By Jim Poggi
Are we starting too late?
There are a few words that scare most of us. “Cancer” is one of those words.
Whether it is a personal diagnosis or a friend sharing their diagnosis, it is one of those words that makes most of us think of worst-case outcomes.
Just being asked to prepare for an MRI or a CT scan when uncomfortable symptoms come up is a frightening prospect. Most of the time, the good news is that the results show that we do not have cancer. But, since cancer is still the second leading cause of death and will be diagnosed in one out of five Americans, we need to face it in our professional lives selling lab products, and also in our personal lives.
This column will cover the current state of cancer screening and whether some cancer screening tests should be performed earlier. This column presents my viewpoint, and does not necessarily represent current mainstream medical practice or science. I think my ideas are on the right track, but this column is intended as food for thought and not necessarily the pathway to better cancer diagnosis.
Facts and figures
First, what are the established statistics on cancer as a cause of death? Should we be concerned? According to National Vital Statistic Reports, Sept. 16, 2025, cancer is the second leading cause of death in the U.S. The good news is that the death rate is declining, but the bad news is that the incidence is still high enough to warrant concern.
According to the latest data from 2023, 1.2 million people will die of cancer in the next 12 months. Additionally, cancer death rates are similar by gender and the data shows that nearly 20% of all deaths in the U.S. are currently due to cancer.
With that rather negative news, what is the point I am trying to make? As I have reported before, both diagnostics and therapeutics for cancer are improving dramatically, and those factors – combined with changes in personal habits such as the reduction in adult smoking – are driving cancer death rates down. That observation led me to ask two questions:
- How is lab technology impacting the diagnosis and follow up on cancer?
- Should screening for cancer start earlier?
Follow along with me as I share some insight on these questions.
Defining liquid biopsy
We will be referring to liquid biopsy frequently in this column. The term has been used in many articles related to emerging diagnostic methods. I am assuming many of you have researched it for yourselves, but I want to make sure we all have the same working definition of liquid biopsy. According to the National Cancer Institute, liquid biopsy is defined as a laboratory test done on a sample of blood, urine, or other body fluid to look for cancer cells from a tumor or small pieces of DNA, RNA, or other molecules released by tumor cells into a person’s body fluids. Liquid biopsy allows multiple samples to be taken over time, which may help doctors understand what kind of genetic or molecular changes are taking place in a tumor. A liquid biopsy may be used to help find cancer at an early stage. It may also be used to help plan treatment or to find out how well treatment is working or if cancer has come back.
If you buy into the philosophy that lab tests should be performed to initiate or modify a patient treatment program, liquid biopsy fits the definition nicely. The complexity of the technology used to perform liquid biopsy limits its utilization in the physician office. And, more to the point, while our knowledge of the causes of cancer and how it changes based on therapies used to eradicate it has increased substantially over the past 20 years, there is still a lot to know, and liquid biopsy is still in its infancy as a fundamental diagnostic method.
Cancer screening
What kinds of screening are we talking about? There are two broad categories of screening, general population screening and risk-based population screening. As we shall see, both categories apply to cancer diagnosis.
The four most common types of cancer – breast, prostate, lung and colon, in that order – account for 50% of all cancers diagnosed annually. But, death rates differ, with lung, colon, pancreas and breast as the four leading causes of cancer death. Why is this? In the case of lung and pancreas, it is largely because diagnosis occurs when symptoms become apparent, usually when cancer has advanced to Stage 3 or 4, where the 5-year survival rate is lower. This leads to the question: what can we do to reduce the mortality of these cancers? My thoughts follow.
Lung cancer
The incidence of lung cancer has declined from a high of 87 cases per 100,000 in 1984 to fewer than 60 cases per 100,000 in 2023. So, progress is being made here. Men still have a higher rate at 59.2 cases per 100,000 than women at 48.1 cases per 100,000.
Decreases in adult smoking, along with public health policies fostering this decrease (taxation on tobacco products, prohibition of smoking in public places and public awareness campaigns) have largely driven this decrease. Reasons for the persistent current incidence include occupational exposure, exposure to secondhand smoke and exposure to radon gas and air pollution.
From a diagnostic viewpoint, annual CT scans are recommended for current and former smokers and are being routinely used for earlier diagnosis when prognosis is better. They have made a significant difference in diagnosis of high-risk individuals, reducing mortality by about 20%. Their use is now well established medical practice for high-risk individuals. From a therapeutic viewpoint, new immunotherapy methods are also improving survival rates for those diagnosed with lung cancer. However, lung cancer continues to be a target for earlier diagnosis since its mortality rate exceeds its new case diagnosis, (20% mortality compared to 11% of new cases diagnosed).
