It’s in the early morning of April 15th, 2030 that when looking at your smart mirror, it beeps a warning notification: that new mole on your chin should be checked by your dermatologist. That was to be expected. After all, your genetic test revealed that you possess a mutation in the CDKN2A gene. But you also get the recommendation to have your esophagus and stomach checked as your connected smart scale registered a noticeable drop in your weight and this mutation also carries an increased risk of gastrointestinal (GI) tract cancer.
With such increased awareness and early-stage diagnosis methods, will the cancer death rate decline further come 2030? How will oncology differ in the future for both physicians and patients?
A.I.- powered diagnosis to aid capacity shortages
A.I.-based and/or remote diagnostics will play a significant role in the future of oncology, as it addresses more than one pain point of the field: capacity shortage of professionals and late diagnosis (and thus worse prospects) of patients. A recent example is DERM, an A.I.-powered, smartphone-based skin cancer detection technology. DERM is the first solution of this kind that has received Class IIA classification in the UK.
It uses machine learning algorithms to recognise the most common malignant, pre-malignant and benign skin lesions, including melanoma – the fifth most common cancer in the UK – and the most dangerous form of the common skin cancers.
The digital device consists of a lens that can be attached to a smartphone, and an app that contains this software to assess a lesion, such as a mole that has started to change its look or behaviour.
A similar solution was developed by SkinVision, an app my trusted dermatologist recommended for me after my genetic test revealed I have a higher-than-average chance for skin cancer. It is also an artificial intelligence-based solution, making my care team a trio: my dermatologist, me and A.I.
Gamification to ease coping with cancer – not just for the little ones
Color me healthy, a gaming app developed for cancer patient children was found useful to track symptoms in a small study carried out in the US. It was used to gather self-reported data on eight common cancer-related symptoms – including pain, fatigue, nausea/vomiting and mouth sores – in a group of 19 children aged six to 12 who received chemotherapy for cancer.
The self-reported dataset was able to highlight multiple important factors previously unknown or overlooked, such as chemotherapy symptoms persisting between treatment cycles or how bothersome children found implanted devices (such as ports to deliver medicine).
Tumour-specific drug testing via ‘avatars’
Recreating a living person’s tumour and trying a variety of treatment options offers a personalised and targeted approach. The team of Alana Welm has achieved success in the realm of the most dangerous breast cancer types, according to their report published in Nature in February 2022.
The researchers used organoids – grown in dishes – and xenografts – implanting tissue into mice – to simulate cancer and tested dozens of treatment options, eventually building a “data bank” of organoids and xenografts of real-patient cancers – that is able to accurately showcase how cancers react to drugs in living humans.
Using these fully accurate ‘avatars’ to research potentially effective drug molecules can save billions of dollars, and a fully personalised treatment regime. The proof of concept study has yet a long way to go but shows intriguing results.
A.I. finding lung cancers a year earlier
Scientists have revealed an artificial intelligence (AI) program capable of identifying key signs of lung cancer in CT scans a full year earlier than existing methods can, according to research presented at the European Respiratory Society International Congress.
The AI program was trained via a set of CT scans taken from 888 patients who had already undergone conventional screenings from radiologists bent on identifying suspicious growths. The researchers then tested the AI program on another group of 1,179 patients who were involved in a lung screening trial that required a three-year follow-up. This group had 177 patients already diagnosed with lung cancer via biopsy, following the final scan during the trial. And the program detected malignant tumors in 172 of the 177 identified by the CT scan, constituting a 97% effectiveness rate in successfully detecting life-threatening cancers.
But let’s get back to our future selves and the 2030 morning in our smart bathrooms. What can we realistically expect in less than a decade?
Taking a close-up shot of that mole and sending it to your dermatologist via your phone for further investigation is not sci-fi anymore, and will be most likely a routine procedure. Following this, you may then connect to a gastroenterologist through the same telemedicine service provider like InTouch Health/Teladoc to inquire about preventive measures regarding your GI tract; after all, uncle John did succumb to colorectal cancer.
