ST. LOUIS — Jackie Paxton’s mom died of pancreatic cancer 11 years ago. His uncle died of lung cancer before that, and his aunt died of cancer too.
Paxton, 72, of Van Buren, Arkansas, passes his annual physicals with flying colors and feels great. But he always felt like the other shoe was about to drop. “In the back of your mind, you always worry about, ‘Well if this many folks in the family passed away of cancer, is there a possibility that I have cancer?’â€
When he heard that Mercy Hospital Fort Smith offered a new blood test that for $949 can screen for more than 50 cancers, he decided either way, the results would give him peace of mind.
Two weeks after the test, in the middle of his first day back for the fall semester as a , Paxton got the results: The test detected signs of cancer of the smooth muscle, which line the inside of organs and blood vessels.
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Two days later, he got a CT scan which revealed a 7-centimeter tumor — about the size of peach — in his upper abdomen. Less than three weeks later, Paxton had surgery to remove the mass. This month, he completed the first of six cycles of chemotherapy to kill the remaining tumor cells.
Doctors found Paxton had , a rare and aggressive type of smooth muscle cancer that can spread quickly to other organs, at which point survival rates plummet. His cancer had not yet spread anywhere else in his body.
“What if it had been six months later before I actually started having symptoms? I would’ve been in much worse shape physically and probably not as able to withstand the treatment as well,†he said.
“It’s really just an amazing thing, the fact that they were able to not only diagnose that I had cancer, but also to determine what kind of cancer it was just off of that single blood draw.â€
Chesterfield-based , with hospitals across Missouri, Arkansas, Kansas and Oklahoma, is among the first health systems in the nation to offer the multi-cancer early detection test , made by California-based .
The tests are hailed as the future of cancer screening, key in reducing cancer deaths and disparities in outcomes. Galleri is listed among top inventions of 2022 by magazine and a top-10 “breakthrough†by .
Despite its promise, the test is not yet approved by the Food and Drug Administration. It is not covered by health insurance. Nor have any medical societies developed recommendations or guidelines on its use.
That’s because about who should be tested and when; and what treatments should follow.
The tests could lead to overdiagnosis of cancers that might never cause problems and result in lifelong anxiety and endless follow-up tests. Scans and imaging required to confirm the blood test results may be costly.
Still, the test can find nearly 41% of patients in the first three stages of cancer, a percentage that rises to nearly 68% when it comes to the 12 deadliest types of cancer.
Among people who do not have cancer, the test returns a false positive result just 0.5% of the time.
With only five cancer available for breast, colorectal, cervical, lung and prostate cancer available, says , Mercy’s chief clinical officer, the ability to catch dozens of other types of cancer earlier and begin treatment can be lifesaving.
“We want to be a leader in early detection,†Mohart said. “Our goal at Mercy is to really be more proactive vs. reactive and waiting for somebody to come in with a problem.â€
‘In a responsible way’
All cells in the body shed DNA into the bloodstream when they die. Multi-cancer early detection tests work by looking for the DNA from cancer cells.
Scientists have gotten better at differentiating cancer cell DNA from the massive amount of noncancerous cell DNA circulating in the blood. But it’s more difficult early in the disease process when there aren’t many tumor cells yet — like finding a needle in a haystack.
Grail made its early detection blood test commercially available in 2021, the first and only company to do so.
Mercy began offering it to patients in July. Since then, more than 2,500 people have expressed interest, and as of Dec. 20, more than 600 have gone through with the test.
, co-director of the Genetics and Solid Tumors Laboratory at the University of Washington Medical Center in Seattle, says that while the technology has vastly improved, many details remain in determining who should get the blood test and how to treat the results.
While a 0.5% false positivity rate sounds low, Pritchard said, that is still about 1 out of every 200 people who will have to undergo needless follow-up tests and worry.
“Think of the consequences of that if we do that across the country with every person,†he said. “We have a long way to go before we know how to use this in medical practice in a responsible way.â€
Another issue, Pritchard said, is what do when cancer is detected at a very early stage. Some slow-growing cancers may never be dangerous.
Current cancer screenings carry the same concern, but the blood test is unique in that it screens for so many cancers at once, he said. “That kind of compounds that issue.â€
Doctors must also determine what follow-up tests to do with a positive blood test result, Pritchard said. Do you scan just the area of the body in question? What if that doesn’t find anything? Do you then do a full-body scan? What if that doesn’t find anything?
“There are some people that are going to worry about it for their whole life, like ‘I got this positive screening result that says I have this kind of cancer, maybe I should keep looking for it,’†he said.
Up to the patient
says the blood test is “recommended for adults with an elevated risk for cancer, such as those aged 50 or older.â€
Mohart said those whose jobs place them at higher risk of exposure to carcinogens, such as firefighters, might also consider getting the test.
Mercy created an online form at for those interested to help determine if they are a good candidate. A Mercy representative will call to discuss further and direct patients to the nearest Mercy hospital offering the test.
“We go through the risks and benefits and advise if they should or shouldn’t get it,†Mohart said, “but then ultimately, it would be up to the patient if they really want it, even though we say you really don’t have to have it.â€
An expert team of physicians reviews the results and determines the best follow-up test and treatment plan, taking into account each patient’s diagnosis and risk factors, he said.
Staff quickly schedules the appointments and navigates the entire process for patients. Insurance coverage also kicks in in once a positive signal is detected in the blood.
So far, most cases have been clear cut, Mohart said. Mercy also participated in Grail’s research of Galleri with about 600 Mercy patients.
“Usually, a positive signal helps navigate us to the right organ and then the right treatment path,†Mohart said.
Officials with , the ÃÛÑ¿´«Ã½ region’s major cancer treatment provider and one of the nation’s leading research institutions, released a statement saying the center is waiting on more research on multi-cancer blood tests, including the center’s own research:
“We are also interested in advances being made by others in the early detection of cancer, including the Galleri test from Grail, once they have been rigorously tested by independent bodies. The (National Cancer Institute) is planning a large-scale study of such tests and Siteman plans to participate in the trial.â€
will begin enrolling 24,000 healthy people ages 45 to 70 in 2024 to assess the tests, which could lead to a larger and longer study of as many as 225,000.
When Paxton got his cancer diagnosis, he had to delay finishing his 12th Western novel, “Bodee and the River Pirates.†It’s now ready to go to the publisher in a week or two, he said.
He’s looking forward to starting his 45th year of teaching next fall, helping prepare future special education teachers. And looking after his 30 miniature donkeys on his farm, and his dog, Bo.
More than anything, he’s hoping that catching his cancer early will lead to more of what he loves most — spending time with friends and family, especially his 9-month-old granddaughter.
And there will certainly be a 13th novel.
“Yeah,†Paxton said, “I’ll be working on that before too long.â€
