As a student at the Renaissance School of Medicine at Stony Brook University, Zachariah Foda knew he wanted to become a physician-scientist studying cancer — a disease with so many medical mysteries that he knew they wouldn’t be solved over the course of his career. While seeing patients during his training, Foda quickly realized that sharing the bad news that someone had cancer was far preferable to telling them that they’d run out of treatment options. This insight informed his decision to become a gastroenterologist, he says.

“Our specialty is inherently about cancer interception and prevention and early diagnosis. Colonoscopy, which accomplishes all these goals, is the main procedure we do. Being able to turn bad news into good news is what drew me to this career,” Foda explains.

Now an assistant professor in the Department of Medicine at Johns Hopkins, his work embodies this goal. Foda not only directs the Johns Hopkins Colon Cancer Risk Assessment Clinic (CCRAC) — a specialty clinic that provides education and recommendations, cancer screenings and diagnostic testing for people with a personal or family history that indicates an increased risk of colon cancer — he also performs lab and clinical research aimed at improving gastrointestinal cancer screening rates and developing new methods for early detection.

Patients are typically referred to the CCRAC by their gastroenterologist or primary care physician due to concerns about hereditary colon cancers or cancer-related syndromes, such as familial adenomatous polyposis or Lynch syndrome, Foda says. Up to 25% of colon and rectal cancers have a family history of these conditions, and approximately 5% to 10% result from an inherited genetic syndrome.

In a patient’s initial visit, Foda and his colleagues collect a detailed personal and family history, which helps guide their next steps. Based on a patient’s risk profile, the team may suggest genetic testing, which focuses on genes known to increase cancer risk. Patients who test positive for hereditary cancer syndromes are followed longitudinally, with Johns Hopkins doctors working together with patients’ existing medical providers to prevent cancers and quickly catch those that arise. The clinic often works with other specialists, such as gynecologic oncologists, for patients with syndromes that increase the risk of other cancers and health issues.

In addition, Foda and his colleagues are working on a new type of liquid biopsy for early detection of gastrointestinal cancers. Unlike most liquid biopsies currently under investigation or in use, those being developed by this team probe the fragmentome, pieces of cell-free DNA that circulate in the blood. Healthy cells package their DNA in an orderly fashion in the nucleus, but cancer cells do so haphazardly, Foda explains. When cancer cells die, the fragments of DNA released into the bloodstream reflect this chaotic organization, providing an early warning system. In 2022, Foda and his collaborators published a paper showing that this liquid biopsy approach is viable for detecting hepatocellular carcinoma.

He’s also working with other colleagues to identify barriers for colorectal cancer screening and factors that help encourage this procedure in Baltimore City and Western Maryland. By personalizing educational materials for these communities, Foda and his colleagues hope to increase screening rates. A second phase of this study will offer fecal occult blood tests to participants.

“We know that detecting cancer early makes the risk of dying much lower,” Foda says. “I don’t think we’ll ever cure cancer. But in my specialty, we can get rid of cancer by intercepting it, preventing countless cancer deaths.”

To refer a patient to the Colon Cancer Risk Assessment Clinic, call 410-502-7082.