♪ ♪ >> IF CANCER SCREENING DIDN'T REQUIRE THE SQUISH, THE PROBE, THE WASHOUT OR THE POKE, WOULD YOU BE MORE INCLINED TO GET IT DONE?

STAY WITH US AS WE TALK WITH Dr. WHITNEY JONES ABOUT USING A SAMPLE OF BLOOD TO SCREEN FOR MOST CANCERS NEXT ON "KENTUCKY HEALTH."

>> IT IS SELF-EVIDENT THAT PREVENTING THE DEVELOPMENT OF CANCER IS THE EASIEST, CHEAPEST AND LEAST INTRUSIVE WAY AVAILABLE TO DECREASE MORTALITY RATES FROM CANCER.

UNFORTUNATELY BECAUSE OF GENETICS AND FACTORS IN AND OUTSIDE OF OUR CONTROL, WE CANNOT PREVENT ALL CANCERS FROM DEVELOPING.

THEREFORE WE ARE LEFT WITH EARLY DETECTION AND EFFECTIVE TREATMENT AS THE NEXT BEST WAY TO MINIMIZE DEATHS FROM CANCER.

MOST OF US, IF NOT ALL OF US, HAVE EITHER AN INTIMATE OR A PASSING ACQUAINTANCE WITH COLONOSCOPY LOOKING MAMMOGRAPHY FOR BREAST CANCER AND PROSTATE CANCER.

AS GOOD AS THESE TESTS AND PROCEDURES ARE IN IDENTIFYING EARLY CANCERS, THEIR UTILIZATION IS HAMPERED BY DISCOMFORT NEED FOR SPECIALIZED EQUIPMENT AND SHORTAGE OF PERSONNEL TO PERFORM AND INTERPRET THE TEST RESULTS.

IDEALLY WHAT WE REALLY WOULD WANT IS AN EFFECTIVE TEST THAT COULD IDENTIFY EARLY CANCERS AND ABLE TO IDENTIFY MORE THAN JUST ONE CANCER, EASY TO CARRY OUT AND BE AVAILABLE IN ALL AREAS.

WHAT IF I TOLD YOU THAT USING A SIMPLE BLOOD DRAW, WE COULD DO ALL OF THE ABOVE AND THIS IS GOING TO HAPPEN VERY SOON?

WOULD YOU DO IT?

I KNOW I WOULD.

TO TALK TO US ABOUT THE FUTURE OF CANCER SCREENING, WE HAVE AS OUR GUEST TODAY Dr. WHITNEY JONES.

GASTROENTEROLOGIST ATTENDING THE UNIVERSITY OF LOUISVILLE AND FELLOW AND RESIDENCY AT THE UNIVERSITY OF TEXAS SOUTHWEST MEDICAL CENTER.

HE COMPLETED FURTHER TRAINING IN ADVANCED ENDOSCOPY IN CANADA AND IN JAPAN.

HE IS IN SO CALLED SEMIRETIREMENT FROM THE PRACTICE OF CLINICAL MEDICINE BUT CONTINUES TO WORK TIRELESSLY TO DECREASE THE MORTALITY FROM ALL CANCERS BUT MOST ESPECIALLY FROM THAT OF COLON AND RECTAL CANCER HE HAS WORKED WITH THE COLON PREVENTION CANCER THAT HAS LED TO A MARKED INCREASE IN CANCER SCREENING AND DECREASE OF COLORECTAL CANCER HERE IN KENTUCKY.

>> IT IS A PLEASURE TO BE WITH YOU.

>> I SAID YOU ARE IN SEMIRETIREMENT BUT YOU ARE CURRENTLY WORKING ON SOME PROJECTS GERMANE TO WHAT WE ARE GOING TO TALK ABOUT TODAY.

>> I WANT TO JUST MAKE SURE, I'VE SPENT LAST TWO YEARS IN SILICON VALLEY WORKING IN BIOTECH FOR A COMPANY THAT HAS A PRODUCT I'M NOT AT THE COMPANY RIGHT NOW BUT I WILL BE JOINING AS A CONSULTANT BY THE TIME THE SHOW AIRS.

OUR GOAL TODAY IS NOT TO TALK ABOUT A SPECIFIC TEST BUT TO TALK ABOUT THIS TECHNOLOGY PLATFORM THAT IS COMING AT WARP SPEED TO THE COUNTRY.

>> GOOD.

WELL I DON'T KNOW WHAT VERSION OF STAR TREK WE ARE ON RIGHT NOW SO WE'LL FIND OUT WHAT WARP SPEED REALLY IS.

FIRST OFF, WE TOSS THE TERM AROUND BUT WHAT IS SCREENING?

>> SCREENING IS TAKING A POPULATION WHO IS AT RISK FOR A PARTICULAR ISSUE, ASYMPTOMATIC, NO SYMPTOMS WHATSOEVER AND PERFORMING A SCREENING TEST THAT HAS THE ABILITY TO IDENTIFY AN UNDERLYING CONDITION, CANCER SCREENING, CHOLESTEROL FOR HEART DISEASE, VISION SCREENING, BLOOD PRESSURE SCREENING AND NOT JUST FINDING IT BUT HAVING THE ABILITY TO IMPACT THAT DISEASE BY FINDING IT EARLY.

