has long had a focus on prevention and early diagnosis, for example through screening programmes, and especially with respect to cancer. 

One key aim of EAPM stakeholders is to focus on the right preventative measures to ensure reliable and sustainable healthcare for the long-term benefit of patients now and in the future.

Back in 2003, the Commission recommended that Member States should offer evidence-based cancer screening through a systematic population-based approach with quality assurance at all appropriate levels. 

It said they should implement screening programmes in accordance with European guidelines on best practice where they exist and facilitate the further development of best practice for high quality cancer screening programmes on a national and, where appropriate, regional level.

Among other recommendations was ensuring that due regard is paid to data protection legislation, particularly as it applies to personal health data, prior to implementing cancer screening programmes, while making available centralised data systems needed to run organised screening programmes.

Staying on data, the Council urged Member States to collect, manage and evaluate data on all screening tests, assessment and final diagnoses, and regularly monitor the process and outcome of organised screening and report these results quickly to the public and the personnel providing the screening.

Training was also mentioned, with the Council suggesting that EU countries adequately train personnel at all levels to ensure that they are able to deliver high quality screening. 

Key, also, was a call for the Commission to support European research on cancer screening including the development of new guidelines and the updating of existing guidelines for cancer screening. 

Since then, the science in medicine has developed at a rapid rate, and the relatively new concept and availability of ‘Big Data’, and all it offers, make it clear that the 2003 Recommendation is way, way, way out of date.

And now we have biomarkers…

In its draft reply to the Commission’s consultation on the Beating Cancer Plan, EAPM has this to say on the potential of biomarker testing and advanced molecular diagnostics: 

“Biomarkers tests at our disposal that predict responses to therapeutic or preventive interventions support a personalised cancer care plan that can maximise health benefits while minimizing debilitating toxicities. 

“Adherence to a one-size-fits-all approach for diseases such as cancer is no longer justifiable from a health-care or quality-of-life perspective and also represents a waste of precious health resources. 

“Initiatives such as the French National Cancer Institute’s molecular testing network, in which a framework of 28 regional laboratories provide a national service that informs treatment selection, represent a model for this type of approach. 

“Increasingly, patients are becoming more aware of the benefits and challenges of personalised medicine and the role of personalised care plans and are participating as active partners. rather than as passive recipients.”

Meanwhile, the European Parliament has passed motions on such matters as lung-cancer screening a cause that EAPM has continually espoused.

Aside from this, EAPM has been at the forefront of pushing the benefits of biomarker/molecular diagnosis, as well as playing a key role in the setting up of the 1 million European genome project, which has seen a swathe of EU Member States, plus other bodies, sign up to a voluntary Declaration geared to bringing about a cohort of a minimum one-million-plus genomes by 2023.

Dear Commissioners…

The Alliance, among other key asks, is now urging the Commission with its new, high focus on cancer to utilise investment to build laboratories, increase education for testing, public and healthcare professional knowledge and understanding of testing, appropriate guidelines and standards, and more efficiency in terms of healthcare budgets.

The bottom line is that most experts in the field have agreed that Europe’s health systems need to adapt quickly to allow patients and citizens to benefit from early diagnosis of cancer and reduce mortality for this lethal disease.

Arguably, the launch of the Beating Cancer Plan represents the best opportunity for nearly two decades. Let’s not waste it.

Despite the devastation bringing wreaked currently by the Corona virus, we have to remember that the world survived the Spanish flu, H1N1, and SARS, and it should survive the latest virus, too.

Viruses come and go. That’s their nature. Cancer is with us always, in its various forms. Dealing with this never-ending threat is perhaps something for the enigmatic Mona Lisa to ponder behind her bullet-proof glass…

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