Pictures of the Future      Fall 2008

The Sooner the Better: New Focus on Early Diagnostics

People are now living longer, not least thanks to advances in health care. At the same time, the world’s population continues to grow. It will increase from 6.6 billion today to 9.2 billion by 2050. Partly as a result of this demographic development, global health care costs are expected to more than double within ten years (from 2003 to 2013)—from about €2.3 trillion to over €5.5 trillion. The costs of treating chronic illnesses account for a large share of this, and they already make up 60 % of health care expenditures, according to the WHO.

Keeping health care affordable despite these rising costs requires a shift in focus from acute care to early diagnosis. This approach will be needed particularly in the case of cardiovascular diseases and cancer. According to the WHO, 17.5 million of 58 million deaths in 2005 were caused by cardiovascular illnesses. In 2015, it will be 20 million.

Cancer is on the rise too. In 2005, 7.9 million people died of cancer, and the figure is expected to rise to 11.5 million by 2030. The earlier these diseases are diagnosed, the more effectively and thus cost-efficiently they can be treated. The WHO notes that a third of all cases of cancer could be cured if the disease could be identified early enough and effectively treated.

One method of achieving this involves comprehensive screenings that identify risks in healthy patients. It has been proven, for instance, that mammography reduces the risk of mortality from breast cancer. In its World Health Statistics (2008), the WHO states that universal availability of precautionary screening and associated counseling of at-risk patients could reduce the global mortality rate from breast cancer by 15 to 25 % in women between 50 and 69 years of age. There are still no reliable figures available for many other illnesses, because the shift in focus to early diagnosis is just beginning.

If a health risk or an initial incidence of illness has already become evident, early and accurate diagnosis becomes important. Medical technology is pursuing a variety of innovative avenues in this regard, particularly in the field of molecular diagnostic techniques (see Pictures of the Future, Spring 2007, Molecular Medicine – Facts and Forecasts), which medical researchers use to try to understand the origins and development of diseases.

In this connection, researchers are developing biomarkers that dock on specific cells, e.g., cancer cells, which are made visible as a result. "Techniques involving radioactively marked glucose 18FDG are already being used for certain types of cancer (such as lung and skin cancer). Researchers are also working on new radiopharmaceuticals, like 18F-FLT, which can image cellular proliferation," says Michael Reitermann, CEO of the Molecular Imaging Division at Siemens Healthcare. These radiopharmaceuticals can show whether a tumor has already formed metastases, for example. It may also be possible to use radiopharmaceuticals in medical check-ups for healthy persons, but they are not widely used for this purpose because of radiation exposure.

The tremendous amount of data generated by new molecular diagnostic techniques must also be evaluated and interpreted. This is where computer aided detection systems come in. They help physicians to recognize tissue anomalies during cancer diagnoses and thereby make the process of identifying tumors more efficient. Although this technology has already been introduced for breast cancer, it is only now starting to be used for diagnoses of lung cancer and intestinal cancer, according to a (2008) study by Frost & Sullivan. This is because different imaging techniques are used in these areas. The study estimated the global market for computer aided detection systems to be worth $335 million in 2007, and it is growing rapidly. In Europe alone, it will grow from $116.9 million to $449.8 million by 2014.

A more accurate early diagnosis means shorter and less stressful treatment, as well as better chances of recovery. What’s more, it reduces health care costs throughout the entire supply chain, because it lowers follow-on costs. For example, higher-precision laboratory and imaging processes can reduce the number of incorrect diagnoses and related unnecessary treatments, or those that come too late. According to a study conducted by AdmeTech Foundation, better imaging techniques and additional in-vivo and in-vitro screenings for prostate cancer could save $1.4 billion per year in unneeded biopsies in the U.S. alone. There are still no global figures available for the over-all savings potential resulting from early diagnoses, however, because a number of factors affect how the benefits are estimated.

What illnesses does a patient develop after recovery from an initial disease? How often is there treatment for health risks that possibly would not develop into actual illnesses? What sort of economic effect does the relationship between the illness and work output have? In addition, more health-promotion programs that keep each individual in good health for as long as possible will be needed in order to effectively reduce costs.
                                                                                                             Dagmar Braun