Elizabeth Cooney , 2025-05-07 15:29:00
Innovation in cancer detection, treatment, and prevention is stirring excitement today, accelerated by advances in artificial intelligence and other technological tools wielded by scientists, physicians, and even patients. Still, serious gaps remain between theory and reality, experts said Tuesday.
There’s a gap in access. There’s a gap between clinical guidance and clinical practice. Then there’s a gap in federal funding for the academic engine that speeds ideas into practice, a panel of health advocates and leaders from pharma and the liquid biopsy industry said Tuesday.
Appearing on a panel at the Milken Institute Global Conference in Los Angeles, the experts explored what is now possible and what is still needed to bring that innovation to cancer patients.
“Are we using all of these great technologies and applying them to where they’re most needed?” asked Wayne Frederick, interim CEO of the American Cancer Society and a gastrointestinal cancer surgeon.
Like 100,000 other Americans, he carries genetic risk for sickle cell disease. There is a potential cure, but it costs $2 million to $3 million per patient.
“We now have a great opportunity to do it, but at what cost?” he asked. “I think as a country, we have to start making tough decisions about what therapies we pursue, who we get them to, and really think of our entire community.”
The panelists’ starting point was progress in understanding cancer where it begins and how it progresses.
“We spent the last 12 years developing technology that uses advanced biochemistry, DNA sequencing, and AI to basically look into a tube of blood and see disease at its earliest stages,” said Helmy Eltoukhy, co-CEO, co-founder, and chairman of Guardant Health, which develops tests to screen and monitor cancer. “I think there’s going to be a wonderful sort of renaissance of drug development because now we can actually see the sort of function of the cell. We can see the specific subtype of the cell. We can see how it behaves. And it’s like going from essentially black-and-white television to 8K resolution in terms of disease.”
Cristian Massacesi, chief medical officer and oncology chief development officer at drugmaker AstraZeneca, said artificial intelligence was increasing the benefits precision oncology can offer patients.
“That can speed up the timing that we can bring this new treatment to the patient. This is an incredibly complex, but incredibly exciting moment to be in oncology,” he said.
Then the question arises: Who can tap these benefits?
“Less than 50% of our patients we are seeing get biomarker testing at the right time,” said Anjee Davis, CEO of Fight Colorectal Cancer, citing a study of 500 million datasets based on claims data. “I mean, how do we know that we can have this promise of precision oncology? We know how we can advance the treatment options, but patients aren’t able to take advantage of it.”
Part of the access problem in health care is the rural-urban divide. Davis, diagnosed with cancer in 2020, had to drive four hours to receive care because she lived in a rural area.
Yet living in a city is no guarantee.
Frederick, who is president emeritus of Howard University, pointed to the 22-year longevity disparity between a Black man in southeastern Washington, D.C., and a white woman 6 miles away in the city’s northwest, home to most of its medical centers.
“There’s a health desert in the nation’s capital,” he said. “We have an issue in our country about access that we have to keep advocating for.”
Marc Hurlbert, CEO of the Melanoma Research Alliance, picked up on that phrase while underscoring the need to screen for sun damage that may presage cancer.
“On the Upper East Side of Manhattan, every other corner is a dermatology practice,” he said about New York. “Across any of the bridges to Brooklyn or Queens, these are dermatology deserts, even in the biggest financial center of the world.”
Eltoukhy and Frederick deplored the gap between what’s known and what’s done in the doctor’s office. Eltoukhy was coming from the world of technological innovation when he first asked why patients weren’t being matched with drugs sitting on shelves that could save their lives.
“What I was just so floored by was the fact that there’s such a big gap between clinical guidelines and clinical practice,” he said. “We can bend mortality curves. We can improve outcomes. But access is a big piece of the puzzle.”
Frederick said guidelines can be good, but not one-size-fits-all, so that’s where AI could help. As a surgeon he performs standard operations for pancreatic or colorectal cancers that prescribe a 1-centimeter margin outside the tumor for everyone.
“While I think we’ve made a lot of advances and we have some great outcomes, we still practice in a very crude way,” he said. “In somebody like a Shaq, for lack of a better description, and probably somebody who’s 4-foot-11, that’s two very different people that I’m trying to get a 1-centimeter margin in, and that to me doesn’t make sense.”
Overshadowing most panelists’ concerns are cuts to the National Institutes of Health, the Food and Drug Administration, and other federal health agencies that fund research and practice.
“We’ve got little fires everywhere, and it’s building up to a big fire,” advocate Davis said. “I’m scared for our young scientists.”
AstraZeneca’s Massacesi is watching the biomedical research ecosystem, where ideas travel from scientists at universities to biotechs to pharma. “It’s a problem for everybody if one piece is going to suffer,” he said.
Frederick’s concerns went beyond the federal funding cuts.
“We have also created a bit of a, I would say, an era of fear, which I think is probably one of the most destructive things around innovation,” he said. “You cannot close a lab and reopen it six months later or 12 months later and have the same type of momentum and outcomes that you expect.”
Guardant’s Eltoukhy said he had a slightly different view, pointing to the vast amount of health care spending in the United States. That expenditure is more than double what other high-income countries pay, but health outcomes in the U.S. are famously subpar.
“There’s definitely more we can be doing. And I completely hear the challenges in some of these short-term disruptions,” he said. “We’ve never been in an era where we have so much data, so much AI, so much productivity gains.”
While Eltoukhy looks to AI to weather the storm of funding cuts, Frederick wants AI to do more.
The missing piece for cancer patients can be the social circumstances that influence patient outcomes and should guide clinical decisions. His example: a patient who underwent significant surgery for pancreatic cancer but who couldn’t get time off work to make it to chemotherapy sessions. More holistic data, powered by AI, could solve that problem, he said.
“What we’re trying to do is to make sure that we can meet people where they are and improve that circumstance,” he said. “What I would want to see NCI and NIH prioritize is exactly that: That whatever we do, regardless of what type of efficiency we apply to what type of metrics around productivity, ultimately what we are trying to make sure is that we are amplifying Americans’ humanity.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
