A test that measures the levels of five chemicals in the breath has shown promising results for the detection of cancers of the esophagus and stomach, in a large patient trial presented by Markar et al at the 2017 European Cancer Congress (Abstract 6LBA).1
Together, stomach and esophageal cancers account for around 1.4 million new cancer diagnoses each year worldwide. Both diseases tend to be diagnosed late, because the symptoms are ambiguous, meaning the 5-year survival rate associated with these two types of cancer is only 15%. The new research, involving more than 300 patients, showed that the test could diagnose cancer with an overall accuracy of 85%.
A breath test could be used as a noninvasive, first-line test to reduce the number of unnecessary endoscopies. In the longer term, this could also mean earlier diagnosis and treatment, [as well as] better survival.— Sheraz Markar, MBBS, MSc, PhD
Sheraz Markar, MBBS, MSc, PhD, National Institute for Health Research Clinical Trials Fellow from the Imperial College London, told the Congress: “At present, the only way to diagnose esophageal cancer or stomach cancer is with endoscopy. This method is expensive, invasive, and has some risk of complications. A breath test could be used as a noninvasive, first-line test to reduce the number of unnecessary endoscopies. In the longer term, this could also mean earlier diagnosis and treatment, [as well as] better survival.”
The trial was based on the results of previous research that suggested differences in the levels of specific chemicals (butyric, pentanoic and hexanoic acids; butanal; and decanal) between patients with stomach or esophageal cancer and patients with upper gastrointestinal symptoms without cancer. The new research aimed to test whether this ‘chemical signature’ that seemed to typify cancer could be the basis of a diagnostic test.
In the new study, the research team collected breath samples from 335 people at St Mary’s Hospital, Imperial College Healthcare National Health Service Trust, University College London Hospital, and the Royal Marsden Hospital, London. Of them, 163 had been diagnosed with stomach or esophageal cancer, and 172 showed no evidence of cancer when they had an endoscopy. All the samples were analyzed with selected ion flow-tube mass spectrometry, which accurately measures small amounts of different chemicals in mixtures of gases, such as breath.
Researchers measured the levels of the five chemicals in each sample to see which ones matched to the “chemical signature” that indicated cancer.
The results showed that the test was 85% accurate overall, with a sensitivity of 80% and a specificity of 81%.
Dr. Markar said, “Because cancer cells are different from healthy ones, they produce a different mixture of chemicals. This study suggests we may be able to detect these differences and use a breath test to indicate which patients are likely to have cancer of the esophagus and stomach and which do not. However, these findings must be validated in a larger sample of patients before the test could be used in the clinic.”
Over the next 3 years, the researchers will continue with a larger trial, using the test with patients who are being given an endoscopy for gastrointestinal symptoms but not yet diagnosed with cancer. This will assess the ability of the test to pick up cases within a group that is likely to contain only a small percentage of cancers.
The team is also working on breath tests for other types of cancer, such as colorectal and pancreatic, which could be used as first-line tests in general practice surgeries. ■
Disclosure: Dr. Markar reported no potential conflicts of interest.
1. Markar S, Wiggins T, Antonowicz S, et al: Breath volatile organic compound analysis for the diagnosis of oesophago-gastric cancer; multi-centre blinded validation clinical trial. 2017 European Cancer Congress. Abstract 6LBA. Presented January 30, 2017.