Notification! You may have cancer. Could smartphones and wearables help detect cancer early?

“There is growing use of smartphones, wearables, and other technology in health and wellness, either as consumer products or medical devices,” says Professor Scott. “The ​​NHS Long Term Plan anticipates that in ten years’ time, people will have 'the option for their physiology to be effortlessly monitored by wearable devices. People will be helped to stay well, to recognise important symptoms early, and to manage their own health, guided by digital tools.'   

What do we mean by ‘wearable’? These are devices that are worn – often on the wrist, or as rings or earbuds or as part of clothing - that detect and monitor biometric data such as heart rate, blood oxygen saturation, physical activity, or temperature whilst the wearer continues their normal routines. There are also  wearables that use skin patches to measure biochemical signals, such as glucose, on a continuous basis and which are increasingly being considered as the standard of care for individuals with certain conditions, for example, diabetes. Smartphones are much more widely used compared to wearables, and have a growing array of different sensors routinely embedded.  

Detecting cancer when it is still small and localised is vital to improve cancer outcomes, but one challenge to early diagnosis is that the early signs of cancer can easily be missed. Symptoms are often subtle or vague and evolve very slowly over time. Some symptoms such as fatigue, weight loss, or stomach problems are not specific to cancer and most of the time have much less serious causes. This means that early symptoms of cancer are hard to notice amongst the plethora of daily symptoms, and presence of transient and chronic conditions. The signal to noise ratio is weak. What is more, our awareness, attention and interpretation of symptoms is affected by our expectations, emotions, beliefs, and the biological, environmental, socio-demographic, and contextual factors in which we find ourselves. 

So could smartphones and wearables help detect cancer and, importantly, detect cancer early?  

Smartphones and wearable technologies have the potential to facilitate detection and tracking of bodily changes that might otherwise be dismissed or interpreted as something we can easily manage ourselves. Excitingly, there is emerging data about how some early, subtle signs of cancer may be amenable to detection by electronic sensors and monitoring of behaviour.  

Sensors could allow detection of changes before someone notices them, or recognises them as symptoms of a serious problem. For instance, a smart watch might note a reduction in activity prior to fatigue, or changes in food consumption prior to weight loss. The tracking of changes over weeks or months would provide a useful insight for clinicians who may only have limited time to see a patient, and for whom cancer is a rare occurrence in their caseload. In addition, there may be utility in using internet search history to highlight searches for symptoms and using smartphones or wearables to alert the user to the need for healthcare consultation, helping to overcome the commonly reported barrier to presentation: “concern about bothering the doctor”.  

Whilst the potential for using wearables and smartphones to detect cancer is an exciting development there is a need to move with caution.  

Robust research and testing are needed to ensure that readings from wearables are accurate and sensitive enough to be useful. This may involve combining signals with other data (e.g. age, risk factors, medical history) to add precision to results.  

Specific regulatory approvals would also be needed to ensure that these tools are not only safe and effective but adoptable by the healthcare system. For example, the National Institute of Health and Care Excellence (NICE) Evidence Standards Framework includes standards concerning safety, quality, acceptability, bias mitigation, data practices, professional oversight, credibility with health professionals, safeguarding assurances, scalability as well as evidence of real-world performance and usage. 

A key issue for wearables and technology is the potential for new innovations to exacerbate inequalities in cancer outcomes. Sociodemographic factors such as household income, age, level of education, gender, have been found to influence use of these types of devices. ​​Development of wearables and technology for cancer detection should be conducted with an equity lens to focus on the views and needs of those living or working in more deprived areas, and those at risk of lower health literacy so that cultural attitudes towards use of technology, affordability and access can be a focus in their development. Inclusion and diversity within development and testing of sensors is vital so that products are not biased and they work equally regardless of skin colour or other physiological differences. 

Success of using smartphones and wearables for cancer also relies on acceptability so that users engage with the devices as intended.  This involves willingness to share data from smartphones and wearables with researchers, medical professionals or private companies, yet there are real concerns about misuse of data, commercialisation and access to data by unauthorised people. It is essential to investigate user perspectives in parallel with the development of wearables and smartphone technologies for cancer detection.  

Finally, there needs to be planning and mitigation surrounding possible unintended consequences of using these technologies for cancer detection.  This includes agreement on how “results” should be delivered to users, what support would be needed at that time, and whose responsibility this would be. There are risks of anxiety, over-investigation and inappropriate use of health care resources or false reassurance. 

The rapid advances in the hardware and software embedded in smartphones and wearables offer exciting and potentially untapped opportunities to detect early warning signs of cancer that may otherwise be missed. Yet we must not get carried away with this excitement: there are potential barriers to successful implementation, and these must be considered as a vital part of the research and development of these devices." 

This opinion piece is drawn from the article in JMIR Cancer: “Notification! You May Have Cancer.” Could Smartphones and Wearables Help Detect Cancer Early?  

Suzanne Scott is Professor of Health Psychology and Early Cancer Diagnosis in the Wolfson Institute of Population Health.