Whitney Jones, MD, thinks biomarkers and genetic testing can help people get in front of cancer
- Bruce Morton
- Jun 3
- 15 min read
Updated: 7 days ago
DESCRIPTION
Whitney Jones, MD, the founder of the Colon Cancer Prevention Project is a staunch advocate of increased usage of biomarkers and genetic testing. When people undergo a hereditary cancer risk assessment, they can learn about their risk for cancer and address the cancer aided by early detection.
Dr. Jones says biomarkers also help a drug passes clinical trials, enabling them to more quickly hit the market. These drug trials can be used in an immunotherapy regimen, which provides an alternative to chemotherapy or radiation. When a genetic marker is identified, it can result in doctors designing therapies they believe would have maximum efficacy. Plavix is a prescription medicine, but some people carry a gene that makes Plavix ineffective. If that gene can be identified through genetic testing, a therapy can be designed that doesn’t include Plavix.
The prostate specific antigen is an example of a biomarker that can result in early detection of prostate cancer. Dr. Jones admits there have been missteps with the prostate specific antigen (PSA), which resulted in its overuse in being an instrument in diagnosing prostate cancer. He says any new technology needs ongoing scrutiny and with that scrutiny will come an increasing number of god outcomes.
Whitney Jones, MD says it of utmost importance for people to maintain a strong connection with their physician because it is part of their job that they stay up to date with the latest literature on the subject of genetic testing.
Wile many advances have been made in the area of biomarkers, Dr. Jones has no doubt there will be many more, with the passage of time. His vision of the future has biomarkers providing the most help in screening for colorectal cancers and human pappilomavirus-related cancers. He also envisions health care providers tracking when patients are due for a screening and sending self-exams to their homes.
However for this to be effective, Whitney Jones, MD says it has to be available for everyone, not just the rich.
Additional Resources:
Support Group:
Colon Cancer Prevention Project: https://www.kickingbutt.org
TRANSCRIPT
Bruce Morton: Greetings and welcome to the @CancerInterviews podcast. What I am is Bruce Morton, your host; what I am not is a doctor or a scientist. So, when I tell you a biomarker is a way to detect disease or infection, I am perhaps grossly oversimplifying; but on this episode, our guest IS a doctor, and he explain biomarkers in a way that is simple and cogent and relevant. He is Whitney Jones, MD, the founder of the Colon Cancer Prevention Project in Louisville, Kentucky. This is his second appearance on Cancer Interviews, so, Whitney, welcome back!
Whitney Jones: Hey, Bruce, great to see you and good morning. In full disclosure, I am an employee and have equity and work for a company called Grail that works in the biomarker space. Thanks so much for having me.
BM: Now, I am going to challenge you and ask you to take off your MD hat and put on your lay person hat. For the benefit of all of we lay people out there, what is a biomarker?
WJ: A biomarker is a hugely broad category. In terms of what they are, they are usually proteins or segments of DNA or associations of DNA, such as RNA, which are the parts of the DNA that help code for proteins that can be found in people’s blood, in their urine, in their sputum, they can get it from tissue specimens, so there is a wide variety, even in cerebral spinal fluid. A huge, broad amount of these and what they are used for is both to evaluate for the presence of disease and primarily used in cancer, but can also be used, as you said, in infectious diseases, even heart disease, diabetes, risk factor issues, but are also primarily used in cancer and that tells us about people’s risk for cancer, it tells us about what type of tumor a person has and potential therapies might be amenable to as well as people who have a known cancer to evaluate for precision oncology opportunities for certain medications as well as follow it longitudally during the course of treatment for those who have cancer, so biomarkers is a relatively small word that covers a huge area for folks, but an example might be PSA, which is a protein, prostate specific antigen. That’s gonna be one most folks have heard of, as well as gene testing, people who undergo hereditary cancer risk assessment in certain genes that they carry. Those are both examples of biomarkers.
BM: You had mentioned the word “medication.” What role do biomarkers play in terms of whether a new drug passes clinical trials and hits the market?
WJ: Well, I think they are being used more and more. The utilization within the trials is just beginning because the technology is relatively new. Most biomarkers have been used for prognostication, but lately we have gotten into immunotherapy. For instance, treatment with advanced lung cancer. We are looking for epidermal growth factor markers in tumors and then utilizing that marker, that expression of that in order to design different therapies around that, so, yes, they are being used now in clinical trials. Another one is Plavix (a prescription medicine). Some people carry a gene that makes Plavix ineffective. It’s really spanning the entire spectrum, and if I can, I would like to go into why particularly the genomic pieces have become so relevant lately. It’s because the ability to sequence DNA deeply and cheaply has exponentially increased. It is sort of like computers. Think of what we could do with computers twenty years ago, versus what we have now? Well, that same impact has occurred in the DNA sequencing territory to where we can sequence and find DNA to a much greater degree, much more inexpensively as well than we ever did before.
