Transcriber: Elisabeth Buffard Reviewer: Miki Sakai
Thanks for having me at TEDx San Diego
where ideas and latrines are worth spreading.
(Laughter)
But stereotypes and cancer definitely are not!
And if you can't tell, that's actually what my talk is on.
So, my big idea is actually universal cancer screening,
and this is what I did as my PhD
and I formed a company out of it.
So the goal is to actually take a single drop of blood
and within 15 minutes,
using the process that I'll be describing,
be able to isolate the cancer by-markers
that allow you to identify
whether or not you have cancer early,
when you can actually have a much better survivability,
as well as a much lower cost.
It saves a lot of lives,
and it's about 50 billion dollars right now,
but the costs keep growing in an exponential manner.
And so this is actually going to have a huge impact.
So, let's talk cancer.
So, most of the people here either know somebody
who's had cancer or unfortunately
has had to go through it themselves.
You know, I can sort of skip through most of these facts
but the idea is that
it causes about a quarter of all deaths worldwide
it's the number one killer now,
and it was projected past heart diseases in 2010.
Still number 2 in the United States,
but number one if you include everywhere in the world.
It costs a 100 billion dollars in direct cost in the United States alone.
If you take indirect cost, which is, you know, time loss,
we're looking at about twice as much, we're looking at 300 billion dollars total.
And that's, you know quite a bit of money when you're looking at it,
and the most important thing to actually know here
is the fact that, while everyone is having a discussion right now
over Congress and the debt and all of that,
the main projected part of the debt
that's actually supposed to be so dangerous is actually Medicare,
because Medicare is actually soaring through the roof.
And the reason why is because
-- and there was a study that came out in 2002
by the US government --
where about 25% of Medicare recipients
are using 85% of the total actual usage of it.
And these are usually patients with chronic diseases,
and on a per patient basis,
cancer is actually the most expensive thing,
and it's projected to increase in an exponential manner.
So this is something that you definitely want to keep in mind.
The reason why this is occuring,
is because it's actually detected too late.
So this is a slide that's used by Doctor Denis Corson
at the Morse Cancer Center in San Diego.
And the main idea behind it is
you have a single cell, it becomes malignant
it just goes through the proliferation of a cancer
where it goes from one cell to 2 to 4 and so forth.
And so this is actually considered stage zero.
It's about 60% of the lifespan of the tumor
we can't detect it right now.
But if you can treat it here actually you'd have tremendous impact.
This is where you have your cancer cells get to about a million cells.
Then when you get to about a billion cells,
it gets about stage one where it's palpable,
so this is where, if you have breast cancer for instance,
you feel a lump,
or, you know, you're usually go in for other reasons, let's say
you broke your leg and they did an X-ray,
and all of a sudden they find a little tumor there.
But you're not really showing any symptoms,
it's completely asymptomatic at this point.
Stage two is where it gets to regional disease,
and stage 3 is where it gets closer to metastatic disease,
where it's now spreading all throughout your body.
And so this is actually the prime area
where it starts showing symptoms.
So stage 4 is where it gets to metastatic disease,
where it's now fully all over your body,
and this is where it causes death,
usually, your prognosis is the worst at this point in time.
So the issue with having most of the cancers detected here
is that here is, in stage 2 and stage 3,
is where you're actually coughing up blood,
or you start bleeding profusely and it won't stop,
or you have blinding headaches for instance, if you had brain cancer,
unexplained stomach pains, things like that.
And then you go to the doctor, and they actually identify it ok.
But by that time, it's already spread everywhere.
What you want to do is just move it slightly above.
You want to detect cancer in the stage 0 - stage 1 phase.
where survival rate for virtually every cancer
is greater than 90%.
So find it when it's early.
And so, you know, a cinic in here might be saying,
"Well, who cares about detecting it early,
you have the same type of drugs,
and what are you going to do with that?"
Well, there's too many issues why.
