The Lung Cancer Symposium brought together academia, industry, patient organisations, the cancer registry and governmental agencies. Photo: Sofia Linden / Oslo Cancer Cluster

Exploring lung cancer: screening and early detection

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Could a screening programme reduce lung cancer mortality in Norway?

Lung cancer is the deadliest type of cancer and the fourth most frequently occurring cancer in Europe. Yet, there are still no established lung cancer screening programmes in the world. Why is that and how can the challenges in screening and early detection be overcome?

These were some of the questions discussed in depth at the Lung Cancer Symposium: Early Diagnostics and Screening, Benchmarking the Nordics+ on 24 May 2023 at Oslo Cancer Cluster.

“Screening for lung cancer has been in the pipeline for years. Now it seems right to start in the Nordic countries. With this first Nordic meeting for lung cancer screening, we had the pleasure to share our pilot projects, the very important selection methods of high-risk populations and our experiences so far. We all met in a very friendly atmosphere and look forward to collaborating in the future,” commented Oluf Dimitri Røe, MD, PhD, Professor, NTNU, the co-chair and moderator of the symposium.

Collective efforts

Attendees from academia, industry, patient organisations, the cancer registry and governmental agencies took part in the symposium.

“Cooperation is key in the fight against cancer. The Lung Cancer Symposium: Early Diagnosis & Screening, Benchmarking the Nordics+ highlighted this as experts in the Nordics and the International Agency for Research on Cancer (IARC/WHO) shared benchmarking with an engaged audience. It was motivating to witness this and to be a part of the collective efforts for cooperation amongst this oncology ecosystem,” confirmed Charlotte Wu Homme, symposium co-chair, who serves as Head of Membership and Events, Oslo Cancer Cluster.

Nordic speakers

The programme included expert speakers from the Nordic countries Sweden, Norway, Denmark, Finland and Iceland. They framed the challenges of lung cancer and addressed clinical models for risk prediction, early diagnosis, and screening in the Nordics.

There was also an introduction by the Norwegian Cancer Society and a digital presentation giving the World Health Organisation’s perspective. Finally, a panel discussion covered implementation models for screening and selection.

About

Lung Cancer Symposium: Early Diagnostics & Screening, Benchmarking the Nordics+ was sponsored by Astra Zeneca and Daiichi Sankyo and received support from Innovation Norway. The first symposium was presented on May 24, 2023. Based on feedback, a follow-up symposium is planned for 2024.

The symposium was organised by Oslo Cancer Cluster (OCC) and the Norwegian University of Science and Technology (NTNU). Organizing committee: Oluf Dimitri Røe, NTNU, and from OCC:  Charlotte Homme, Dave Tippett, Marine Jeanmougin. 

List of speakers (full titles):

  • Ole Alexander Opdalshei, Deputy of Research, Norwegian Cancer Society
  • Oluf Dimitri Røe, MD, PhD, Professor, Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science & Technology (NTNU), Department of Oncology, Levanger Hospital, Levanger, Norway,
  • Mattias Johansson, Head Scientist, International Agency for Research on Cancer (IARC/WHO) Lyon, France
  • Aija Knuuttila, MD PhD, Associate Professor, Department of Medicine, HUS Comprehensive Cancer Center, Helsinki, Finland
  • Hrönn Harðardóttir, Pulmonologist, Landspítali University Hospital, Reykjevik, Iceland
  • Bengt Bergman, M.D, Ph,D,, Respiratory Medicine, Sahlgrenska University Hospital, Göteborg
  • Zaigham Saghir, MD, PhD, Professor, Department of Respiratory Medicine, Gentofte University Hospital, Hellerup, Denmark
  • Haseem Ashraf, Associate Professor, University of Oslo, Oslo, Norway, Department of Imaging, Akershus University Hospital, Oslo, Norway

 

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PRS tests provide a statistical prediction of an individual's increased clinical risk for a specific condition. Photo: Gerd Altmann, Pixabay

Guidance on polygenic risk scores

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The Estonian provider of PRS tests Antegenes supports the recent guidance from the American College of Medical Genetics and Genomics.

Polygenic risk scores (PRS) have recently been the subject of statements by the American College of Medical Genetics and Genomics (ACMG). These scores are used in the clinical assessment of an individual’s genetic risk for certain diseases. In simple terms, PRS tests provide a statistical prediction of an individual’s increased clinical risk for a specific condition, such as cancer.

Antegenes, an Estonian provider of PRS tests, welcomes ACMG’s initiative and considers it a crucial step towards establishing best practices and guidelines for the widespread use of PRS technology.

Dr Peeter Padrik, CEO of Antegenes, explains: “The considerations by ACMG align with our guiding principles at Antegenes for the development and use of our polygenic risk score tests. Our clinical grade genetic tests are in use in several European countries, and we have already applied these principles in their development and in providing cancer prevention services.”

Understanding polygenic risk scores

ACMG’s statements emphasize several important points related to PRS testing. First, it is crucial to understand that PRS test results do not provide a definitive diagnosis of a disease, such as cancer. Instead, they offer a statistical prediction of an increased clinical risk. Antegenes ensures clarity on this matter by providing explicit information in their test materials.

Furthermore, a low PRS does not exclude the possibility of significant risk for the disease in question. PRS represents only one aspect of an individual’s hereditary risk, and there are other factors that can influence the development of tumors. Antegenes emphasizes the importance of considering PRS results within the context of other relevant clinical data.

Considerations for effective implementation

Another factor to consider is that PRS predictions may vary based on the population used as reference. Ethnic background plays a role in this variation. Antegenes addresses this by analyzing PRS performance using data from different ethnic groups and making necessary adjustments to the test results. They always include information about an individual’s ethnic group in their genetic testing process.