AND THAT'S REALLY WHAT SCREENING IS ABOUT.

FINDING THE CONDITION THAT DOESN'T HAVE SYMPTOMS AT THE TIME YOU ARE LOOKING FOR IT AND THEN SCREENING FOR A CONDITION THAT CAN BE APPROPRIATELY AND WELL TREATED, NOT JUST FINDING A CONDITION.

>> HOW DOES THAT DIFFER FROM A DIAGNOSTIC TEST> >> DIAGNOSTIC TESTS ARE WHEN PEOPLE HAVE ACTUAL SYMPTOMS, THEY PRESENT WITH A PROBLEM, COUGH, ABDOMINAL PAIN, CHANGE IN BOWEL MOVEMENT.

IT COULD BE A STRUCTURAL ISSUE OR INFLAMMATORY ISSUE.

BUT DIAGNOSTIC TESTS ARE FOR PEOPLE WHO HAVE SYMPTOMS AND SCREENING IS FOR THE ASYMPTOMATIC INDIVIDUAL.

>> WHERE ARE WE NOW WITH SCREENING FOR CANCER?

ARE WE LOOKING AT JUST A SINGLE TEST TO IDENTIFY A SINGLE CANCER AND WHAT ARE SOME OF THOSE THINGS?

>> THAT'S A GREAT QUESTION.

AND WE'LL GET TO YOUR INTRODUCTION BECAUSE I WISH I COULD GET RID OF THE PROBE AND THE POKE AND ALL THOSE.

BUT WE ARE NOT GOING TO BE QUITE THERE YET BUT WE ARE GOING TO BE ABLE TO-- RIGHT NOW WE HAVE FIVE MAJOR SCREENING TESTS PROSTATE, BREAST, CERVICAL, COLON AN LUNG.

THOSE ARE OUR BIG ONES AND WE ARE NUMBER ONE IN THE NATION FOR COLON CANCER AND LUNG CANCER INCIDENTS.

I ENCOURAGE EVERYONE WHO MEET THE CRITERIA TO GO OUT.

BUT UNFORTUNATELY, WE ONLY DETECT ABOUT 16% OF CANCERS THROUGH SCREENING.

THE VAST MAJORITY OF CANCERS DON'T HAVE ANY SCREENING WHATSOEVER.

SO THOSE PEOPLE TEND TO PRESENT TO THE DOCTOR WITH SYMPTOMS.

NEEDING A DIAGNOSTIC WORKUP AND UNFORTUNATELY, THE STATISTICS ARE DREADFUL WHEN YOU PRESENT WITH SYMPTOMS FOR CANCER.

THE MAJORITY OF PEOPLE ARE DIAGNOSED IN STAGE 4 AND STAGE 3 DISEASE, WHICH IS ADVANCED CANCER.

CHEMO, RADIATION NEEDED.

AND SO REALLY THE BIG I AM IMPETUS AS WE TALK ABOUT TODAY'S TOPIC IS BEING ABLE TO INCREASE THE CANCER DETECTION RATE FROM 16%, AND I THINK WE OUGHT TO HAVE A LOFTY GOAL OF 70 TO 80% OF IT, TRYING TO FIND IT-- BECAUSE IF YOU FIND CANCER BEFORE IT'S SYMPTOMATIC, IT IS MUCH MORE LIKELY TO BE EARLIER STAGES AND EFFECTIVELY TREATED.

>> BUT WE HAVE COLONOSCOPIES, MAMMOGRAPHIES AND PAP SMEARS, AND YOU CAN ARGUE ABOUT THE PSA TOAFTS, WHAT ARE THE LIMITATIONS OF THESE PROCEDURES DONE FOR MORE PEOPLE?

>> WELL, I MEAN, THE BIGGEST LIMITATION IS WE CAN'T GET FOLKS ENGAGED IN SCREENING.

AND IT'S IMPORTANT TO KNOW THAT EACH OF THOSE CANCERS THAT YOU JUST TALKED ABOUT ARE VERY COMMON CANCERS.

CERVICAL CANCER USED TO BE THE NUMBER ONE KILLER IN WOMEN NOW AND WITH THE HPV AND VACCINATIONS, IT'S RARE.

BUT EACH OF THOSE SCREENINGS, THERE ARE SCREENING TESTS SIMPLY BECAUSE THEY WERE VERY COMMON CANCERS AND PEOPLE DEVELOPED IT.

UNFORTUNATELY, ABOUT 70% OF CANCERS HAVE NO SCREENING AVAILABLE WHATSOEVER.

AND SO AS WE TALK ABOUT THIS NEW TECHNOLOGICAL PLATFORM, YOU KNOW, IT'S NOT GOING TO REPLACE STANDARDIZED UNITED STATES PREVENTATIVE TASK FORCE SERVICES BECAUSE THOSE ARE REALLY HIGHLY SENSITIVE TESTS MEANING THEY HARDLY EVER MISS ANY CANCERS.

ON THE OTHER HAND, THEY HAVE A LOT OF FALSE POSITIVES THAT GO WITH THEM BECAUSE, YOU KNOW, YOU CAN'T HAVE BOTH SENSITIVITY AND I DON'T WANT TO GET INTO STATISTICS, BUT THE KEY IS THE MOST CANCERS DON'T HAVE ANY SCREENING WHATSOEVER AND BECAUSE OF 50 DIFFERENT TYPES OF CANCER, IT'S IMPRACTICAL TO THINK WE ARE GOING TO DEVELOP A SCREENING TEST.

