First, congratulations on winning the Early Detection Impact Award! How did it feel to receive that recognition, and what does it mean to you at this point in your career?
I am deeply honoured. More than anything, this award recognises our team’s extraordinary dedication.
When we embarked on a screening study involving over 20,000 people, we didn’t know whether plasma DNA could detect cancer before symptoms or if that would improve outcomes. For three years, colleagues went out every weekend to recruit participants. We then rescreened the cohort around four years later, including during the COVID-19 pandemic, when restrictions meant team members visited individual households to collect samples. It was demanding work that rarely appears in a scientific paper.
Seeing the effort of our researchers, clinicians, students and participants recognised at this stage of my career means a great deal to me.
Alot of your work has centred on using circulating DNA to detect cancer before symptoms appear. What have been the advances that have made early detection through a blood test increasingly feasible?
Our non-invasive prenatal testing work showed that clinically useful information could be extracted from tiny amounts of cell-free DNA amid a much larger background. In 2009, we used digital PCR to detect EGFR mutations in the plasma of patients with lung cancer.
Sequencing, methylation analysis and DNA-fragment profiling have since made cancer signals much easier to discern. But much earlier multi-cancer technology development relied on case–control studies comparing diagnosed cancer patients, often symptomatic, with people without cancer. Whether a blood test could find asymptomatic cancers in the general population was uncertain.
Screening studies yield relatively few cases and require enormous effort and expense; undertaking ours some 15 years ago was a gamble. In over 20,000 asymptomatic men, we showed that plasma Epstein–Barr virus (EBV) DNA screening could find nasopharyngeal cancer (NPC) predominantly at an early stage. That prospective evidence helped establish a model for multi-cancer early detection.
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