Multi-cancer blood test could thwart progression to late stage cancer

9 May 2025

Screening is currently reliable for only a few cancers (breast, bowel, cervix, and lung) and, while effective at lowering death rates from these diseases, the optimal interval at which screening will pick up the most cancers at an early stage (I and II) while at the same time avoiding unnecessary testing and treatment is not clear.

Using a disease progression model for many different cancers, researchers predicted the impact of screening with an MCED test on the time of cancer diagnosis and patient death for different screening schedules, and for two sets of cancer growth scenarios (fast and fast aggressive). The modelling included cancers of the anus, bladder, breast, cervix, bowel/rectum, oesophagus, gallbladder, head and neck,  kidney, liver/ bile-duct, lung, ovary, pancreas, prostate, soft tissues/bone (sarcoma), stomach, thyroid, urothelial tract, and uterus, as well as leukaemia, lymphoma, melanoma, and blood cancers (myeloid neoplasm, immune cell cancers (plasma cell neoplasm).

Results showed that all MCED screening intervals had more favourable early-stage diagnostic rates than usual care alone, and there was a larger impact on stage shift for tumours with fast growth than for tumours with fast aggressive growth. Annual MCED screening prevented more deaths within 5 years than biennial screening for the fast tumour growth scenario, but biennial screening picked up more cancers for each completed test. Biennial screening was also more efficient at preventing more deaths within 5 years per 100,000 tests (132 v 84), although it prevented fewer deaths per year. From the modelling scenario in which 392 people are diagnosed each year with an aggressive cancer that would kill them within 5 years, earlier diagnosis through biennial MCED screening could have averted 54 (14%) of these deaths, but annual MCED screening could have avoided 84 (21%) deaths.

Researchers conclude that both annual and biennial screening with an MCED test have the potential to intercept 31-49% of cancers at stage I-II that would otherwise present at stage III-IV. The estimates assume 100% compliance with the screening schedule and 100% accuracy of confirmatory follow up tests, and so represent the upper bounds of potential benefits of MCED cancer screening. “The optimal choice of screening interval will depend on assessments of real-world cancer survival and the costs of confirmatory testing after MCED screening. However, both annual and biennial MCED screening intervals have the potential to avert deaths associated with late-stage cancers when used in addition to current guideline-based cancer screening.”

Lead author, Peter Sasieni, said: “When choosing how often to offer different types of cancer screening there is a balance to be made between preventing more cancer deaths and obtaining the greatest benefit for the costs and inconvenience of screening. Generally, the faster the cancer develops the more frequently one needs to screen. We modelled what might be appropriate for a screening test that can detect all types of cancer. If screening works, even screening once every three years would prevent a substantial proportion of advanced stage cancers, but more frequent screening is needed to maximise the potential benefit. Depending on pricing, it seems likely that annual testing might deemed the most appropriate for blood-based multi-cancer screening.”