Given your background, the doctor determines that she needs to visually assess your GI tract before coming to any conclusions. As such, she prescribes you the latest PillCam, a high-resolution pill-sized camera that records and takes pictures, which it transmits in real-time as it travels along the GI tract after being ingested.
The new 2030 edition even takes biopsy samples from different segments of the digestive system as the PillCam moves through. You can then send it with a fecal sample for analysis. And all of this is done without leaving the comfort of your home; you settle the PillCam payment online, which is then delivered to your place within hours by a delivery drone and the next day you send the samples back via a drone.
The ease of access to remote yet quality healthcare enabled by improving technology and better internet infrastructure will be one of the highlights in oncology. Currently, with kits like the Atlas Biomed and Dante Labs, people can have genetic tests done without leaving their homes. They can just order their kit, mail back their saliva sample to be analysed, and expect a result within a few weeks.
With increased access to healthcare and awareness methods like smart mirrors even in the most remote areas, earlier detection of cancerous symptoms will be more feasible and subsequently prevent their progression. Some of these tests determine medication side effects, which is a crucial bunch of information for cancer patients when taking multiple drugs. Oncologists will need some level of expertise to be able to deal with such data when patients bring it to the point-of-care.
Tailor-made cancer treatment
A few days later, the results are in: good or bad news? Best-case scenario, your dermatologist just recommends you to keep an eye out for that new mole and contact him in case you see any changes to it. Your gastroenterologist also told you that there’s nothing to worry about. It’s possible that you were stressing out a bit in anticipation of your next job interview and were not eating properly. She recommends another PillCam assessment a few months later.
If it does not play out so well, then you’ll have to undergo therapy. However, cancer treatment is not a walk in the park. The condition itself depends on several factors like the origin, malignancy potential, and the extent of progression, among many others. Subsequently, oncologists need to factor in those conditions in order to tailor the appropriate treatment regime.
Interactive data visualisation designer Will Stahl-Timmins illustrates the complexity of oncology, especially the non-linearity in adults, in an infographic for the National Institute for Health and Care Excellence (NICE). Thanks to detailed genome analysis, precision medicine will provide individualised therapy tailored for your condition based on your genetic makeup.
Companies like Foundation Medicine and BioNTech are already foraying into this possibility. “Mutations are random. If you look at one patient’s tumor and compare it to another patient’s, it would be highly unlikely that there will be a match,” Sean Marett, CBO and CCO at immuno-oncology company BioNTech explained in this article. “Each patient gets a tailor-made product just for them.”
Treating cancer is not the end of the story. Follow-ups need to be performed regularly to determine the effectiveness of the treatment, prevent relapse and assess side effects. Portable non-invasive devices to measure blood cell count are already a thing like the one MIT researchers developed to detect severe neutropenia in chemotherapy patients from their homes.
Digestible PillCams can again be used for GI checkups, while chronic pain can be managed using wearables like Quell. With the advent of remote check-up methods, coping with cancer will be made easier as patients will be able to follow up on their treatment in the familiar environment of their homes while being surrounded by their close ones.
Oncologists of the future and their tech-fueled profession
At the other end of the spectrum, oncology will also change for physicians specialised in this field. In addition to telemedical consultations and follow-ups, oncologists will have more reliable devices and technology at their disposal to assist them in their tasks.
With time, larger and more diverse clinical databases for fairer and more reliable AI-driven analysis used in radiology scans and software relying on facial recognition technology will be available. A.I.-based medical decision support will have a central role in the future of oncology as it is already advancing healthcare.
Examples are already ripe with A.I.’s help in oncology, such as in the identification of metastatic breast cancer, analysis of histology slides to detect cancer and evaluation of thyroid nodules that might have malignancy potential.
For cases requiring surgery, your human surgeon is likely to be assisted by a non-human aide. Global surgical robotics market is forecasted to quadruple its 2021 value by 2030. Precision surgery is a reality in ORs equipped with the Da Vinci and with other competitors like Versius and Medtronic’s Hugo, which both aim to be more cost-effective than the Da Vinci, and such robots will be available in more and more hospitals.
Those predictions are based on slight extrapolations of existing technologies and current trends. The future of oncology looks bright for patients and doctors alike; we have to embrace the technologies that will make this future possible.