OTHERWISE IMAGINE EVERY WEEK YOU WOULD BE FIGURING OUT WHICH CANCER SCREENING TEST YOU ARE GOING TO LOOK AT.

FORTUNATELY WHAT WE HAVE IS BLOOD IN THE BODY IN CONTACT WITH ALMOST EVERY SINGLE ORGANIZE ORGAN IN THE BODY AND WHAT WE HAVE BEEN ABLE TO DO IS HAVE A SAMPLE OF THAT BLOOD AND JUST LIKE TESTING A PREGNANT WOMAN NOW FOR THE DNA OF THEIR CHILD, RATHER THAN DOING AMNIOCENTESES, NOW WE ARE ABLE TO SAMPLE A PERSON'S BLOOD AND GET DNA FRAGMENTS AND PATTERNS FROM CANCERS IN PEOPLE WHO DON'T HAVE SYMPTOMS.

>> SO, ARE YOU SAYING THAT EVEN EARLY ON, A CANCER WILL SHED CELLS INTO THE BLOOD THAT CAN BE IDENTIFIED?

>> WELL, THEY CAN SHED CELLS, BUT IF THE CELLS ARE IN THERE, THAT'S MICRO METASTATIC DISEASE.

THESE ARE SMALL FRAGMENTS OF DNA.

THE WHOLE DNA IS 3.2 BILLION BASE PAIRS LONG.

THESE ARE 100 TO 150.

VERY SHORT, HALF LIFE OF 30 MINUTES.

MEANING THEY'RE THERE AND THEN THEY'RE NOT.

IT'S TRULY A SNAPSHOT BUT NOT CELLS OF CANCER.

IT'S FRAGMENTS OF CELLS OF CANCERS AS THEY BREAK DOWN AND THE IMMUNE SYSTEM ATTACKS THEM.

OR THEY DIE.

IT'S THE SAME TECHNOLOGY THAT WE USE IN NON-INVASIVE PRENATAL TESTING FOR WOMEN BUT JUST EXPANDED INTO THE CANCER SPACE.

THAT WAS THE AHA MOMENT THAT LED TO A COMPANY BEING SPUN OUT TO ANSWER THIS QUESTION.

AND NOW THERE ARE 24 COMPANIES IN THE WORLD WORKING ON THIS.

>> ARE YOU ABLE TO DETECT OR WOULD WE BE ABLE TO DETECT THE SPECIFIC SITE OF ORIGIN OF THOSE CELLS?

OR IS IT SAYING HEY, THERE IS A CANCER HERE.

>> A COUPLE THINGS.

NUMBER ONE: OBVIOUSLY THE BIGGER A CANCER IS, THE MORE DNA SHEDDING IS GOING TO OCCUR.

SO ALL OF THESE EARLY CANCER MULTI-DETECTION EARLY DETECTION TESTS ARE MORE SENSITIVE AS THE STAGE INCREASES.

BUT CERTAIN CANCERS ARE ALREADY PRETTY AGGRESSIVE.

SO THAT'S NUMBER ONE.

THERE ARE SEVERAL DIFFERENT TYPES OF TECHNOLOGY, SOME OF THE TESTS ACTUALLY CAN IDENTIFY WHERE THE CANCER SIGNAL ORIGIN IS COMING FROM.

AND I CAN GO INTO THAT A LITTLE BIT BUT THERE ARE OTHER TESTS THAT DETECT THE COMMON CANCER SIGNAL AND THEY HAVE TO USE IMAGING LIKE A TOTAL BODY CAT SCAN.

ALL OF THE PLATFORMS ARE DESIGNED TO HAVE VERY FEW FALSE POSITIVES COMPARED TO THE SCREENING TEST YOU MENTIONED WITH USPTF.

>> IS IT APPROPRIATE FOR THE COMMON LANGUAGE THAT I HEAR WHEN WE TALK ABOUT THIS, TO SAY WE ARE GOING TO DO A LIQUID BIOPSY?

>> THAT'S THE MOST COMMON PIECE BECAUSE IT'S CIRCULATING IN THE BLOOD IN THE PLASMA, THE LIQUID PART OF I DON'T ARE BLOOD.

THE LIQUID PART OF YOUR BLOOD.

THAT'S OKAY TO TALK ABOUT.

MULTI-CANCER JUST DESCRIBES THE FACT THAT IT IS NOT LOOKING FOR A SINGLE CANCER.

RIGHT NOW WHEN PEOPLE HAVE CANCER AND HAVE A DIAGNOSIS AND THEY'RE TRYING TO SEE IF IT'S RECURRED OR DID WE GET IT ALL, YOU KNOW, THERE ARE SINGLE CANCER LIQUID BIOPSIES USED POST TREATMENT BUT THIS IS A DIFFERENT ONE.

THIS IS FOR ASYMPTOMATIC PEOPLE UPSTREAM SO LIQUID BIOPSY IS FINE.

>> WHICH WHICH RAISES TWO QUESTIONS FOR ME.

