New urine test could prevent thousands of cancer deaths

By Jodie Sinnema, (May 17, 2012) EDMONTON - Researchers at the University of Alberta have developed a simple urine test to detect pre-cancerous polyps in the colon that could revolutionize screening programs around the world and save thousands of lives.

For the past 50 years, doctors have sent patients home with a standard fecal test, requiring people to dip into their toilets and smear a poo sample onto a prepared strip. That strip is sent to a lab to detect microscopic traces of blood caused by cancer-causing polyps in the large intestines. If those polyps are left to grow to two centimetres, they will develop into cancer. 

But those tests have low accuracy rates of three to 15 per cent, partly because they also detect blood from the stomach or esophagus and can result in false positives. 

Only 14 per cent of people over the age of 50 actually do the fecal smear when asked, most putting it off because of the "yuck" factor. 

Drs. Richard Fedorak, a gastroenterologist, and Haili Wang, a colorectal surgeon at the University Hospital, have developed a new technology that can detect molecules in a urine sample that indicates polyps have formed in the colon. The first version of the new metabolomics medical technology was tested on 1,200 patients and had an accuracy rate of 82 per cent, Fedorak said. A second version tested with 97-per-cent accuracy. 

Once the polyps are removed, a followup urine test can confirm if all the polyps are gone. 

"Things that come out in your urine reflect what's happening inside of your body because of the metabolites," Fedorak said. Think about the blood sugar found in the urine of a diabetic, then multiply the complexity of that test to find colon cancer markers. "It's kind of a measure of what's going on in your body in real time. We can pick up these metabolites that act like a fingerprint. They're small minute molecules that we can measure." 

The urine test requires a sophisticated nuclear magnetic resonance machine to detect the metabolites in frozen samples. Such machines are available in Edmonton and Calgary, although they're mostly used for research rather than clinical tests. Fedorak and his team are now preparing a pilot project to run in Lethbridge, where 500 patients will consent to have a urine test, three fecal matter tests, plus a colonoscopy. The project aims to prove frozen urine samples sent to the specialized lab in Edmonton will remain viable for the test. 

"We're the world leader here in metabolomics," Fedorak said before flying to California to present his findings at a conference for medical gastro-intestinal specialists. "Since the fecal tests were invented 50 years ago, we haven't had a new screening test for polyps. This would represent the first new screening test to determine whether there are polyps there in real time. It will fundamentally change the colon cancer screening programs. You'll pick (polyps) up more, and picking up more means you have fewer colon cancer deaths." 

In Alberta, 1,200 people are diagnosed with colon cancer every year and 600 die from the disease, Fedorak said. 

"It's completely preventable so what you want to do is increase the colonoscopies to remove the polyps and prevent 600 deaths," Fedorak said. "We will have more colonoscopies to remove polyps, but that will save cancer deaths." 

Performing colonoscopies as a screening tool isn't practical, he said, because 300,000 people need one each year. 

People are counselled to do one fecal test after they reach the age of 50. Those with a familial history of colon cancer need the tests more often and there are already waiting times to have the procedure. 

A urine sample is far simpler and can be largely given on demand. The metabolomic test costs $50 to $100, compared to the $15 to $25 for the less accurate fecal tests. 

He said he hopes the final urine test will cost about $50, once a second version of the test is created that can be read and analyzed by mass spectrometry machines, which are more common in medical centres. 

Fedorak estimates the urine screening test will be available to Albertans in late 2012 as the new U of A spin-out company called Metabolomic Technolgies Inc. commercializes it. A clinical trial is also being done with 1,000 patients in China, where the government has expressed interest in making it available to its citizens. 

"We hope that Alberta would be a leader in this technology and that Alberta would then license it out to other provinces," Fedorak said. "These tests are very close to being available, but are not yet available. Don't rush out to get one."

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