A urine profile of three glycosaminoglycan disacharrides (GAGs) predicted five-year cancer risk in healthy adults, according to a peer-reviewed study published in Cancer Epidemiology, Biomarkers & Prevention. The study, sponsored by cancer risk-stratification company Elypta, included 5,436 adults. GAGs are sugar chains in the tissue matrix involved in cancer-related processes.

Combined with established risk factors, the GAG profile (GAGome score) placed an estimated 13–23% of participants in a pre-specified high-risk group. This group accounted for 54% of cancers diagnosed within five years and 54% of in situ carcinomas. Only about 17% of people who stayed cancer-free fell into it. The GAGome score performed at least as well in adults under 50 and best for cancers without population screening, such as pancreatic, kidney and brain cancer and lymphoma.

"Today we choose who to screen largely by age and smoking history. This study shows that a biological signal in urine adds information about who is at higher risk of cancer, including at the earliest stages," said Karl Bergman, CEO of Elypta. "It uses just three GAGs, so we see it as a proof of concept for our cancer risk program, which builds on broader GAG panels and also plasma."

Unlike inherited risk, GAG levels reflect what is happening in the body dynamically. Such a marker could help direct screening to those most likely to benefit. It could also support multi-cancer detection tests, which are expected to work best in people at elevated risk.

"The association was independent of established risk factors and consistent across cancer stages, which makes this dynamic biological marker worth testing prospectively," said John Field, Professor of Molecular Oncology at the University of Liverpool, co-author of the study.

Researchers from Lund University, the University of Liverpool, Dana-Farber Cancer Institute and Elypta used 24-hour urine from a Dutch Lifelines cohort of 124,436 adults. They analysed all 827 people later diagnosed with cancer and a random sample of 4,609 who were not. Three chondroitin sulfate disaccharides were measured by mass spectrometry. The retrospective study was pre-registered (NCT05235009).

The GAGome score needs independent prospective validation before any clinical use.

Elypta offers the MIRAM® GAGome Kit for quantification of urine CS disaccharides (FRUOU-CS) by UHPLC-MS/MS for Research Use Only. Not for use in diagnostic procedures.