Twenty-one years ago, when President Bill Clinton declared March as National Colorectal Cancer Awareness Month, he highlighted the importance of early detection in improving outcomes associated with the disease and pointed to the lack of identifiable symptoms as a major impediment to early diagnosis. As is always the case, many of the 130,000 colorectal cancers diagnosed in the U.S. that year were found after the cancers had progressed too far to be effectively treated.
Since the inception of National Colorectal Cancer Awareness Month, which addresses the third-leading cause of cancer-related deaths in the United States, increased awareness around the importance of screening has successfully lowered rates of colorectal cancer among those considered at high risk for the disease.
One of the Biggest Barriers to Early Detection is Understanding Who is at Risk
Despite more screening, certain populations are increasingly diagnosed with colorectal cancer, largely owing to our inability to appreciate who is at risk. For instance, not long ago, we believed that colorectal cancer screening was not necessary until age 50 and that familial risk was relevant only if a family member had overt colorectal cancer.
Clinical observations have helped us recognize that colorectal cancer screening should occur earlier and that a family history of precancerous adenoma is enough to increase one’s risk for cancer. Nonetheless, there remain significant gaps in our understanding of who will develop colorectal cancer. We therefore have an urgent need for new ways to identify early who is at higher risk, as well as ways to act on that information.
Another impediment to early detection is the limited predictive power of our gold-standard screening technique – the colonoscopy. While colonoscopies are valuable for detecting and removing potentially pre-cancerous polyps, their clinical benefits – even when combined with pathology – depend on the presence of clinical features that likely indicate that problematic biological processes are already underway.
If we could identify changes at the molecular level that precede what can be detected through colonoscopies, we could determine who is at a higher risk for colorectal cancer much earlier than our conventional tools allow. Critically, we could then also develop therapeutics to address those early biological changes and prevent the formation of the precancerous growths that are identified through colonoscopies.
New Techniques for Early Detection will Allow Us to Intercept Cancers Before They Develop
Identifying biomarkers and developing targeted therapeutics to treat colorectal cancer before it starts are major efforts currently underway at Janssen. Our clinical trials in colorectal cancer interception are investigating how we can discover and disrupt biological processes that enable the growth of tissue that eventually becomes cancerous.
Our vision for eliminating colorectal cancer involves identifying and treating people who may develop the disease so early that the colonoscopy becomes a tool to confirm the absence of malignancies rather than to catch those malignancies early. Critically, our goals include generating more data from people of different ethnicities and backgrounds so that any biologically-based drivers of the health disparities we observe in colorectal cancer can be adequately addressed through precision medicine.
Interception also has advantages that begin with the screening itself. Unlike colonoscopies that are invasive and relatively inconvenient, screening for molecular markers for colorectal cancer has the potential to be noninvasive and convenient for both patients and providers. At Janssen, we are studying and advancing therapeutic strategies to intercept colorectal cancer by targeting key molecular events, with a goal of eliminating precancerous cells.
Even with Innovative Interception Technologies, Awareness Remains Key
No matter how advanced or powerful our innovations for identifying and treating people at increased risk for colorectal cancer become, their ability to address colorectal cancer depends on how well they are deployed. As with any screening or treatment program, patient awareness and education are critical, and we must make sure that our outreach efforts during National Colorectal Cancer Awareness Month reflect the new information we have on colorectal cancer.
Despite the therapeutic advances of recent decades in treating advanced disease, colorectal cancer is expected to take nearly 53,000 lives in the U.S. this year. While the goal around colorectal cancer was once to increase screening so that overt cancers could be found and treated before they matured further, the goal now is to develop tools for identifying those individuals at an increased risk of developing colorectal cancer so that we can intervene and prevent the cancer from forming in the first place.
