Fig. 2 | npj Precision Oncology

Fig. 2

From: The potential of liquid biopsies for the early detection of cancer

Fig. 2

Tumors, clonal expansions and their respective lead times. a In breast cancer, tumors with “favorable” biological features (grade 1) may have extensive lead times of up to 19 years and these tumors contribute to significant overdiagnosis by screening mammography. Even if detected at a late stage, these tumors often have an excellent prognosis. In contrast, breast cancers with unfavorable biological features (grade 2–3) usually have short lead times (<2 years) and are therefore less frequently identified by screening mammography. However, because of their biology, early diagnosis would be mandatory to significantly reduce mortality. b In CRC, tumors develop through well-defined stages (i.e., stages I–IV), a process which may take up to 20–40 years and is the result of the accrual of specific mutations in tumor driver genes127 (image adapted from refs. 127,128). As survival rates are stage-dependent, the earlier the diagnosis is made the better. In the two scenarios depicted in a and b, the primary clinical challenge remains to determine the fate of the specific lesions so that they do not always differ fundamentally, but transitions exist. c Clonal expansions are best characterized in hematopoietic systems and are frequently associated with known driver gene mutations. Their lead time is hard to determine. For CHIP (clonal hematopoiesis of indetermined potential), the odds of progression to overt neoplasia were estimated to be approximately 0.5–1% per year65

Back to article page