Governments often use slogans referring to “The War on Cancer” and talk of “Cancer Moonshoots” because these words convey the magnitude of the task needed to outwit a complex disease that is still the leading cause of death worldwide. Our immune defences are often oblivious to the danger that lies within, often unable to see the threat given its adeptness in mimicking healthy cells, masking its adversarial intent but active in its quest for uninhibited replication. In Rumsfeldian terms—current scientific advancements have an authorative grip on the known knowns and are making headway in the valleys of known unknowns, but if we’re to cross into enemy territory and win this war then it is in the biological hinterlands of unknown unknowns that we shall need to conquer.

Ultimately early detection and screening of cancers such as bowel, lung, breast, and ovarian lead to far more favorable outcomes through early treatment and indeed preventative measures. The field of multi cancer early detection (MCED) is predicated on the capability to detect a signal across as many as 50 cancers from one drop of blood. This is clearly a transformational step but it is still early days and we have no data currently to support correlations to decreased mortality, so more work is needed but I am sure this will inevitably evolve in due course. Certainly, there seem to be very positive early signs on the sensitivity, specificity and concordance of the testing. There would appear to be a clear economic case to be made for paying for one single test as opposed to multiple tests, but we still need to be sure of who we should be testing and indeed when to test. For pancreatic, small bowel and stomach cancers, where there are currently no screening strategies in place—MCED testing is primed to be fine tuned and developed further to offer hope for these often silent killers.

In terms of guiding the right treatment for many of these cancers, comprehensive genomic profiling is becoming an increasingly valuable tool in the oncologists’ armamentarium in helping deliver the treatment based on the tumor mutation. We’re also seeing a shift to tissue agnostic treatments and the field of cellular senescence and associated therapeutic interventions is an area that’s gaining more and more traction.

So to win this war and complete our moonshot we’ll need to keep building the silver bullet, creating a truly golden era of precision oncology.