Charles Swanton

The battle is still raging.

I think one of the papers that I read a couple of years ago that, that really struck me as fascinating in the lung case was that Charlie Swanton paper about particulate matter 2.5, um, I think back in 2023 during COVID he published that.

And he proposed a, a really interesting new mechanism which was nothing to do with carcinogens at all, where, um, small particulate matter of a- around the, the 2.5 micrometer size could come into the lungs, cause, uh, epithelial damage, uh, attract macrophages.

Those macrophages, uh, excreted, um, interleukin 1 beta, and that caused inflammation which for a subtype of genetic groups, I think EGFR and KRAS, could drive cancer through a completely non-carcinogen mechanism.

So what about those patients that I see in my clinic that have not had that level of tobacco exposure, that would not be eligible for lung cancer screening that still get lung cancer? We're not picking them up, right? So we need to have other better ways of picking them up, and I think some sort of blood-based testing is gonna be the way forward.

And you know, I think the NHS has moved really very quickly on implementing and trialing blood-based diagnostics for early detection precisely for this reason, right? And I think the most famous of these is the NHS Galleri trial, um, which the NHS has partnered with Galleri to evaluate the role of a multi-cancer evaluation detection test, MCED test, um, versus not doing anything in, in normal patients.

And these data were presented at ASCO this year by Charlie, uh, Charlie Swanton.

And, you know, the, the endpoint of the study was unusual insofar as normally for a screening study, you want to be looking for intervention to reduce mortality.