Recently I have had the honour of being awarded The Aftershock Foundation Research Grant Award – a philanthropic grant valued at AUD$120,000. The Aftershock is a not-for-profile, start-up organisation with the mission to raise funds and awareness of high-mortality rate and rare cancers. It was founded by Suzanne Neate, who had recently experienced the tragic loss of her mother, Theresa Neate, to metastatic medullary thyroid cancer. The organisation prides itself in transparency and accountability, with every dollar raised going towards supporting the intended research.
The incidence of thyroid cancer is on the rise. It is now the 7th most commonly diagnosed cancer in women, and 3rd in women between 24 and 49 years of age. While this phenomenon is multifactorial and likely contributed significantly by detection bias, but the fact remains, a rapidly increasing number of patients will carry the diagnosis of thyroid cancer. While clinicians continue to debate the clinical significance of this, or the threshold to warrant further treatment, patients are seeking second opinions and dealing with the anxiety associated with their cancer diagnosis. In addition, the rate of indeterminate FNA cytology results continue to be reported between 20 to 25 % of all FNA samples from clinically significant nodules. This further plays into both the patients’ anxiety and clinicians’ uncertainty if surgery was not performed.
Molecular profiling of thyroid FNA (needle biopsy) samples continues to hold the promise to at least reduce, if not eliminate that preoperative uncertainty. Several commercialised products are currently available in the USA, with the promise to significantly improve the diagnostic accuracy of thyroid FNA. However, not only are none of these currently available in Australia, the published evidence also casts doubt in the utility of these diagnostic adjuncts in their current status. We believe that with further research, the potential of FNA molecular testing will be realised.
It has been shown that the true utility and the eventual gain in diagnostic accuracy depend on the prevalence of the disease as well as the frequency of indeterminate results in FNA samples of the specific region. Therefore, it is important for such research to take place locally here in Victoria. As the technique matures and clinical outcome information becomes available in time, it is envisaged that the clinical benefit of pre-operative molecular testing would be beyond the initial diagnostic phase, but also be able to inform clinicians on the prognosis.
There is no doubt that precision medicine with molecular techniques is the next frontier. Whether it is to inform on diagnosis, prognosis or likely response to treatment, the careful integration of pre-operative molecular testing should aim to streamline and optimise management of patients with thyroid nodules or malignancy. Patients with rare cancers such as thyroid cancer have much to gain from such cutting-edge technology, especially when there is significant heterogeneity in its clinical course. The ability to better predict clinical behaviour from molecular information will enhance the clinician’s confidence in recommending the appropriate level of treatment right from the outset, thus avoiding over- and under-treatment on an individual basis.
The support of philanthropic foundations such as The Aftershock is vital in our endeavours in the research and development of new techniques here in Victoria. The pilot data and studies will allow us to leverage more funding support from government agencies. As a rare cancer, research in thyroid cancer are ideally conducted in multicenter studies, and non-institutional seed funding affords the researcher freedom to be collaborative. Therefore, this Aftershock grant will contribute to establishing collaborations of multiple Melbourne institutions, including Alfred Health, Monash Health, and Epworth HealthCare.
Only one year into their existence, The Aftershock is already making a significant contribution to the medical research of rare cancers here in Victoria. Further funds have been pledged for both thyroid and brain cancers in the coming years. We are grateful for their work. We look forward to ongoing collaborations with The Aftershock, and draw much inspiration from their phenomenal fund-raising efforts.
For more information on The Aftershock, go to www.theaftershock.org
No comments:
Post a Comment