Catching Cancer Early

NASSER HANNA HAS a vision for a world without cancer deaths. Over the past year, he has led Indiana University Health to a 40% increase in screenings for lung cancer — the No. 1 cancer killer in Indiana, the U.S., and worldwide. Now he aims to expand that success to other types of cancers — even ones without any current screening tests.

“The future of early detection will include artificial intelligence, it will include a more robust electronic medical record, and it will include biomarkers, which are multi-cancer detection blood tests,” said Hanna, MD, the Tom and Julie Wood Family Foundation Professor of Lung Cancer Clinical Research and the associate division director of oncology at the IU School of Medicine.

He expects this trifecta of technologies to noticeably dent Indiana’s cancer deaths by 2035. This year alone, nearly 14,000 Hoosiers and more than 618,000 people in the U.S. are expected to die of cancer, according to the National Cancer Institute.

Hanna is the founder of the End Lung Cancer Now initiative at the IU Melvin and Bren Simon Comprehensive Cancer Center and was named director of IU Health’s overall cancer screening program in 2024. Aided by the opening of seven new sites in Indianapolis and Indiana’s first mobile lung screening unit, made possible by a $4.5 million gift from the Wood Family Foundation, the metropolitan area saw a 300% increase in lung cancer screening in 2024, plus an additional 74% increase in the first half of 2025.

“This has translated into results — the discovery of many more lung cancers, most of which are stage 1,” Hanna said. “This is saving lives.”

But what about other types of cancer? More than 100 have been identified, and few have screening tests.

“We have individual screening programs which are very good, but we need to bridge these programs and synergize how things are being done to fill in gaps and make sure we’re offering comprehensive care,” Hanna said. “We are working too much in siloes.”

He’s charting the course for Indiana to lead the nation in having the most coordinated, convenient and comprehensive program for early cancer detection.

 

Personalizing cancer prevention

Step one is to maximize the electronic medical records (EMR) system to provide personalized screening recommendations for each patient.

“To understand your personal risk, you have to weigh a bunch of risk factors and assess risk for different types of cancers on an annual basis and a lifetime risk basis,” Hanna said. “This goes way beyond saying, ‘Based on your age, it’s time for your mammogram.’”

Personal risk factors for cancer can include family history, occupation, environmental exposures, lifestyle choices, body mass index and other specified data points. A health system can also record them in a patient’s EMR.

IU Health is currently transitioning to the EPIC records system, which enables patients’ health records to be shared with any provider they see. The system could be programmed to provide individualized risk modeling — equipping both the patient and the provider to engage in shared decision-making about which screenings should be scheduled and their frequency.

Hanna expects IU Health to be poised for personalized risk modeling by 2027.

 

A blood test for all cancers

Early detection programs are only available for a few types of cancer — breast, cervical, lung and colorectal. Compliance with recommended screening varies from about 70% among people eligible for mammograms to just 18% among people eligible for low-dose CT scans for lung cancer.

What if screening for multiple types of cancers could be done with one simple blood test? That kind of convenience could be revolutionary for early cancer detection.
The technology exists now. However, Bryan Schneider, an IU researcher and breast cancer specialist who has been at the forefront of developing blood biomarkers in cancer, cautions against rushing ahead too quickly.

“I think this is some of the most powerful technology that we’re ever going to see in early cancer detection,” said Schneider, MD, the Vera Bradley Professor of Oncology and leader of precision genomics at the IU School of Medicine. “We’re vested in this technology. But it’s only a toddler — we’re not ready to send this out to drive a car yet.”

The technology works by finding circulating tumor DNA that the cancer has shed into a person’s bloodstream. It’s like analyzing soil erosion along a stream from a water sample. Schneider calls this technology “one of the most disruptive and powerful tools that we have seen in the world of cancer.” So, what’s the downside?

Clinical trials have been few, and the results have been mixed. In the largest study on a multicancer early detection blood test to date, 29 out of 6,621 participants had a new cancer detected, and 14 of those cases were early-stage cancers that could be treated to change their destiny. However, for 57 people, the tests produced an anxiety-inducing false positive, resulting in months of subsequent screenings and procedures, each with their own risks, that ultimately failed to find cancer — leaving an uneasy suspicion of something still lurking.

The bottom line, according to Hanna, is this: “We know it can find cancer. But we need more research on how to use it. Does it actually have the intended outcome, which is to reduce suffering or reduce mortality? That’s not a given.”

With further study and refinement of these technologies, a world without cancer deaths seems more than a pipe dream.

“We are working to develop the research protocol leveraging these multi-cancer detection tests,” Hanna said. “I have no doubt this is going to be part of our robust early detection programs in the next 5 to 10 years.”

 

To learn more about supporting cancer screening and early detection research at the IU Melvin and Bren Simon Comprehensive Cancer Center, please contact Amber Kleopfer Senseny at akleopfe@iu.edu.