Hopkins Program to Individualize Cancer Screening (inCAS)
The goal of inCAS is to transform the practice of cancer screening. Despite being effective for only a subset of individuals, many screening guidelines target large swaths of the population. Additionally, screening tests can be invasive and generate false positives, leading to considerable psychological distress. inCAS investigators are creating innovative tools, rooted in risk prediction, that will ensure that only the individuals most likely to benefit from screening are actually screened. inCAS is also identifying novel measures of early cancer detection that will ideally increase the likelihood of successful treatment in those who are screened. In accomplishing its goal, inCAS will increase the effectiveness and safety of screening programs considerably while also reducing their associated costs.
To develop the innovative tools and measures necessary to individualize cancer screening, inCAS investigators are leveraging advances made in the basic sciences and in Big Data that have led to an increasingly nuanced understanding of how cancer forms and progresses. By harnessing this information, inCAS, in conjunction with the School of Medicine, the Bloomberg School of Public Health, and the Welch Center for Prevention, Epidemiology, and Clinical Research, has developed a state-of-the-art prostate cancer screening decision support tool that will be implemented in the electronic medical record system and comes with an iPAD app. The tool combines each patient’s unique demographic profile and family history with a prediction of their expected survival to guide screening decision-making. Intended for use by patients and their clinicians, the tool will help avoid unnecessary screening and the risks associated with false positives.
inCAS is also focusing on colorectal, breast, cervical, and lung cancer screening. Through collaborations with Johns Hopkins Community Physicians and Bayview Hospital, inCAS investigators are conducting surveys of health care providers to understand barriers to colonoscopy uptake, preferred intervals for colorectal cancer screening, knowledge about lung cancer CT screening effectiveness, practices surrounding breast cancer screening, and factors associated with human papillomavirus (HPV) vaccination in adolescents. These research efforts will lay the foundation for evidence-based, individualized screening guidelines that are informed by provider experience.
In addition to better guidelines, inCAS recognizes that a transformation in current screening practices will require better screening tests. Accordingly, inCAS investigators are researching circulating tumor DNA with the intent of developing measures of early cancer detection that will lead to more effective treatment and longer patient survival.
inCAS is working towards a future where clinicians screen patients only when the information is likely to improve patient outcome while using less invasive, more accurate screening tests that can detect cancers earlier. In this model, health care systems will contain costs, and patients will experience less advanced disease, fewer unnecessary procedures, and lower burdens of disability.