BM: It sounds like the biomarker provides a level of scrutiny, but is there any scrutiny of the biomarker?
WJ: A lot of biomarkers have undergone scrutiny, and we see them in common utilization today. If a person has a history of breast cancer, then you know evaluating their underlying genetics for mutations is considered standard. Certainly, we have had missteps in biomarkers, and PSA is the perfect example of that. There were many things that caused elevation of PSA, including prostatitis, just age-related issues and probably overused that in diagnosing people with prostate cancer. I think certain people underwent surgery because prostate cancer is quite an indolent issue in many people, so, yes, I think biomarkers is new, but I think any new technology is undergoing ongoing scrutiny in what we would call an adaptive process where we are learning as we are discovering, and again, waiting fifteen years, I think we learned from the COVID experience that we can accelerate much more aggressively when we identify opportunities. And don’t forget, we have a COVID-sized epidemic every single year in the United States with cancer deaths.
BM: All of this sounds like it can lead to good outcomes, but it sounds like it is taking place on the playing field, while we lay people are in the back row of the bleachers. How can biomarkers help and what they do be made relevant to the lay person?
WJ: I think the most important thing is that people need to understand and deal with their cancer risk or dealing with cancer, have a connection to their physicians. Your physicians are reading literature that’s appropriate. They are looking at guidelines, they are looking at evolving technology. People who are treating cancer, this is part of their daily read. This is something that is no longer in the future. This is part of the therapy that is right in front of their eyes, and again, we are very quick to develop new therapies and new treatments for cancer. What takes longer are those biomarker utilizations and either predicting cancer or detecting cancer early, those take much longer to develop those studies. My big recommendation to your listeners is not only to do your internet research with Doctor Google, but have those discussions with your doctors who can help put that information into perspective for you.
BM: You talked about computers twenty years ago, computers today and computers twenty years from now. Let’s extrapolate that to biomarkers. What is your vision as to where they will be in two decades?
WJ: My personal vision and this isn’t representing Grail’s vision, I think that a lot of screening tests for cancer, I think we will find that many blood tests are suitable for some of the current things we already screen for, particularly colorectal cancer, and human pappilomavirus-associated cancers. Those are some of the ones we screen for now. I think that in addition to that, a platform called multi cancer early detection, where we are utilizing the genomic sequence, not just the genes, that part you inherit from your parents, but what’s called the epigenomic signature, the methalation patterns. I don’t want to get too much in the weeds, but the reason your muscle cell knows how to be a muscle cell and eyeball cell knows how to do what it does is not because they have different DNA, but they have different patterns of methalation that turn off and turn on various proteins that can be expressed. So, the DNA is the code, then it is going to be expressed, so I think we will in twenty years be in a place, hopefully, where we have the capacity to screen for many tumors simultaneously, including unusual and rare ones, and also they can be done with blood tests, which can be performed either at home, I think twenty years from now, we’ll have a way to draw your own blood at home. The third part is that in twenty years we have figured out logistics so that if you are due for an annual screen, that test gets to your house every single year a week before it’s due to allow you and other people to be screened. Again, for this to work, it can’t just work for the wealthiest and the most rich; this has to be something that narrows our gaps and disparities and is available broadly throughout the population from the highest socioeconomic end, but also for people that are uninsured, for people who have Medicaid, and I think twenty years from now we will have a national healthcare system, and it will help support that. So, I think we are going to flatten the playing field and we are going to democratize screening and hopefully we will utilize logistics to get this across the finish line, and if we don’t get it across the finish line within the cancer community, Amazon will.
BM: In our first interview, we learned of your mantra, “Go on offense against cancer.” Biomarkers would seem to be a player on that team. What about genetic testing? To what degree do biomarkers cross paths with genetic testing?
