RT Journal Article SR Electronic T1 Hallmark Circulating Tumor-Associated Cell Clusters Signify 230 Times Higher One-Year Cancer Risk JF Cancer Prevention Research JO Cancer Prev Res (Phila) FD American Association for Cancer Research DO 10.1158/1940-6207.CAPR-20-0322 A1 Ranade, Anantbhushan A1 Bhatt, Amit A1 Page, Raymond A1 Limaye, Sewanti A1 Crook, Timothy A1 Akolkar, Dadasaheb A1 Patil, Darshana YR 2020 UL http://cancerpreventionresearch.aacrjournals.org/content/early/2020/10/18/1940-6207.CAPR-20-0322.abstract AB We have previously shown that circulating ensembles of tumor-associated cells (C-ETACs) are a systemic hallmark of cancer based on analysis of blood samples from 16,134 individuals including 10,625 asymptomatic individuals and 5,509 diagnosed cases of cancer. C-ETACs were ubiquitously (90%) detected across all cancer types and were rare (3.6%) among the asymptomatic population. Consequently, we hypothesized that asymptomatic individuals with detectable C-ETACs would have a definitively elevated risk of developing cancer as compared with individuals without C-ETACs. In the present manuscript we present 1-year follow-up data of the asymptomatic cohort which shows that C-ETAC positive individuals have a 230-fold (P < 0.00001) higher 1-year cancer risk as compared with individuals where C-ETACs were undetectable. Simultaneously, we also expanded the study to include 4,419 symptomatic individuals, suspected of cancer, prior to undergoing an invasive biopsy for diagnosis. C-ETACs were detected in 4,101 (92.8%) of these 4,419 cases where cancer was eventually confirmed. We conclude that detection of C-ETACs can identify patients at risk of cancer and can be reliably used to stratify asymptomatic individuals with an elevated 1-year risk of cancer.