Cancer doesn’t wait

Georgie girl, before cancer

In the past two weeks, my family has been rocked by news of two friends with cancer – one diagnosis, one death. After two years of grim front-page Covid statistics, bumped now from headlines by the carnage of war, it’s understandable that quotidian nightmares draw less attention. Last month, the CDC noted that screening rates for breast and cervical cancers fell by more than 80% during the pandemic, “with the most severe declines occurring in populations of low-income women of color.” Although the pace of screening has picked up since the first year of the pandemic, we haven’t made up the difference.  “Experts predict that more than 10,000 more people will die from breast and colorectal cancer alone due to screening delays.”

President Biden’s 2022 budget for the National Institutes of Health includes a request for funding Advanced Research Projects Agency for Health (ARPA-H). According to the NIH, “ARPA-H will be tasked with building high-risk, high-reward capabilities (or platforms) to drive biomedical breakthroughs – ranging from molecular to societal – that would provide transformative solutions for all patients.” I searched the site looking for a reference to the use of canine olfaction for early screening, disappointed to find zero search results. I found a paper on the NIH website that did review the use of canine olfaction, but it dismissed its use for detecting disease and cancer.

Science and health industries focus on supply: developing and distributing healthcare technology. What if we approached cancer from a retail perspective, focusing on people first?

The retail perspective

Pixabay

Every successful retailer today has retooled to be competitive with Amazon. Competitiveness requires that shopping must be accessible at any time, cheap, and easy. Those ghosts of companies who weren’t able to make the transition now haunt the vacant retail mall spaces blighting suburbs. Product innovation hasn’t ceased, but it’s simply not enough.  Consumers don’t want shopping to be work, regardless of the appeal of the newest thing.

Healthcare as an industry has been a laggard in this transformation. A retail consumer needs only seconds to compare prices on almost any product, and within minutes can make an informed purchase online. For even mundane purchases that cost very little, the consumer can review literally thousands of reviews from others who’ve used the product, allowing the consumer to make an informed decision on the item’s quality.

Compare this to the healthcare experience. A healthcare consumer is unlikely to know, when making an appointment, what the bill will be or whether the cost is competitive. The consumer must make a blind choice, based at best on a doctor’s advice, about the quality of the healthcare product or service and its limitations. Often, patients must schedule routine screening appointments months in advance. Overall, the healthcare industry has made very little substantive effort to remove barriers to early, routine screening for all. This is how tens of thousands of lives are lost needlessly.

Early screening significantly reduced cancer mortality over the past several decades. Increasing the number of people screened routinely can only produce positive outcomes against cancers. This is possible only if current barriers are removed.

Making cancer screening accessible, cheap and easy

dog with nose in air

Cancer screening must be ubiquitous, cheap, and easy, and canine medical detection ticks all three boxes. Although canine olfaction is proven to be effective in cancer screening, healthcare has so far dismissed it due to the limited number of trained dogs currently available. Instead, interest is coalescing around learning how dogs detect the presence of cancer, so that technologists can use these canine templates to create devices that mimic canine scenting. A study that piloted this kind of technology reported:

“Our results demonstrate the canine ability to discriminate, learn, and improve detection even when presented a small number of samples of a complex odor. The challenge remains on how to port canine intelligence into machine olfactors.”

Feasibility of integrating canine olfaction with chemical and microbial profiling of urine to detect lethal prostate cancer, 17 February 2021

You may be wondering what problem this effort is trying to solve. The study’s authors concede that canine detection is unmatched by man-made technology. However, the fact that there are not enough trained dogs led them to test how they can ‘port canine intelligence into machine olfactors.’ Should this effort be successful in the future, it will produce yet another high-cost healthcare product that will be inaccessible to many. It won’t be ubiquitous, it won’t be cheap, and it may not be easy for the consumer.

There are about 90 million dogs in the US (272,727 per 1 million inhabitants). To provide a sense of scale, let’s consider how many mammography machines there are: 22,110 or 67 machines per 1 million inhabitants. To scale canine detection to the same number of machines would require 0.024% of dogs living in the US to have both the capability and training for medical detection. To increase access tenfold, 0.245% of dogs would have to be capable and trained. The fundamental issue isn’t availability of resource but rather the will to address the problem of increasing the number of trained resources.

Dogs have a cognitive and olfactory ability that we can match neither biologically nor technically. We could put efforts into figuring out how to train more of them and make their services available at a low cost, with high accuracy and fast results, to many more people.

Cancer’s not waiting for us to figure it out.  

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