WJ: Genetic tests are biomarkers. Again, biomarkers are a huge umbrella. Hereditary risk assessment and genomics are further up on the continuum of cancer. What they do is identify a person’s risk for cancer based on hereditary components. Unfortunately, we have incredibly great tests with large panels that are available, but we have very low utilization in primary care, which is really a shame because we haven’t elevated it to an important enough piece that we reimburse for it, that we measure it. If it is worth doing, it is worth measuring, and unfortunately in primary care we really get under-utilization of the family history to determine those people who are most appropriate for genetic testing. I would ask all of your listeners to go online because there are many different websites where you can put in your family history, determine whether or not you meet one of the various guidelines for hereditary cancer risk. That’s one of the great things about genomic testing. It used to be five-, ten- or fifteen-thousand dollars to see if you had one bracket gene and now you can get a wide variety of panels, you know, fifty to one hundred genes for under $300. That’s the kind of change we are seeing here, so, people need to take their family history in their own hands. I do recommend they discuss this with their doctor to close that loop because you don’t want to just see Doctor Google, you want to have your real doctor involved in this, but unfortunately, we don’t see the adherence we would like to see. That’s why I encourage you to know your family history, take advantage of online tools and bring that to your physician’s attention.
BM: Whitney, you have given our listeners a great deal of information on which they can act, but how can get this information out to everyone? It may involve something that has nothing to do with medicine, but may be more along the line of marketing and PR.
WJ: I seldom try to give the marketers and PR any more info than I have to, because people who work for companies, that’s all they do all day long. I think what we really need to do is redefine the cancer continuum because there is a great physician, Dr. Azra Raza, an oncologist. She talks about our focus and determination on the last cancer cell, which are people who already have established cancer, finding those therapies for Stage III and Stage IV disease. We have no shortage of money and investment dollars and marketing dollars around that. All you have to do is watch television to know that those marketing dollars are being put to work; but if you begin to look in front of the oncologist’s door, to be able to detect cancer at its earliest stages when it can be treated, or find a person’s risk so they can undergo appropriate screening at the right time to either prevent cancer, imagine a woman with a bracha mutation, who gets a mastectomy as a way of avoiding breast cancer, even further upstream to understand what your test results may be in terms of longterm care that don’t have anything to do with anything you inherited, there is no problem with money behind the oncologist’s door, I’ll you that. The problem with investment is on the preventive side, the early detection side and the risk side. I think those are harder because they don’t have the product involved with them and I think the threshold to get approval for those has tended to be long, complicated studies that last fifteen years. Some people want to have all-cause mortality reduction as a threshold for improving screening. Others look at reduction of cancer deaths as a threshold and a finish line. I think what we really to begin to look at is stage shift. Can you diagnose these cancers for which people are at risk earlier and find them at Stage I and Stage II, even Stage III is better than Stage IV. Again, the issue is that screening has lagged in funding in America forever. I don’t know the exact answer to your question, but I think it has to do with leadership and a reapportionment of resources. Just think of this. Nicotine levels in your blood are a biomarker because you know if you are smoking cigarettes and tobacco, you are at risk for all the cancers that go with tobacco. We don’t need a biomarker for everybody, we just need a smoking reduction. In my opinion, we need to shift resources from behind the oncologist’s door, where again, we have lots of great therapies and studies that last fifteen years and instead in prevention and early detection.
BM: I don’t know if I am sticking my head in the lion’s mouth when I rephrase my question this way, but involvement from the public sector in this investment shift?
WJ: I think we’ve seen it. We’ve seen the public sector invest in insurance products, except in genetic testing. There are many companies that are looking to develop and promote early cancer detection protocols as an improvement of tests, and I think that is the public sector. That is from people with their own business. They are pushing things out there, but I look to leadership organizations like the American Cancer Society, I look to the Prevent Cancer Foundation, who are extremely well thought of, well respected folks who take their time, but there are also people who are willing to accelerate. For instance, in the multi-cancer detection space, there are over 300 organizations that want to accelerate some of these pathways for understanding and determining whether or not these are going to be covered by insurance, particularly those with Medicare, who have suffered the greatest burden of cancer. I think advocacy organizations, like yours, like mine, like the ACS, I think we need to get a little higher on our stools, talk a little louder, make sure we are discussing this with people in government who hold a lot of the funds and moneys, I mean, why do we spend 95 percent of the NCI’s budget on cancer treatment and only five percent of the budget on prevention? That’s a great question to ask, and that’s always where I like to start, so, in the private world, we are doing it right now.
BM: We talked about individuals, people like myself getting educated on this, and there may be a different answer for each governmental body you go, but if you were to look at the CDC, NIH to the American Cancer Society, even though it is not a government organization, do you sense that they are receptive to being educated about this, or do you see them as old dogs that can’t learn new tricks?
