The addition of multi-cancer early detection screening using a single blood sample improved patient outcomes whether conducted on an annual or every 2-year basis, according to findings from a modelling study published in BMJ Open.
With earlier detection of disease progression, many cancers could be prevented from progressing to later-stage diseases that are more difficult to cure. Because there is no real-world evidence available for multi-cancer early detection intervals, modelling is used to evaluate potential screening intervals for new multi-cancer early detection screening tests.
“Both annual and biennial [multi-cancer early detection] screening intervals have the potential to avert deaths associated with late-stage cancers when used in addition to current guideline-based cancer screening,” the study authors, led by Brian Rous, MB, BChir, PhD, of Cambridge University Hospitals NHS Foundation Trust in the United Kingdom, stated.
Study Methods and Results
The study authors sought out to determine the effects of multi-cancer early detection screening at different intervals on cancer stage at both diagnosis and mortality.
They conducted a modelling study based on a previously published state-transition model of multi-cancer early detection screening performance results by cancer type and cancer stage at diagnosis, as well as data from Surveillance, Epidemiology and End Results (SEER) of stage-specific cancer incidence and survival for people aged 50 to 79 in the United States for all cancer types.
The results of the model study showed that multi-cancer early detection screening conducted annually was associated with more diagnoses within 5 years for patients with fast tumor growth. The annual screening interval led to 370 more cancers detected per year in every 100,000 people screened as well as 49% fewer late-stage cancer diagnoses and 21% fewer deaths within 5 years than would be found with usual care alone.
Biennial screening, on the other hand, showed a higher positive predictive value of 54% compared with 43% for annual screening. This interval was also associated with more deaths prevented per 100,000 tests within 5 years than annual screening, but not on a per-year basis.
When screening was conducted every 2 years, 292 more cancers were detected per year for every 100,000 people screened than usual care alone. Additionally, 39% fewer late-stage diagnoses were reported and 17% fewer deaths within 5 years than with usual care alone.
“Based on the performance characteristics from a case control study, both annual and biennial screening with an [multi-cancer early detection] test have the potential to intercept 31% to 49% of cancers at stage I–II that would otherwise present at stage III–IV,” Rous et al stated. “Of these, approximately equal numbers would be detected at stage I and at stage II: 14% stage I and 16% stage II to 23% stage I and 26% stage II.”
The study authors concluded that “the optimal choice of screening interval will depend on assessments of real-world cancer survival and the costs of confirmatory testing after multi-cancer early detection screening.”
Professor Peter Sasieni of Queen Mary University of London, London, UK, is the corresponding author of the study.
Disclosure: For full disclosures of the study authors, visit bmjopen.bmj.com.
