More effective and equitable implementation of cancer screening represents a significant opportunity for the National Cancer Program, with the potential to reduce the burden of cancer, according to a report released February 2, 2022, by the President’s Cancer Panel. The Panel’s report, Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access, presents goals and recommendations to optimize cancer screening informed by a series of meetings conducted 2020-2021.
Timely cancer screening saves lives and reduces the burden of cancer treatment. Though much progress has been made in the past 50 years, gaps in cancer screening rates remain. This means that too many Americans are enduring aggressive treatment or death from cancers that could have been avoided if detected at an earlier stage. Currently, many individuals don’t receive appropriate cancer screening due to lack of knowledge, lack of provider recommendation, fear, and/or lack of access to medical facilities.
In their report, the Panel identifies four critical goals to connect people, communities, and systems to improve access to appropriate cancer screening in the United States. These goals include improving and aligning communications about cancer screening, facilitating equitable access to screening services through community outreach and expanded self-sampling, strengthening workforce collaborations to support cancer screening and risk assessment—including genetic risk assessment, and building health IT tools that promote appropriate cancer screening and aid in clinical decision-making.
Notably, outlined in the building effective health IT tools goal, one of the tools highlighted was MeTree, a web-based, patient-facing tool to collect family health history and inform clinicians of important health related information. MeTree was developed by a team of researchers at the Duke Center for Applied Genomics & Precision Medicine (CAGPM).
Lori Orlando, MD, MHS, MMCI, Professor of Medicine and Director of the Precision Medicine Program in CAGPM, leads the team behind MeTree and studies decision modeling and implementation science as it relates to identifying and managing individuals in clinical settings at increased risk for medical conditions.
The panel has recommended MeTree, as a tool to facilitate clinical decision-making, which asks patients to enter information such as diet, exercise, smoking, and family history. Often this type of information is not present in electronic medical records or in standardized forms. The panel notes that giving patients the opportunity to enter information beforehand can increase the quantity and quality of data compared with what is usually collected during a primary care visit. Although barriers continue to exist in various health screenings, MeTree is helping to promote risk management and shared decision making by enhancing the provider-patient relationship.
MeTree has needed to stay agile, as researchers have found healthcare systems and clinical environments each have unique settings. Recently, the team has received funding to help them understand how to scale the MeTree technology in different settings and how to make it easier to anticipate and address these differences. For example, a risk assessment process is currently being developed to help manage risk through access to resources that may not be available in community clinics, such as virtual genetic counseling.
“Exploring how to put together the different risk assessment and management components into a comprehensive end-to-end pipeline that adapts to each unique setting might finally bridge the access gap and start to extend healthcare advances related to prevention and maintaining health into community settings,” shared Dr. Orlando.
Orlando and her team are honored to have their research be a key component in the President’s Cancer Panel recommendations and hope their studies can help continue advance health care and provide high-quality care to patients. The effort started with the Genomic Medicine Model, a multi-institutional project, whose goal was to implement personalized medicine in primary care practices. The success of that project led to funding as part of National Human Genome Research Institute’s (NHGRI) IGNITE (Implementing Genomics in Clinical Practice) network.
“For the last 10 years my team has worked hard to try to find the best ways to leverage emerging healthcare data standards for interoperability to improve the process of risk assessment and shared decision-making between providers and patients,” said Orlando. “It has been an intriguing and rewarding endeavor, which has really helped to shape our understanding of the needs, barriers, and potential solutions to scale this type of work. To have it highlighted by the President’s Panel is beyond anything I could have ever imagined. There is still much to be done and we hope to continue to help shape the path forward as our studies progress.”
The Duke Center for Applied Genomics & Precision Medicine aspires to be home for the rapidly evolving field of precision medicine and a global leader in developing innovative precision medicine tools to enable impact on helping people optimize their health and patients and providers to manage their disease. Projects, such as MeTree, continue the Center and Duke’s support for genomic testing in the clinical setting. These studies serve as a foundation to build other genomic efforts for the healthcare system.
“Exploring how to put together the different risk assessment and management components into a comprehensive end-to-end pipeline that adapts to each unique setting might finally bridge the access gap and start to extend healthcare advances related to prevention and maintaining health into community settings." - Lori Orlando, MD, MHS, MMCI
The Panel concluded that implementation of these recommendations will optimize cancer screening in the United States and has the potential to accelerate the decline in cancer deaths. The Panel urges all stakeholders to work together to close gaps in cancer screening to ensure these improvements reach all populations. “The time to stem this tide is now,” reports the Panel members in their letter to President Biden, “We can and must improve uptake of cancer screening for all Americans, and we must effect meaningful change well before the next milestone anniversary of the National Cancer Act.” Read the full report of recommendations here.
About MeTree
MeTree is a patient-facing web-based family and personal health history collection and clinical decision support program developed by Duke Center for Applied Genomics & Precision Medicine. It collects personal history on diet, exercise, smoking, and clinical data to calculate the Gail, BRCApro, and Framingham scores in addition to personal and family health history on 20 cancers, 14 hereditary cancer and cardiovascular syndromes, and 21 other conditions. It provides clinical decision support to patients and providers for breast cancer, ovarian cancer, colon cancer, hereditary cancer syndromes, thrombosis, coronary artery disease, aortic aneurysm, ischemic cerebrovascular disease, hereditary cardiovascular diseases, type 2 diabetes, and hereditary liver diseases. The program is set up as a web-service with data stored on a secure central server.
More Information on MeTree can be found here.
About the President’s Cancer Panel
The President's Cancer Panel consists of three members appointed by the President of the United States. Current members are John P. Williams, MD, FACS, Chair, Breast Cancer Surgeon, Breast Cancer School for Patients; Edith P. Mitchell, MD, MACP, FCPP, FRCP (London), Clinical Professor of Medicine and Medical Oncology, Director, Center to Eliminate Health Disparities, Associate Director of Diversity Affairs, Sidney Kimmel Cancer Center, Thomas Jefferson University; and Robert A. Ingram, General Partner, Hatteras Venture Partners.
The Panel, established by the National Cancer Act of 1971, is an independent entity charged with monitoring the National Cancer Program and reporting to the President on any barriers to its execution. More information about the Panel’s role and background on its members can be found here.