What does the future look like? I believe it is bright. New liquid biopsy technologies are coming into the market, combined with AI and its application to big data they deliver the promise of detecting lung cancer tumors and cellular mutations indicative of early lung cancer earlier.
What type of screening could improve the outcome for lung cancer diagnosis? I believe it would be risk-based screening, focused on exposure type, specifically persons with occupational and secondhand smoke exposure. There are no well-established tumor marker screening tests for lung cancer cleared by the FDA.
Prostate cancer
Prostate cancer is gender specific, and is the second most commonly diagnosed cancer. But, it has a high survival rate, with a 98% survival rate across all stages at 5 years. There are many reasons. It tends to be a slow growing cancer and is frequently diagnosed in elderly men, who may die of other causes before prostate cancer becomes a factor.
PSA and free PSA tests continue to be the “gold standard” suite of diagnostic tests, though improvements in specificity are being researched, along with assays that could determine which prostate cancers will be aggressive and which will be latent. AI, big data and liquid biopsy are likely factors in reducing mortality and also selectively determining which patients diagnosed with prostate cancer should be followed up for more intense treatment. Current age-based screening methods and improvements in diagnostic specificity are the key to the future.
Colorectal cancer
Colorectal cancer (CRC) is the cancer type that got me thinking about whether we should be screening earlier. It is the fourth most commonly diagnosed type of cancer in the U.S., and while typically slow growing, it has the second highest mortality rate. This clearly paints the picture that early detection is the key to improving mortality rates.
Mortality rates vary significantly based upon whether the disease was diagnosed at the local stage or later. Five-year survival is up to 81% even for CRC diagnosed at the regional level, but only 23% or less when diagnosed at the distant level. As a consequence, early diagnosis is critical to patient outcomes. Current guidelines from the United States Preventive Services Task Force (USPSTF) give screening for adults aged 50 to 75 years an “A” rating, and screening for adults aged 45-49 a “B” rating.
What do these grades mean? Grade “A” is defined as strongly recommended and grade “B” is defined as recommended. The American Cancer Society recommends colorectal cancer screening beginning at age 45.
Recommendations for CRC testing from both organizations are virtually identical: FOBT or FIT yearly starting at 45; colonoscopy every 10 years for patients at average risk. Physician offices have led the way with screening for colorectal cancer, and physician office lab testing options for colorectal cancer screening have a long and successful history (fecal occult blood tests (FOBT) followed by fecal immunochemical tests (FIT)).
In the greater scheme of testing for CRC, there are currently available send out tests, including those that combine stool FIT with methylated DNA tests. Determining the amount of DNA that is methylated is important since methylation of DNA is associated with the development of cancer.
Even more sophisticated molecular tests are on the horizon. New CRC tests are in development with advances in liquid biopsy promising even better early diagnosis and superior ways to evaluate post treatment eradication of cancer.
While test methods are advancing, there is a quirk in the age of incidence that is just beginning to be understood. In a 2026 publication by the American Cancer Society, there is data showing that the recently reported age-related incidence rate of CRC shows a rise starting at 30-34 that exceeds the published incidence rate for the same age group in 1995. So, colorectal cancer is occurring earlier. And the rate of incidence in this population group is increasing. What does this mean? Will testing recommendations start earlier?
So far, the recommended age for first screening remains at 45 for both ACS and USPSTF. But, as more data becomes available, I believe it is likely that at least risk-based screening will begin earlier as the risk elements become better understood. I strongly recommend you discuss this information with your trusted lab manufacturers of CRC tests to get their insight on the future of CRC testing. I believe there will be reasons to begin risk-based testing earlier and that at least some molecular tests will migrate down to the physician office market, just as respiratory tests did a few years ago. Keep a close eye on developments.
Breast cancer
Breast cancer is a type of cancer where we could declare we are “winning” or at least beginning to see evidence of winning. Despite being gender specific, breast cancer is the most commonly diagnosed cancer at 16% of all cases, but has a 7% mortality rate, placing it behind lung, colon and pancreas cancer related to its mortality rate. Seven percent mortality rate compared to 16% incidence rate does not mean we need to be complacent or satisfied with the current state, but it does indicate that current diagnostic and treatment methods are having a positive impact. While the incidence rate of breast cancer has remained steady at about 140 cases per 100,000 of the female population since 1992, the mortality rate has declined steadily from 31.7 cases in 1992 to 18.6 cases in 2023.
