This year medicine inevitably has been defined by Covid-19, and consequentially medical developments have focused on combatting the virus with a vaccine. But part of this time of this year is reflecting on the previous year while also looking ahead to what might come. In that spirit, 2021 and beyond is looking to be an innovative and fascinating time for medicine – in terms of diagnostic techniques, medical treatments, and digital technologies.

The 2021 Galleri NHS trial

An interesting developing diagnostic and monitoring tool is that of liquid biopsies, where a sample of blood is taken to look for cancer cells or DNA from a tumour. This technique has the potential to identify cancer at an early stage or 'stage zero' and to plan treatments pertaining to whether the patients cancer has returned.

One such test is the Galleri multi-cancer early detection produced by healthcare company GRAIL, which announced in November a partnership program with the NHS for a trial of their product to be rolled out in 2021. Their blood test has so far proven to be promising; clinical trials in the US of an earlier version of Galleri detected over 50 types of cancer with a low false-positive rate of less than 1%. And according to GRAIL, adding the blood test to existing care procedures could cut the number of late-stage diagnoses by nearly half and could potentially reduce cancer mortality in the UK by 20%.

Overall, the UK 2021 trial will involve 165,000 people split into two groups. The first group of 140,000 people over the age of 50 without any suspicion of cancer and the second will include 25,000 people aged 40 and above with suspicious signs or symptoms of cancer. If the program is deemed a success, the program has been earmarked for a further expansion to approximately one million people across 2024 to 2025 and then onto a larger population afterwards.

When the partnership was announced Lord David Prior, Chair of NHS England said: “This collaboration between the NHS and GRAIL offers the chance for a wide range of cancers to be diagnosed much earlier and could fundamentally change the outlook for people with cancer.”

Multigene panels, NGS tests, and digital technology

However, the expansion of the use of liquid biopsies was contended at the Frost & Sullivan’s Global Healthcare Predictions 2021 webinar. The speakers preferred oncological diagnostic tools for 2021 were multigene panels and next-generation sequencing (NGS) tests, over liquid biopsies as they said they are less invasive.

Multigene panel testing is a type of genetic testing that examines gene mutations in multiple genes at once, which can help healthcare providers determine what cancer screenings a person may need, therefore providing a personalised treatment plan for those who already have been identified as being genetically at risk from certain cancers. While NGS tests are a rapid and cheap sequencing of genomes, that could be invaluable in cancer treatment as it will enable a more precise diagnostics and will facilitate personalised therapies.

These treatments have been rapidly adopted in Japan and the US and were projected by the Frost & Sullivan webinar speakers to be worth $1.7 billion by the end of 2021. And which the panels said could be particularly useful to determine early indicator treatments of nonsmall-cell lung carcinoma and prostate cancer.

Another healthcare sector that is projected to experience growth in 2021 is digital platforms, as unsurprisingly the pandemic has reinforced and propelled the digital transformation of healthcare. The speakers at the Frost & Sullivan webinar predicted that 35% of patients interactions would go virtual globally in 2021; and a physician will no longer be the automatic first touchpoint, as care moves outside the four walls of the hospital and into the home.

Gene editing technology

Also, looking beyond 2021, a story from 2019 will have implications for the transformation and the development of new treatments for people with genetic illnesses. In 2019 Victoria Gray was given a revolutionary gene-editing treatment called CRISPR for her sickle cell disease.

CRISPR edits the genes within cells to promote the production of foetal haemoglobin, which usually stops being produced at around four months of life, this haemoglobin partially replaces the defective sickling blood cells and therefore alleviates the symptoms of sickle cell disease. This year Victoria Gray told NPR that she has continued to improved post-treatment; this has given confidence to researchers and clinicians that this approach is safe for the treatment of people with the sickle cell disease and transfusion-dependent β-thalassemia.

What we can gather from these medical developments and trends is that medicine both at the point of access and treatment will become increasingly idiosyncratic, better at identifying early warning signs, and ever more present outside hospitals and GP surgeries. And as we move into 2021, the future seems to be entirely more positive than the year before and will not be wholly defined by Covid-19 but will hopefully contain positive developments, especially for cancer treatments and early identification.