ARE WE LITERALLY TALKING ABOUT DRAWING A SAMPLE OF BLOOD FROM A PERSON?

AND YOU SEND IT OFF TO A MACHINE THAT IS READING THIS?

OR IS SOMEBODY HAVE TO LOOK AT SOMETHING UNDER THE MICROSCOPE.

>> IT'S A BLOOD TEST.

LET ME BACK THAT UP.

SO WHAT IS REALLY HAPPENED IN THE LAST COUPLE OF DECADES IS NUMBER ONE, WE HAD A MASSIVE INVESTMENT IN UNDERSTANDING THE HUMAN GENOME.

COST LITERALLY BILLIONS OF DOLLARS TO FIGURE OUT THE CODE OF YOUR DNA FROM THE BEGINNING TO THE END, RIGHT?

AT THE SAME TIME WE ALSO DISCOVERED THAT IT'S NOT JUST THE CODE OF YOUR DNA, BUT YOUR DNA IS STRUCTURED AND WRAPPED AND FOLDED AND IT ACTUALLY HAVE ALL THESE OTHER LAYERS THAT ACTUALLY THE REASON WHY YOUR LIVER CELL AND EYE CELL ARE SO DIFFERENT, IS NOT BECAUSE THE DNA AND EVERY SINGLE CELL ISN'T THE SAME, IT IS EVERY SINGLE CELL.

WE ALL GREW UP WITH THAT.

IT'S THAT THE SMALL CHANGES IN HOW THE DNA IS READ ARE IMPACTED BY THIS EPI GENOME.

YOU HAVE A SCRIPT.

YOU HAVE HIGHLIGHTS, MARKERS, SAY THIS, DON'T SAY THIS.

>> I'M DOING THIS OFF THE TOP OF MY HEAD.

>> I KNOW YOU ARE.

>> BUT GO AHEAD.

>> THE EPI GENOME HOPES MODIFY THE SCRIPT THAT YOU HAVE IN EVERY CELL TO CREATE THE PROTEINS AND STRUCTURES THAT MAKE A LIVER CELL AND OVER ON THIS OTHER SIDE, MAKE A LUNG CELL AND THAT HAPPENS AT THE BEGINNING OF LIFE THE BEGINNING OF LIFE AS THE SIGH GOAT AND CELL ARE DEVELOPING BUT WE CAN USE THOSE PATTERNS OF CELLULAR DEVELOPMENT AND THE WHOLE PROCES OF THE DNA, EPI GENOME TO WHAT IS WRACHED AROUND IT TO RNA WHERE HOW THE CELLS SENDS MESSAGES OUT TO MAKE PROTEINS AS WELL AS PROTEINS.

THAT WHOLE AREA IS GOING TO BE HACKED AND BETTER UNDERSTOOD AT A MOLECULAR LEVEL.

THINK OF A MICROSCOPE WHERE YOU CAN LOOK DOWN TO THE DNA AND SEE WHICH BASE PAIRS ARE HERE AND WHICH ARE ASSOCIATED.

THE SECOND PART OF THAT IS USING MACHINES, ARTIFICIAL INTELLIGENCE IS SUPER SEXY TO TALK ABOUT, BUT USING MACHINE LEARNING TO GO THROUGH COMPLICATED REPETITIONS TO IDENTIFY PATTERNS.

THE BEST WAY FOR YOUR AUDIENCE TO THINK ABOUT IT, Dr. TUCKSON IS LIKE A QR CODE.

YOU KNOW WHAT IT IS.

THE COMPUTER CAN FIND IT.

BUT THEY ALL LOOK THE SAME TO ME.

I CAN'T TELL THE DIFFERENCE.

BUT THIS IS GOING TO COME DOWN TO A BLOOD TEST WHICH WILL END UP BEING POSITIVE OR NEGATIVE AND IT'S IMPORTANT TO KNOW THAT A POSITIVE BLOOD TEST IS GOING TO REQUIRE A DIAGNOSTIC EVALUATION OR COMPLETION OF SCREENING WOULD BE MORE APPROPRIATE.

IF YOU HAVE A POSITIVE TEST, YOU HAVE AROUND A 50% CHANCE MORE OR LESS OF HAVING CANCER, DEPENDING ON WHAT YOUR RISK WAS BEFORE.

THAT'S INCREDIBLE.

50% RISK.

THAT'S ALMOST 10 TIMES MORE THAN THE RISK OF A POSITIVE MAMMOGRAM HAVING CANCER OR POSITIVE STOOL TEST HAVING CANCER.

SO IT IS A POWERFUL TECHNICAL BUT IT'S GOING TO BE A BLOOD TEST, UNBELIEVABLE.

>> HOW DOES THIS DIFFER FROM IF I HAVE A LUNG CANCER AND YOU DRAW A SAMPLE OF BLOOD AND YOU DETERMINE WHAT MAY BE THE BEST COURSE OF CHEMOTHERAPY?

OR OTHER TREATMENT?

SAME KIND OF THING OR DIFFERENT?

>> SO MANY ATTIC TESTING SOMATIC TESTING.

WE KNOW THE PATTERN OF THE DNA INSIDE OF A CANCER CELL GIVES US CLUES HOW TO TREAT IT.