ACMG also highlights the importance of complementing PRS testing with monogenic testing in certain clinical scenarios where the underlying genetic cause is known or suspected. Antegenes fully supports this approach and recommends considering both PRS testing and monogenic pathogenic variant testing, aligning with established clinical guidelines.

Promoting evidence-based medical management

Antegenes agrees with ACMG’s stance that patients and healthcare providers should have informed discussions about the indications for PRS testing and how the results will be used in guiding medical management. They emphasize the importance of evidence-based PRS-based medical management and have developed clinical recommendations based on PRS risk levels and existing professional guidelines.

In summary, Antegenes fully supports ACMG’s statements and has taken into account the described limitations of PRS testing. They have implemented solutions, provided relevant information, and developed clinical recommendations based on available evidence for the prevention and screening of specific tumor types.

About

Antegenes is a member of Oslo Cancer Cluster. The Antenor implementational research project, focused on preventing breast cancer based on genetic risks, is currently underway in collaboration with Norwegian scientific and clinical partners and is scheduled to conclude by the end of 2023. The project partners are Oslo University Hospital, the University of Oslo, Vestre Viken Hospital Trust, Oslo Cancer Cluster and Antegenes.

The post Guidance on polygenic risk scores first appeared on Oslo Cancer Cluster.

From left to right: Iselin Holmedal Marstrander (EHiN), Ellen Rønning-Arnesen (Ministry of Health and Care Services), Ketil Widerberg (Oslo Cancer Cluster), Bettina Lundgren (Danish National Genome Center), Gun Peggy Strømstad Knudsen (Norwegian Institute of Public Health), Nard Schreurs (EHiN).

Suggested a Nordic Health Data Space

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How can the Nordics use health data to accelerate the development of cancer precision medicine?

”We have a foundation for health data that is among the best in the world.”

State Secretary Ellen Rønning-Arnesen from the Ministry of Health and Care Services presented the government’s work with health data at an EHiN meeting earlier this month.

“Our main task now is to make Norwegian health data even more available for research. We have a good starting point for this with good systems and high trust from the population that the data will be used safely and securely,” commented Rønning-Arnesen.

More targeted treatments

Ketil Widerberg, general manager of Oslo Cancer Cluster, presented an idea to the government’s vision, inspired by the EU initiative European Health Data Space:

“The Nordics can become a test bed for precision medicine, we can create a Nordic Health Data Space and do regulatory innovation. The old way of documenting the effect of treatments doesn’t work, especially in cancer. The patient groups are so small that we can’t use control arms the same way as before.”

Widerberg mentioned the national clinical study IMPRESS-Norway as an example. By using advanced molecular diagnostics, they have identified targeted treatments for cancer patients with no other options left.

“Health data should be used as documentation for faster approval of new medicines. Norway and the Nordics can lead the way here in regulatory innovation. Let’s create a Nordic Health Data Space to solve this challenge now!” Widerberg suggested.

Potential of genome data

Denmark is already using health data for clinical research and patient treatment. The Danish National Genome Center work with the implementation of whole genome sequencing in patient treatment, collecting and storing Danish genome data, making genome data accessible for clinicians, researchers and patients, and promoting the development of personalised medicine in Denmark.

“Genetic data are important and should be used when sensible, especially for research, development of new medicine and patient treatment. We are still operating too much from a one-size-fits-all. When it comes to cancer, the Nordic countries cooperate well together,” commented Bettina Lundgren, director at Danish National Genome Center.

The Norwegian Institute of Public Health also has excellent experience with making use of health data.

“Through the pandemic, we demonstrated that we could get quick access to data. We got data in almost real-time and at quite a low cost. We also need to lift the Norwegian population-based cohorts as a valuable source. We can use them to analyse the side effects of vaccines and the genetic risk of developing disease. We can hope for a future personalized vaccine strategy,” said Gun Peggy Strømstad Knudsen, deputy director general of the Norwegian Institute of Public Health.

Want to learn more?

EHiN (E-Health in Norway) has been an annual conference for almost a decade and arranges meetings throughout the year. Here are some of the upcoming events:

  • 31 May – Helsesikkerhetsdagen
  • 1-2 June – Plattformdagene
  • 15-17 August – Arendalsuka
  • 7-8 November – EHiN 2023

The post Suggested a Nordic Health Data Space first appeared on Oslo Cancer Cluster.

Margrethe Biong (the Norwegian Research Council), Astrid Bjerke (the Norwegian Cancer Society), Marine Jeanmougin (Oslo Cancer Cluster) and Ketil Widerberg (Oslo Cancer Cluster) represented Norway at the kick-off-meeting in Lisboa.

Europe united against cancer 

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Europe has its own moonshot against cancer!

The European Union has awarded 6 million euros to a consortium of 57 organizations spanning across 28 countries. They have joined forces to fight cancer at all levels of society, by supporting cancer research and innovation, policy development and citizen engagement. 

“The ambitious approach taken by the European Commission to reduce the cancer burden for patients requires a coordinated response from relevant actors across Europe,” commented Marine Jeanmougin, responsible for EU affairs and digitalisation at Oslo Cancer Cluster.

The project is called ECHoS and is coordinated by the Portugese Agência de Investigação Clínica e Inovação Biomédica (AICIB). Oslo Cancer Cluster together with partners of Cancer Mission Hub Norway have contributed from the Norwegian side. 

“The strong collaboration between Oslo Cancer Cluster, the Research Council, the Cancer Society and their partners, has brought Norway to take a central role in ECHoS. The Cancer Mission Hub Norway has the potential to shape best practices, in a joint effort with our European collaborators,” Jeanmougin commented. 

Read the press release (in English)

Read the press release (in Norwegian)

 

Funded by the European Union under the Horizon Europe Framework Programme. Grant Agreement Nº: 101104587. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them. 

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