WJ: I don’t think they need to be educated. I think they are educated. I think that they oftentimes are very methodical about the way they do data. Remember, we are in a transformational time in the way we do medicine. We never would have thought we would have done so much telemedicine before COVID. We never thought we would be able to sequence whole gnomes for under $1,000, and so, what I have seen at the national level, I think the laggard in this has been the national organizations to some degree, in other words, the federal organizations. I think these private non-profits have been very aggressive. In fact, they have been pushing hard to have studies and I think the National Cancer Institute just announced they are going to do a multi-year on multi cancer early detection testing with over 200,000 individuals, and that’s going to really advance the size dramatically. I am always thinking why is the United States a year and a half behind the National Health Service in England? Everybody wants to reduce cancer deaths, everybody wants to reduce cancer costs and cancer treatment costs, so, I feel the system is working. It seems excruciatingly slow to me sometimes because I am an accelerator, but I want to let your listeners know you don’t accept all biomarkers. They have to go through each of these various tests to determine what the appropriate relevance is. We don’t want to release untested, unvalidated tests on the public.
BM: The final area I want to touch on, Whitney, might involve a little bit of pushback not necessarily from me, but from people I have read and heard who look at the whole notion of biomarkers with some measure of skepticism. To those skeptics, what would you say?
WJ: Let’s look at the data. Let’s be more afraid of advanced cancer than we are of missteps in early diagnosis. No one wants to have overdiagnosis, no one wants to have lead time bias, where you are diagnosis, where you are diagnosing a person too early. Let’s not have a higher threshold than what we are using right now because again in the multi-cancer space, we diagnose about fifteen percent of cancers through screening. We can potentially increase that to fifty percent of cancers through screening when people are asympomatic, particularly among those people who have higher levels of aggressive tumors, ling, ovary, pancreas, we all know what they are. We are in the middle of a paradigm shift and we are learning as we go along, but we can do adaptive approval and processes that accelerate this into the sector where it is going to really go out there and help patients while we continue to study their impact. I think that’s where we need to be in this new accelerated world we live in.
BM: The answer to my final question is one you have already covered in part, and perhaps in whole, but I would still like you to say it one more time, even if some of it is redundant. If you had a private audience with someone and you wanted to spread the gospel about biomarkers, if there is one overarching point you would like to make, what would it be?
WJ: I would say that we need to accelerate our clinical research and our funding in front of the oncologist’s door to prevent and detect early cancers to avoid the fiscal and emotional and personal catastrophe that is currently cancer in the United States. I would ask them to prioritize their funding further upstream where I believe it can make a greater difference and have a chance for a cure.
BM: Fantastic. Whitney Jones, MD of the Colon Cancer Prevention Project in Louisville, Kentucky, thanks so much for some thought-provoking information, information that I hope will reach the lay person who will act on this to the extent that they can and ultimately that can lead to better screening and better outcomes. Whitney, thanks so much for being with us on Cancer Interviews.
WJ: It’s my pleasure, Bruce. Always a pleasure to be with you, and great work by your team.
BM: Thanks so much, and again, we want to remind you if you are on any sort of cancer journey, you are not alone. There are plenty of individuals like Whitney who have information that can help you along your way, so until next time, we’ll see you on down the road.
Support Group:
Colon Cancer Prevention Project
SHOW NOTES
TITLE: Whitney Jones, MD, Founder, Colon Cancer Prevention Project – Louisville, Kentucky, USA
The term 'biomarker' sounds complicated, and it is; but now and going forward, it can do plenty to reduce your risk of cancer and the more you know about it, the better. Listen to this tutorial on the subject from Whitney Jones, MD, founder of the Louisville-based Colon Cancer Prevention Project.
Additional Resources:
Colon Cancer Prevention Project:
Time Stamps:
01:10 Whitney explains the term biomarker.
04:55 Are biomarkers held to any scrutiny?
06:35 While you might want to consult the internet, ultimately you should talk to your physician as to whether genetic testing is appropriate for you.
07:59 His vision for the role of biomarkers 10-20 years from now.
12:18 Whitney outlines what people can do to put biomarkers to work for them.
16:01 More money needs to be devoted to cancer prevention instead of cancer treatment.
20:59 Whitney’s response to biomarker’s skeptics.
KEYWORDS (tags):
cancer
biomarker
whitney jones
genetic testing
cancer interviews
immunotherapy
prostate specific antigen
bruce morton
colorectal cancer
cancer bootcamp
human papillomavirus
hereditary risk assessment
cancer survival checklist
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