IMMUNOTHERAPY, BUT WHAT WE HAVE FOUND OUT IS YOU CAN FIND SOME OF THE SIMILAR INFORMATION NOT FROM A BIOPSY OF THE TUMOR BUT FROM FRAGMENTS OF THAT TUMOR THAT HAVE BASICALLY BEEN SECRETED INTO THE BLOOD, SHEDDING IS WHAT WE CALL IT.

INSTEAD OF HAVING TO DO A LUNG BIOPSY TO GET A TUMOR SPECIMEN, YOU CAN USE BLOOD.

BLOOD IS USED IN PEOPLE WITH CANCER AFTER THEIR KNOWN DIAGNOSIS AND TREATMENT.

INSTEAD OF HAVING TO GO BACK AND LOOK WITH CAT SCANS, A COMPLEMENT TO FIND IT AT ITS EARLIEST STAGES OF RECURRENCE.

IT PLAYS A ROLE AND THE CANCER SPACE, YOU ARE TALKING ABOUT METASTATIC CANCER.

YOU ARE TALKING ABOUT STAGE 4 DISEASE.

YOU ARE TALKING ABOUT THE END OF THE HIGHWAY IN TERMS OF TREATMENT OPTIONS AND THANK GOD WE HAVE SO MANY GREAT THERAPIES.

BUT IF WE ARE GOING TO BUILD A BRIDGE TO A FUTURE WHERE WE ARE EITHER PREVENTING CANCER OR FINDING IT EARLY, WE ARE GOING TO SHIFT THOSE TECHNOLOGIES BACK IN THIS CANCER COURSE TO HAVE THE GREATEST IMPACT.

>> THERE ARE A LOT OF PEOPLE WHO ARE OUT THERE.

YOU SEE IT, SOME OF OUR SOCIAL MEDIA INFLUENCERS WILL HAVE, EVERYONE SHOULD GET A C.T.

SCAN OR EVERYONE SHOULD GET A WHOLE BODY MRI.

NOT NECESSARILY LOOKING FOR A PARTICULAR ONE THING BUT JUST TO TELL WHAT YOU YOU HAVE OR DON'T HAVE.

IS THIS DIFFERENT?

>> THESE DEFENDANTS ARE DIFFERENT BECAUSE THEY'RE FOCUSED ON CANCER ALONE, RIGHT?

IMAGING STUDIES, USUALLY WHOLE BODY MRIS, THEY HAVE SOME GOOD PARTS.

IN OTHER WORDS, THEY LOOK AT THE BRAIN.

AND USUALLY IT DOESN'T CROSS THE BLOOD BRAIN BARRIER AND IMAGING STUDIES PICK UP VASCULAR LESIONS.

CARDIOVASCULAR DISEASE IS THE NUMBER ONE CAUSE OF DEATH UNTIL 2030 WHEN CANCER WILL SURPASS IT.

SO VASCULAR THINGS THEIL PROVIDE ADDITIONAL INFORMATION BUT ISSUES AROUND IMAGING AS A CANCER SCREENING MODALITY.

IT IS NOT GOING TO REPLACE ANYTHING WE JUST TALKED ABOUT EXCEPT MAYBE LUNG CANCER SCREENING BECAUSE YOU ARE GETTING A LUNG CANCER C.T.

OR MRI AT THE SAME TIME.

BUT THERE IS LOTS OF WHAT WE CALL INCIDENTAL OMAS ON IMAGING.

IF YOU TAKE NORMAL PEOPLE AND RUN THEM THROUGH EXPRESSWAYS, THEY'RE GOING PIEF FIVE-- X-RAYS, THEY'LL FIND THINGS, FALSE POSITIVE IN THE VAST MAJORITY OF CASES IS GOING TO BE HIGH, 20 TO 30% IN SOME STUDIES BUT SIGNIFICANT ENOUGH AT A POPULATION LEVEL, IT'S A LOT OF PEOPLE.

>> YOU HAVE USED THAT TERM A COUPLE OF TIMES, FALSE POSITIVE, FALSE NEGATIVE.

TRUE POSITIVE, TRUE NEGATIVE.

WHAT DOES THIS MEAN?

IT'S TOUGH.

PHYSICIANS DON'T EVEN UNDERSTAND BASE THERUM AND A LONG TIME AGO I QUIT TRYING TO TEACH IT BUT A TRUE POSITIVE TEST IS WHEN YOU HAVE CANCER, AND FINDS IT AND SAYS YOU HAVE CANCER.

THAT'S TRUE POSITIVE.

A FALSE POSITIVE IS A TEST THAT SAYS YOU HAVE CANCER BUT YOU DON'T HAVE CANCER.

THAT'S GOOD THAT YOU DON'T HAVE CANCER, BUT IT STILL MEANS YOU ARE UNDERGOING A LOT OF DIAGNOSTIC TESTS FOLLOWUP BIOPSIES ON MAMMOGRAMS, FOLLOWUP C.T.s, A TRUE NEGATIVE IS WHEN THE TEST SHOWS NEGATIVE AND YOU DON'T HAVE CANCER.

WHEREAS A FALSE NEGATIVE MEANS YOU HAVE A NEGATIVE TEST, BUT YOU ACTUALLY HAVE CANCER AND IT MISSED IT.

