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Breath Test for Detecting Lung Cancer Under Study, Looking Promising

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Some members had previously asked about a breath test to detect lung cancer, and at the time I was not familiar with this work. But research has been ongoing with a new test designed by Menssana Research to detect lung cancer (LC) by noting a pattern of volatile organic compounds (VOCs), essentially chemicals in exhaled breath, that characterizes people with lung cancer but isn’t seen in other people (recent summary papers here and here). In fact, VOCs are present in the air around us, and in the exhaled breath of people who don’t have cancer, but the technique used by the company involves using a complex computer analysis to detect patterns of VOC concentrations that are common to LC patients but not seen in people without cancer. Here’s the summary of their hypothesis for this work:

VOCs in LC

The test itself is simple, just involving a subject breathing for two minutes into a tube connected to a machine that collects these VOCs, and at the same time collecting a sample from the background air (which has its own VOC pattern, subtracted from the patient’s result). The pattern is analyzed, and if the result is “positive”, it corresponds to an approximately 81% likelihood of a person having lung cancer, and a negative result appears to rule out lung cancer approximately 85% of the time. This is in the same ballpark as in some CT scan studies of LC screening.

Interestingly, the results weren’t affected by cigarette smoking, and results weren’t more likely to be positive in patients with bulkier or more advanced disease than in patients with early stage disease. Importantly as well, LC patients who had undergone surgery continued to show a positive test, indicating that this isn’t an effective means of detecting recurrence, and also that whatever makes the test positive isn’t the tumor itself (and suggests to me that it may detect a very high risk setting in patients who test positive on the breath test but show no evidence of disease on scans).

This work remains investigational, and my center is participating in a breath test study, along with several centers in NYC and a few other places on the east coast, in which the test is being done on all sorts of patients to assess how well it discriminates in a larger population:

1) asymptomatic high risk patients (smokers, 50 and older)

2) high risk patients getting evaluated for a lung problem like cough or shortness of breath who haven’t been diagnosed with LC

3) patients with a tissue diagnosis of lung cancer (including resected or otherwise treated) or another lung problem like emphysema or pulmonary infection (I’m not sure why they’re lumping these patients with LC patients)

4) asymptomatic patients, not high risk, without significant medical problems

You can learn details about this study here.

Given the potential issues with CT screening, particularly the risk of false positives that can lead to anything from lots of anxiety to unnecessary invasive procedures, having the ability to add a level of confidence about a nodule being the real deal or more likely something unrelated to cancer would be a major step forward. Menssana is interested in using the breath test to help identify a group of patients who would be the highest yield to screen with CT, and I agree that the two studies together, in either order, could address many of the problems of each alone. I’ll be very interested in seeing the further development of this technology.


3 Responses to Breath Test for Detecting Lung Cancer Under Study, Looking Promising

  • jaminkw says:

    “whatever makes the test positive isn’t the tumor itself (and suggests to me that it may detect a very high risk setting in patients who test positive on the breath test but show no evidence of disease on scans)”

    I don’t quite understand why this test won’t predict recurrance, but according to this statement, do I understand it could identify false remissions?

    Judy in Key West

  • ValS says:

    Dr. West
    Have any of your patients told you about an unusual odor from their stool, that is consistent and seeingly not related to their diet?

    Prior to my dx IIIB NSCLC (nonsmoker)inoperable, advanced, pleural effusion, large single tumor in RL, 1 node, no mets, I noticed a different smell. First thought it was from eating pork or lamb, but no matter what I ate it did not change and I had never smelled it before the last month or two. Beginning 06/07 I had 4 Carbo/Taxol/Avastins 3 weeks apart. CT scans after 4th one, and every scan since, “No disease detected.” I am in clinical study AVF3671g Avastin and Tarceva or placebo. All side effects indicate I am likely receiving Tarceva. Odor persists and I was wondering if it could be caused by some metabolic products from the LC (could it be a predictor?) I am a healthy caucasian women 69 yrs, naturally slender and active, with treated HBP & hypothyroid.

    Recently I was at lunch with my daughter and I smelled the same odor outside the coffee shop. She said it was coffee roasting. I never drink coffee or products containing coffee because they keep me awake.

    Hope you can figure this one out! I remember seeing a demonstration of dogs sniffing out bladder (I believe) cancer and wondered if this might be similar.
    Thank you
    Valerie

  • Dr. West says:

    Val,

    That’s a new one for me, and I don’t think I have a good answer. Almost the only think I can think of is that it’s possible you’re having a small amount of seizure activity in one of the temporal lobes of the brain, which could be from a brain metastasis or unrelated. I’m not saying that’s likely, but temporal lobe epilepsy can have someone feeling fine, living their life, but have olfactory (odor-related) hallucinations, most commonly reported as a smell of rotting strawberries or burning rubber. It might be worth talking to your doctor about the value of a brain MRI just to rule out any visible abnormality. Otherwise, I’m having trouble thinking of any explanation.

    But you having the ability to smell the odor of cancer cells would surprise me.

    -Dr. West

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