By Gretchen Cuda Kroen
cleveland.com
CLEVELAND, Ohio — There’s a new tool in the arsenal against cancer. A screening test that its developers say can detect the presence of cancerous cells in the body - up to 50 different kinds - sometimes long before any symptoms appear.
The test, called the Galleri test, was developed in California by a healthcare company called Grail. It’s been available nationwide since 2021, and now University Hospitals in Cleveland is helping to make the test accessible to some of the Northeast Ohioans who need it most: firefighters.
Catching cancers earlier is one of the best ways to save lives.
That’s why when the Highland Heights fire department learned about the test from UH representatives at one of their monthly emergency management meetings, they jumped at the chance to make it available to any first responder who wanted it.
“The chief and I immediately started working on a funding source so we could bring this testing in for our staff,” said Highland Heights Assistant Fire Chief Bill Bernhard, citing the concerns that he and his fellow firefighters have about the increased risk of cancer in their profession.
A study by the National Institute for Occupational Safety and Health found that firefighters had a 9% increase in cancer diagnoses and a 14% increase in cancer-related deaths compared to the average population.
And in 2023, 72% of International Association of Fire Fighter member line-of-duty deaths were due to occupational cancer, the organization says on its website.
“It’s a huge concern. Everything nowadays is made of plastics, and when plastics burn they let off carcinogens, so we get exposed to that more than the general public,” Bernhard said. “Obviously we weren’t mandating this for anyone, but I’d rather know than not know.”
Finding a cancer signal
Despite great strides in cancer diagnoses and treatments, screening tests are available for only five kinds of cancer: breast, cervical, prostate, colon and lung cancers. However, roughly 70% of cancer deaths are from cancers that lack a method of screening, and consequently, these cancers are often caught too late for treatments to be the most effective.
The Galleri test works differently than other screening methods, looking for a chemical signal found in the DNA circulating freely in the bloodstream. DNA from cancer cells can frequently be differentiated from that of healthy cells by a chemical signature called a methylation pattern. These chemical signatures not only indicate the presence of cancer cells somewhere in the body, but they indicate the tissue type or organ associated with the cancer signal with 88% accuracy, the company claims.
In the studies published so far, the test was able to detect cancers in 1% of people aged 50 and over who had no symptoms whatsoever, and in 5% of people who had some type of symptoms but no cancer diagnosis.
Although the numbers sound small, Dr. Jordan Winter, a pancreatic cancer surgeon at UH, says for those individuals, the early diagnosis was potentially life-saving. With cancers like pancreatic cancer, the sooner it is detected and treated the better the chances of survival.
“Even if you can detect it with an earlier lead time of a month, let alone three months six months or a year you can affect the outcome of that patient,” Winter said. “I wish I met every single one of my patients one month earlier.”
It’s important to understand that if a cancer signal is detected via the test it’s not a definitive answer. A negative result means you likely do not have cancer but it doesn’t mean you definitely don’t, explained Winter. Patients should still pay attention to symptoms and see their doctor routinely.
On the other hand, he says a positive result is also not conclusive. A positive signal on the test is only truly positive around 50% of the time, which is why it’s important to see a doctor with that positive result so it can be evaluated with additional diagnostic testing, including lab work or imaging to confirm the cancer and its location.
“Sometimes we don’t find that cancer and that can be a very good thing. That means that a cancer may not exist,” Winter said.
Getting the test
Although anyone can get the Galleri test, the company is currently only recommending it for people 50 and older, or anyone who is at an increased risk of cancer due to their family history or occupation. It can be requested through a patient’s primary care provider who orders the test for them, or directly by patients themselves through via Grail’s website.
But for those who want it, it’s likely they’ll have to pay for it out-of-pocket.
The test is so new that there has not been any formal recommendation from the various medical societies, the U.S. Prevention Task Force, or National Comprehensive Cancer Network, explained Winter. Until that happens, insurance generally won’t pay. But he is optimistic that in time, the guidelines will catch up.
Meanwhile, the direct-to-consumer cost listed on the company website is $949.
Apart from saving individual lives, Winter says an early detection test for multiple cancers like Galleri is shaping not only individual lives but also changing the way cancer research is done.
“There have been tens of thousands of patients who have been in clinical trials and right now we are in the process of understanding those results and collecting new information prospectively,” said Winter “But what’s really exciting about this is that we can now become innovative with how we are utilizing this test in terms of potential research questions.”
For example, Winter said he and his colleagues are about to open a clinical trial exploring the relationship between unintentional weight loss and cancer.
“Unintentional weight loss is such a common presentation of so many cancers that we are giving smart scales to 1,000 patients and we are having them step on the scale every week. And as soon as they lose weight unintentionally, we are giving them the Galleri test. We expect to detect a lot of cancers that way.”
This is all good news for firefighters like Bernhard, who says that he and his colleagues know they will get the treatment they need should any of the tests come back signaling the possibility of an early cancer.
“The partnership with UH means that if we do find something bad on one of these tests, they’re going to get us in contact with the appropriate doctors in a timely fashion so that we’re going to be able to get out in front of it,” Bernhard said.
More data is needed to fully understand where the Galleri test fits into the treatment paradigm of cancer in the future, but Winter is extremely optimistic, and not just for firefighters, but for everyone.
This is just version 1.0, he said. Version 2.0 is going to be even better. “If this is where we are now, imagine where we will be in five to 10 years.”
At University Hospitals Seidman Cancer Center, positive Galleri tests may be referred to the Diagnostic Clinic at 216-286-2626 for further evaluation and workup if needed.
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