AND THEY EACH HAVE ISSUES, BUT AT A POPULATION LEVEL, LOOKING AT 100 MILLION PEOPLE IN THE UNITED STATES OVER 50 ELEVATED RISK FOR CANCERS, YOU CAN'T HAVE TESTS THAT GENERATE FALSE POSITIVES.

YOU HAVE TO HAVE ONES THAT ARE HIGHLY SPECIFIC AND SENSITIVE AS WELL.

BUT THE SENSITIVITY, AGAIN, FOR WHAT WE USE, WITH BREAST AND CERVICAL, OUR CURRENT ONES IS VERY HIGH.

AND THE SMES FIST AT THIS IS LOW WHICH IS THE FALSE NEGATIVES.

FOR INSTANCE, WE FIND ABOUT 200,000 CANCERS EACH YEAR IN AMERICA THROUGH SCREENING WITH THE CURRENT ONES YOU TALKED ABOUT.

BUT THEY GENERATE 8.8 MILLION FALSE POSITIVES.

>> 8.8 MILLION THAT HAVE TO BE WORKED UP AND LOOKED THROUGH.

THE NEWER TECHNOLOGY, BASED ON A MORE SPECIFIC APPROACH, ONE THAT HIGHLIGHTS SPECIFICITY OVER SENSITIVITY, HAS THE POTENTIAL TO DOUBLE OR TRIPLE THAT RATE OF CANCER DETECTION AND ONLY ADD ABOUT 10 TO 15% TO THAT FALSE POSITIVE NUMBER.

SO IT'S MORE EFFICIENT WOULD BE THE BEST WAY THAT I WOULD DESCRIBE IT.

>> I APOLOGIZE TO OUR VIEWERS, BUT I GOT TO GO TO THE STATISTICAL ANALYSIS AGAIN.

SENSE-- SENSITIVITY VERSUS SPECIFICITY.

>> SPECIFICITY IS THE LIKELIHOOD THAT YOU KNOW, YOU ARE ACTUALLY EVERY TEST YOU ARE HAVING IS CANCER AND YOU ARE ACCURATE.

AND SENSITIVITY IS WHETHER OR NOT YOU ARE FINDING CANCER AND NEVER MISSING IT.

AND SO AGAIN, MAYBE YOU CAN POST IT ONLINE... >> NO WAY.

>> BUT I CERTAINLY WORK WITH MY GROUP TO SORT OF SAY THAT WE'VE GOT TO BRING THIS DOWN.

BASICALLY HIGHLY SENSITIVE TEST NEVER MISSES TEST.

HIGHLY SPECIFIC TEST ALMOST NEVER CALLS CANCER WHEN THERE'S NO CANCER THERE.

>> THAT'S IMPORTANT.

THESE ARE TERMS THAT ARE THROWN AROUND VERY LIGHTLY.

AND ALL OF US OUGHT TO HAVE SOME CURSORY UNDERSTANDING.

AND I APPRECIATE YOU MAKING IT VERY SIMPLE FOR US.

>> I HOPE I DID.

WE'LL SEE WHAT THE STATISTICIANS WHO GIVE US THE EMAILS AFTERWARDS.

>> I'LL HANDLE THAT FOR YOU.

IF A TEST IS POSITIVE, WORK THROUGH, IF YOU WILL, WE HAVE A POSITIVE TEST ON DOING THE BLOOD DRAW.

WHAT IS THE NEXT STEP A PATIENT COULD EXPECT TO GO THROUGH.

>> LET ME BACK UP A TAD FROM THAT.

WHO THE TESTS ARE MEANT FOR ARE PEOPLE AT ELEVATED RISK FOR CANCER.

AND THE MOST DOMINANT RISK FACTOR FOR CANCER IS AGE.

SO THIS IS PROBABLY GOING TO BE A 50 AND OVER TYPE OF TEST.

>> NOT 45 LIKE WOULD YOU SAY BECAUSE RIGHT NOW WE ARE SAYING FOR COLON CANCER WE SCREEN AT 45... >> A LOT OF STUDIES AROUND IT BUT RIGHT NOW MOST PEOPLE ARE LOOKING FOR 50.

AND PEOPLE WITH OTHER ELEVATED RISKS FOR CANCER, CANCER SURVIVORS, HEAVY SMOKERS, PEOPLE WITH BAD SOCIAL DETERMINANTS OF HEALTH.

A BLACK MAN IN AMERICA IS THREE TIMES MORE LIKELY TO HAVE CANCER THAN AN ASIAN WOMAN.

SO AFTER AGE IS SMOKING.

AFTER SMOKING IS OBESITY.

AND AFTER OBESITY ARE FAMILY HISTORIES AND GENETIC SYNDROMES SO THESE TESTS ARE NOT MEANT TO BE FOR 22 YEAR OLDS WHO DON'T FEEL GOOD, RIGHT?

THIS IS NOT WHAT THAT IS ABOUT.

THIS IS ABOUT SCREENING A POPULATION AT ELEVATED RISK.

SO ONCE THAT TEST IS DONE, AND IT REALLY IS A BLOOD TEST, ABSOLUTELY JUST LIKE WERE YOU TO GET YOUR CHOLESTEROL CHECKED OR ANYTHING ELSE, THAT TAKES ANYWHERE IN, YOU KNOW, 10 DAYS, YOU KNOW, TO, AGAIN, I CAN'T SPEAK FOR EACH OF THOSE 24 COMPANIES WHO ARE WORKING ON IT, WHAT THE TURN AROUND TIME IS BUT IT COULD BE AS LITTLE AS TWO WEEKS.