I mean, leaving even toxicity aside,
of the chemotherapy drugs,
which are the drugs that they actually give you
throughout your body to try to reduce the tumor,
to get rid of it altogether,
you have roughly a 50% efficacy
across all diseases of using a specific drug.
But in cancer by itself, you're looking at 25% efficacy.
So this is something that 2 years ago,
Greg Lucier, who is the CEO of Life Technologies,
had a nice speech, where he said,
"Four out of 5 patients, you first run the chemotherapy,
it does absolutely nothing. It just poisons you."
So you have 4 to 6 weeks, at the end of that 6 weeks,
they then take a CT scan, they go "What is this?"
you know, it didn't work. And they'll put you on some other drug.
So it's very important that we actually combat it
from the prevention side and the diagnostic side at the beginning
rather than the cure side.
You know, there's no magic pill,
because cancer is a million different diseases.
But luckily, there is a way of being able to identify it.
And that's what we've done ourselves.
And the reason why it cost so much, and you have all of these issues,
is because of ineffective detection.
And so this actually takes me to a story
that my professor likes to tell everybody.
So you have a drunk who's looking for his keys,
in the middle of the night, you know.
And he's looking for it under a lamp post.
A policeman comes over and he goes,
"What's going on? What are you looking for?"
and he says, "I'm looking for my keys."
and so the policeman gets down on all fours
and searches with the drunk,
but they can't find the keys.
And so he gets up and says,
"I don't see the keys anywhere near the lamp post.
Where did you lose them?" He says, "Over there in the corner."
So he asks, "Why are you looking over here?"
"That's where the light is."
And that's the biggest issue:
right now, we don't know where to look,
so we look based off of the markers that we have.
So you have for instance digital rectal exams,
as well as PFC markers for prostate cancer
which any man over the age of 50 will tell you he dreads,
he has to go through it once a year.
It's the same thing for breast cancer when you go through mammograms
It's the exact same issue as well if you're doing X-rays
and try to identify: is that a spot, is that a shadow, is that a tumor...
how do you actually identify it.
It's the same thing for after therapy.
So we have a very awful method of being able to tell
with the exception of, for instance, skin cancer.
And so this is a model which is actually pretty good ,
where there's a very high rate of having people have it.
But it does not have a correspondingly high mortality rate.
And the reason why is, you go, "What the heck is that?"
And you look at it, and you take it to the doctor
he removes it, removes he area around it, and that's it.
The goal is to actually find something like that everywhere in your body.
If you can do that, it's actually a pretty powerful tool.
So we're looking somewhere, based on the tools we have,
what we need to do is actually look verywhere,
illuminate everything.
So what you want to to is be able to isolate and identify this.
So this is a specific quote from Doctor Leland H. Hartwell,
who's a Nobel Prize winner in Medicine and Physiology:
he says, "For me, the biggest payoff in cancer research
would be the discovery of biomarkers measured in blood
that reflect presence of early-stage cancer.
For nearly all cancers, early detection means cure".
So, we have the cure already.
We just need to find it early.
So what you need for early detection
is basically two things:
the blood-based biomarker that exists
for virtually every cancer you're looking at,
and the technology to isolate this biomarker.
So the way this actually works nicely is that
cancer causes unnatural cell death.
So if you're looking at, let's say, DNA itself, it's a blueprint:
so if you have a bricklayer, and your cells are bricks,
he's basically putting bricks together into a nice little house.
Normal, right?
And then you have very little [unclear]
in a controlled manner.
Cancer is basically a lazy bricklayer.
And so he's basically going to pile it all together
as quickly as possible into a mountain,
so you get a mountain of bricks,
and it's going to have a lot of shattered bricks,
a lot of pieces of bricks floating around.
In the same way, you actually have these pieces of the cells,
which is the DNA floating around your blood stream.
So this biomarker cell for DNA,
works for every single cancer, because it's cancer's Achille's heel.
For every single cancer, basically the definition is
it's a cell that divides uncontrollably.