Advancements in understanding the different types of breast cancer as well the understanding which treatment plans can be most effective in treating them are factors influencing the reduction in death rates from breast cancer. Mammography remains an essential screening method, along with MRI and ultrasound. USPSTF recommends mammography every other year beginning at age 40 with a grade of B. ACS recommends routine mammograms annually beginning at age 45, with the option for women 40-45 to begin mammograms.
Breast cancer is another example of screening recommendations moving to younger patients, though USPSTF and ACS recommendations vary somewhat. Lab tests for breast cancer include CA 27-29 and CA 15-3. Like many other types of cancer, liquid biopsy is gaining acceptance, particularly to monitor treatment response as well as to detect relapse post treatment. It is also used to guide therapies by detecting cancer cell mutations and informing appropriate treatment based on these findings. Liquid biopsy is more established for breast cancer than any other type of cancer I am aware of.
Pancreatic cancer
Pancreatic cancer currently does not have a specific, well defined and accepted screening test. Multiple companies are working to research liquid biopsy methods of detecting pancreatic cancer, but at this time there is no FDA 510(k) or other FDA cleared test for pancreatic cancer.
Pancreatic cancer is drawing increased research interest because it is lower in incidence than the other cancers mentioned above but represents 8% of the cancer deaths reported in 2025. The most generally accepted reason is that pancreatic cancer does not have specific signs and symptoms that lead to a definitive diagnosis until it has become well established.
Current survival statistics paint a grim picture. The best 5-year survival rates for pancreatic cancer are 44% if diagnosed at the local stage, which is unlikely. The rate drops to 17% for regional disease and 3% for distant diagnosis. Worldwide research is working diligently to find a clear diagnostic marker associated with pancreatic cancer, particularly in early stages. Early results of the research are encouraging but there is a lot of work to do in order to establish a marker that meets established criteria to be a useful screening tool.
Risk-based screening is most likely to be the first screening modality for pancreatic cancer. Acknowledged risk factors include smoking, diabetes, excess body weight and workplace exposure to certain chemicals as well as family history.
Today imaging tests including CT and MRI are used for patients with established signs and symptoms (fatigue, jaundice, weight loss, abdominal or back pain and others) associated with pancreatic cancer. CA 19-9 and CEA are also used as part of the diagnostic picture for patients exhibiting symptoms associated with pancreatic cancer.
Reasons for earlier diagnosis
So, where does this leave us? Does it prove that earlier diagnosis of cancer is the key to reduction in mortality? I believe it provides at least some data to suggest that there are reasons to perform colorectal cancer testing earlier, especially if we can clearly define CRC risk factors in this population group.
Secondly, it establishes that risk-based screening is important across the board for the most common cancers. Finally, it confirms that early diagnosis is the key to reducing cancer mortality no matter which type of cancer we are referring to.
That is where you and your trusted lab manufacturers come into play. Your responsibility? Continue to promote early cancer screening with your customers and continue to learn more about future screening developments from your lab manufacturers.
Your lab manufacturers have the heavy lift: continuing to improve current screening methods and also establishing liquid biopsy as viable screening and follow up methods for cancer while working on ways to make it available at the point of care.
With colorectal cancer, you and your trusted lab manufacturers have proven that cancer testing at the point of care is the key to significantly reducing mortality. Keep doing your work and keep in touch with your lab manufacturers. We are winning some battles with cancer, but the future requires further improvement. Stay engaged and play your part actively.
Cancer Screening Snapshot: What to Know Now
Lung cancer
- Who to screen: Annual low-dose CT scans are recommended for current and former smokers at high risk, reducing mortality by ~20%.
- What’s next: Emerging liquid biopsy and AI-driven risk models may expand screening beyond smoking history to include occupational and environmental exposures.
Prostate cancer
- Core tools: PSA and free PSA tests remain the gold standard for early detection.
- Future focus: Improved diagnostics aim to distinguish aggressive cancers from slow-growing cases, helping avoid overtreatment.
Colorectal cancer (CRC)
- Start earlier: Screening is recommended beginning at age 45, with options including annual FIT/FOBT tests or colonoscopy every 10 years.
- Why it matters: Early detection dramatically improves survival—up to 81% at regional stages vs. ~23% when diagnosed late.
Breast cancer
- Routine screening: Mammography remains essential, with most guidelines recommending screening starting at age 40–45.
- Advancing tools: Liquid biopsy and molecular testing are increasingly used to monitor treatment response and detect recurrence.
Pancreatic cancer
- Screening gap: No widely accepted or FDA-cleared screening test exists today.
- Risk-based future: Early detection efforts are focused on high-risk populations, with liquid biopsy research offering promising—but still developing—solutions.