AND THAT COMES BACK REALLY IN BINARY ROUTE, COMES BACK NEGATIVE, YOU DON'T HAVE CANCER AND AGAIN THAT'S REALLY PRETTY GOOD.

IT GIVES YOU A GREAT FEELING.

A 99.5% CHANCE OF NOT HAVING CANCER BUT IT'S A REPEATED TEST ON A REGULAR BASIS.

AND IF THAT TEST COMES BACK AS POSITIVE, WHICH, IN SOME COMMERCIAL FIRMS RIGHT NOW IS ABOUT 1%, THEN YOU NEED TO UNDERGO A DIAGNOSTIC EVALUATION AND DEPENDING ON WHICH TESTS ARE AVAILABLE AND RIGHT NOW THERE IS ONLY ONE AVAILABLE IN THE UNITED STATES, BUT AGAIN THAT'S GOING TO CHANGE RAPIDLY.

THAT TEST TELLS YOU WHERE TO LOOK AND THAT LEADS THE DIAGNOSTIC EVALUATION.

SOME OF THE OTHER TESTS ARE GOING TO BE, YOU KNOW, ASKING FOR A PERSON TO UNDERGO A TOTAL BODY IMAGING PROGRAM LIKE A CAT SCAN OR PET C.T.

WE ARE IN THE EARLIER STAGES OF SOME OF THE COMMERCIALIZATION AND UNDERSTANDING.

BUT THE COMMERCIALLY AVAILABLE PRODUCTS NOW TELL YOU WHERE WITH A HIGH DEGREE OF ACCURACY NINE OUT OF 10 TIMES WHERE THE CANCER SIGNAL IS COMING FROM BUT LOOKS FOR A COMMON CANCER SIGNAL AND ONCE THE SIGNAL IS FOUND, THEN IT BRINGS IT IN AND THAT'S WHAT IMAGING DOES, TOO.

YOU HAVE A CANCER SIGNAL.

NOW LET'S LOOK FOR A STRUCTURAL PIECE TO BIOPSY OR DO SOMETHING TO.

>> YOU INTIMATED THAT WE ARE A LITTLE BIT BEHIND HERE IN THE UNITED STATES.

TELL ME WHERE IN THE WORLD CAN WE LOOK TO SEE WHERE SOMEONE IS STARTING TO INSTITUTE THIS AND GETTING RESULTS?

>> THE UNITED STATES IS THE FIRST, YOU KNOW, COUNTRY TO HAVE A COMMERCIALLY AVAILABLE TEST BUT THE INCREDIBLE RESEARCH GOING ON IS AT THE U.K., THE NATIONAL HEALTH SERVICE.

THAT'S THE NATIONAL HEALTH ARM OF THE BRITISH GOVERNMENT.

WHERE THEY OWN YOUR RISK FROM CRADLE TO GRAVE AND SO THERE IS AN INVESTMENT TO TRY TO REDUCE CANCER COSTS, RIGHT?

AND TO TRY TO REDUCE IT BY SCREENING.

AND THEY ARE IN THE PROCESS OF A HUGE TRIAL CALLED THE GALLERY TRIAL NHS GALLERY TRIAL AND THEY HAVE BASICALLY TAKEN 140,000 PEOPLE AND SPLIT THEM INTO TWO GROUPS, BOTH GROUPS GET THE BLOOD TEST BUT ONLY HAVE OF THE PEOPLE-- HALF OF THE PEOPLE GET THE RESULTS.

EVERY GETS ROUTINE SCREENING.

MAMMOGRAPHIES, ABSOLUTELY.

THAT IS A BASELINE THAT WILL TAKE US MANY YEARS TO DETERMINE THE BEST ROUTE AND HOW LIQUID BIOPSY PLAY A ROLE AND MULTI-CANCER THERE.

BUT THEY ARE TWO YEARS INTO A THREE-YEAR TRIAL AND WILL BE KNOWING RESULTS IN 2024.

IT WILL PROBABLY BE THE FIRST BIG PICTURES AND MY UNDERSTANDING IS THEY'RE LOOKING TO EXPAND IF THE RESULTS ARE MET.

WE ARE STILL IN THE RESEARCH PHASE BUT JUST LIKE CELL PHONES WHICH WAS RADIO AND TELEPHONE BECAME CELL PHONE TECHNOLOGY, WE HAVE THE MOTOROLA BRICK PHONE.

WE ARE NOT THE IPHONE 30 YET BUT MAKE NO DOUBT WE WILL BE.

>> HOW FAR AWAY ARE WE?

>> WE ARE THERE.

WE JUST HAVE THE MOTOROLA BRICK PHONE.

I WOULD SAY THE COMPANIES ARE GOING TO HAVE MULTIPLE ITERATIONS WITH UPDATES BASED ON LEARNING, BASED UPON IMPROVEMENTS AND CLINICAL TRIALS, IMPROVING THE ALGORITHMS, EVERYBODY KNOWS ABOUT ALGORITHM AND A.I., DIALING IN, THAT'S WHAT IS GOING TO HAPPEN AND THAT'S THE BENEFIT OF THESE MACHINE LEARNING PROGRAMS, YOU KNOW, LETTING COMPUTERS REALLY ACCELERATE WHAT WE COULD ACTUALLY NEVER DO, YOU KNOW, WITH CALCULATORS.