So while it's dividing, it's not able to provide enough nutrients
and enough oxygen, for instance, to the cells,
and the cells explode and they release these big chunks of DNA.
So if you were to isolate this DNA then,
you're actually able to do a variety of things with it.
You're then able to look at sequencing mutilations, mutations,
what type of drug is correct for you,
whether of not you have cancer,
where that cancer is located and all sorts of other very important
and interesting things for this.
So this is actually the very good biomarker
that's actually gaining a lot of prominence,
there's almost a thousand papers now.
And it's been shown for every single cancer that they've tested on so far.
So, how do you actually isolate it?
That's the second issue. And that's when the technology comes in.
So we actually have a technology,
and don't be alarmed if you don't actually see anything here,
you're not supposed to.
This is a normal serum sample run through our electro-microarray.
You see nothing there.
This is a cancer patient sample.
So you can see the cell free circulating DNA,
which is these rings,
each of these rings are microelectrodes that are 80 microns in diameter.
They're about the width of a human hair.
There's a thousand of them in there,
and in any single system, and you run it through,
it's very cheap, it's very fast, and easy to use.
This is how it actually works:
take a single drop, take 15 minutes,
- there we go -
and you have red blood cells, white blood cells
in a high molecular DNA, for instance.
So each one of the yellow circles
is actually your micro electro array.
You turn on the electric field,
the cells will actually move away from the electrodes,
at the same time that this is occuring,
the DNA will move directly on the electrodes.
The DNA is seen here in green.
And this is basically all automated.
All you have to do is insert the drop of blood and push a button.
Nothing else.
When you have the floating wash,
you have the DNA left over, all your cells have moved away,
and you can keep the cells if you want to identify them
or you take the DNA.
You amplify genotyping.
So here are actual results in normal and cancer serum samples,
and you're going to see this is the case for every single thing we've tested so far.
So you're looking at normal samples that look like that,
this is breast cancer serum sample,
colorectal, pancreatic and prostate cancers.
We've also done this for lung cancer, a variety of other cancers as well.
And you can see these bright green rings that actually show up
in these different cancers, that don't exist in normal.
And so this is the DNA that's actually flowing in your blood.
So if you can isolate it, you can do major identification with it.
So, getting back to the main point,
we can save these lives with both early detection as well as the cost.
And so as to give you an idea, this is a chart
giving you incidence, mortality and spread.
As well as survivability. So if you look at cancer when it spread,
your survival rate is in some cases 3%
to 4 % for the four major cancers,
but if you find it early, when it's localized,
you're looking at a survival rate that's closer to 100% for prostate cancer,
almost 100% for breast cancer and so on and so forth.
This is actually a pretty powerful method of being able to isolate and identify.
In the same time, this is a chart showing you from 1960 to 2008.
So this is not even taking 2010 cost, which is now over 100 billion dollars
89 billion dollars,
you can see an exponential growth that goes all the way up.
And this is a major concern actually.
How do you save lives and how do you put a price
on being able to breathe without pain?
Well, if you can identify it early,
you don't have to actually do any of that stuff.
It's a surgical precision move where you remove the tumor,
rather than carpet bombing, which is what we do now
with chemotherapy and radiation, trying to actually reduce the tumor
so that they can then go in with surgery and try to cure it.
If you do something like this for early detection,
you're looking at a reduction of over half,
so 50 billion dollars you're going to be able to save just on cost alone.
And you can slow down this growth rate.
As you guys are probably familiar,
you know, the United States is also having an aging population.
So this is something that is more prominent
because the older you are, the higher the chances of cancer,
it's a disease of mutation.
So in this manner, you can actually save lives
as well as save a lot of people, a lot of money.
And you're looking at over 90% less cost, actually,
if you find cancer in stage 1 vs stage 4
for virtually every cancer as well.
So cancer is complicated.
But it's not invincible.
All you have to do is find it early.
(Applause)