Author(s): Stefan H Bossmann 1 * , Deryl L Troyer 2
cancer diagnosis; circulating tumor cells; electrochemical analysis methods; ELISA; FISH; immunohistochemical staining methods; PCR; point-of-care testing; protease measurements; quantitative fluorescence detection/image analysis
"We will experience a shift from curative medicine to predictive and highly personalized medicine."
The hallmark of point-of-care testing is that the results can be obtained in a timely manner. This will enable clinicians to make decisions that are based on solid data and to perform course corrections during the treatment of the disease  . There are multiple point-of-care testing methods that are currently under development. Whereas virtually any molecule (e.g., lipid spectrum) or macromolecule (e.g., proteins, DNA and RNA) of biological origin could be used as a biomarker, proteins are, to date, the most extensively studied candidates.
During the last decade, diagnostic laboratories in academia and industry have been working on the development of a multitude of different approaches, among them electrochemical analysis methods  , immunohistochemical staining methods  , FISH  , ELISA  and the many variants of PCR  , such as reverse transcription PCR (RT-PCR)  and quantitative or real-time PCR (qPCR)  , as well as quantitative fluorescence detection/image analysis  .
Virtually all of these methods have the potential to be miniaturized so that they can be used routinely in the physician's office, an ambulance or in the field. PCR methods for the detection of leukemia and lymphomas are already in use  . Electrochemical and fluorescence detection methods are especially suited to miniaturization. We expect that they will be available as implants within one or two decades. This technology will help to address the apparent disparity in the quality of healthcare that exists in the USA (Great Plains areas vs the coastal areas) and even more so when comparing the developing and the developed world. However, some of these technologies (e.g., FISH, ELISA, genomics and proteomics) will remain in high-throughput analytical laboratories for the foreseeable future because they require considerable investments and highly trained personnel.
All of these approaches combined will lead to significant changes in the way that healthcare is provided: we will experience a shift from curative medicine to predictive and highly personalized medicine. Physicians will be able to rely on frequent testing to provide the best care possible. At the same time, advances in computer networking will allow cancer patients to pursue their lives with much more personal freedom than what is possible today.
What advantages would point-of-care routine rapid screening provide in cancer diagnostics & treatment?
According to the National Cancer Institute, "Cancer is not just one disease but many diseases. There are more than 100 different types of cancer"  . We use statistical methods to describe the response of cancers to treatment and classify them according to the cell type of origin. The required course of action is usually determined by the stage of the disease. Whereas there are acceptable treatment options available for numerous cancers if detected in early stages, survival statistics are far less favorable for cancers in late...