SO I THINK WE ARE IS THERE.

I JUST THINK WHAT WE CAN EXPECT IS ONGOING IMPROVEMENT IN SENSITIVITY, WHILE AT THE SAME TIME MAINTAINING THAT REALLY, YOU KNOW, HIGH SPECIFICITY MEANING NOT SPINNING OFF A BUNCH OF FALSE POSITIVES AND KEEPING THE NUMBER DOWN.

>> IN THE UNITED KINGDOM THE NATIONAL HEALTH SERVICE, COST IS NOT A FACTOR THERE BECAUSE OF THAT.

THEY'RE TRYING TO SAVE-- THIS IS THE COUNTRY PAYING FOR THINGS.

>> THAT'S RIGHT.

>> HOW DO WE LOOK AT IT HERE IN THE UNITED STATES?

WHAT KIND OF PROJECTION ARE WE SEEING AS FAR AS COST?

IS THIS GOING TO BE IN THE REALM OF WHAT IT TAKES TO GET A COLONOSCOPY OR MAMMOGRAM OR WHATEVER OTHER TESTS THAT ARE OUT THERE?

>> MY OWN OPINION IS THAT IT SHOULD BE A SCREENING TEST THAT IS COVERED BY INSURANCE AS PART OF A SCREENING PARADIGM.

LIKE EVERY ONE OF THE TESTS YOU'VE DISCUSSED SHOULD BE COVERED AS A NO OUT OF POCKET COST FOR PEOPLE.

IF ANYBODY IS RECEIVING BILLS FOR SCREENING LUNG CANCER MAMMOGRAMS OR COLON CANCER, YOU SHOULD NOT BE IN KENTUCKY WE HAVE GREAT RULES AROUND THAT.

RIGHT NOW EVERY SINGLE NEW TECHNOLOGY THAT COMES OUT, GENETIC SCREENING OR NON-INVASIVE PRENATAL TESTING COSTS A LOT AT THE BEGINNING OF THE JOURNEY AND THEN THROUGH COMPETITION AND COST OF GOODS AND SCALE COMES DOWN.

EVEN THOUGH AT PRESENT SOME OF THESE TESTS ARE NORTH OF $900, AROUND A THOUSAND BUCKS, I WOULD EXPECT THOSE TO DIFFICULT MIN SH GREATLY-- DIMINISH GREATLY AS THE TECHNICAL GETS ADDITIONAL ADOPTION, MEANING DOWN TO WAY LESS THAN $500 OVER TIME.

>> I WANT THE 25 SECOND ANSWER.

WHAT IS THE ONE THING WE NEED TO KEEP IN THE BACK OF OUR MIND ABOUT THIS TECHNOLOGY?

>> KENTUCKY NEEDS TO BE FIRST IN LINE BECAUSE WE HAVE THE HIGHEST CANCER INCIDENTS RATE IN THE NATION.

WE SHOULD BE AVAILABLE IN DOING STUDIES IN KENTUCKY, WE SHOULD BE DOING PILOT PROGRAMS WITH PAYERS IN OUR MEDICAID AND HIGH RISK CANCER POPULATIONS.

AND WE NEED TO BE ON THE GAME WITH THIS.

AND CONTINUE WHAT WE ARE DOING.

THE HIGHEST RISK CANCER POPULATIONS ARE GOING TO HAVE THE GREATEST BENEFIT FROM THIS TECHNOLOGY.

>> WELL, Dr. JONES, WHITNEY, I GOT TO TELL YOU FIRST OFF, YOU ALWAYS BRING EXCITEMENT WHEN YOU HAVE BEEN ON THE SHOW AND YOU HAVE BEEN HERE QUITE A FEW TIMES SO THANK YOU FOR THAT.

THIS IS A REALLY, REALLY EXCITING TECHNOLOGY.

I'M EXCITED AND I HOPE THE REST OF YOU OUT THERE ARE GETTING EXCITED ABOUT THIS BECAUSE YOU KNOW, SOMETIMES SCREENING TEST, AS A PERSON WHO DID THEM AND HAS HAD THEM DONE, YOU CAN CAN UNCOMFORTABLE BUT IT IS NICE TO KNOW THERE IS SOMETHING BETTER FOR US OUT THERE IN THE FUTURE.

THANK YOU FOR BEING WITH US TODAY.

I HOPE YOU HAVE A BETTER UNDERSTANDING OF WHAT SCREENING IS, WHEN IT SHOULD BE DONE, THE CURRENT AVAILABLE TESTS AND WHAT LIES JUST DOWN THE ROAD.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT "KENTUCKY HEALTH" AND IN THE MEANTIME, IF YOU HAVEN'T BEEN SCREENED TALK TO YOUR HEALTHCARE PROVIDER ABOUT GETTING YOU SCREENED AND SOON WE'LL HAVE EVEN BETTER WAY THAN WHATEVER TEST THEY'RE GOING TO RECOMMEND FOR YOU.

SEE YOU NEXT WEEK.