10 Chapter 1 GENERAL INTRODUCTION The global cancer burden of 19 million new cases in 2020 is expected to grow to over 30 million new cases in 2040, based on population growth and aging (1). Cancer remains one of the leading causes of death worldwide, despite the development and use of innovative treatments during the last decades (2). High mortality rates are partly caused by late diagnosis, as cancer is often detected at an advanced stage when treatment options are limited. Another major cause of high mortality rates is recurrence after effective initial treatment (3). The rising cancer burden has also increased the focus on understanding the underlying causes of cancer. As a result, more cancer risk factors are known, thereby also increasing the number of individuals with a high cancer risk (4). This places increasing pressure on the healthcare system, emphasizing the need for innovative cancer detection strategies. Patient-friendly cancer detection methods could offer a potential solution to advance cancer diagnostics. This strategy would allow self-collection from home and reduce the initial need to visit a healthcare professional, which could alleviate the burden on both patients and healthcare systems. 1.1 Challenges and opportunities in cancer diagnostics and surveillance Currently, invasive tissue biopsy procedures are performed in the diagnostic workup of individuals with suspected cancer. However, conventional tissue sampling is often associated with discomfort, time-consuming procedures, high costs, and potential complications. Moreover, cancerous lesions can be missed or incompletely captured during biopsy procedures. These limitations encourage the development of alternative and less invasive methods for cancer diagnosis (5). The use of a liquid biopsy, which refers to the sampling and analysis of body fluids, holds potential as a novel tool for cancer detection (6, 7). Blood is the most extensively investigated liquid biopsy, but also alternative fluids are actively pursued, including saliva, sputum, stool, urine, and vaginal fluid (8). Their patient-friendly collection method enables the convenient and repetitive acquisition of fresh tumor material, which can easily be performed at home. Home-based sample collection has readily been implemented in cancer screening programs. The examination of home-collected cervicovaginal material (9) and stool (10) for cervical and colorectal cancer screening, respectively, helps to identify individuals with an increased cancer risk. Patient-friendly sample collection at home maximizes the reach of health monitoring efforts while minimizing logistical challenges and patient burden.
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