eprintid: 10206230
rev_number: 8
eprint_status: archive
userid: 699
dir: disk0/10/20/62/30
datestamp: 2025-03-17 16:25:07
lastmod: 2025-03-17 16:27:26
status_changed: 2025-03-17 16:25:07
type: article
metadata_visibility: show
sword_depositor: 699
creators_name: Callender, Thomas
creators_name: Payne, Katherine
creators_name: Pashayan, Nora
creators_name: Mackie, Anne
title: Screening for multiple cancers: evaluation must go beyond aggregate measures
ispublished: pub
divisions: UCL
divisions: B02
divisions: C10
divisions: D17
divisions: D12
divisions: K71
divisions: G21
note: This version is the author-accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: Tom Callender and colleagues argue that aggregate outcomes amongst groups of cancers
are insufficient for the evaluation of multi-cancer detection tests for cancer screening and
that research providing cancer-specific outcomes will be necessary.
Multi-cancer detection tests (MCDs) using blood-based biomarkers for the concurrent
screening of multiple cancer types in asymptomatic individuals are currently being trialled in
the UK and elsewhere [1]. This has led to talk of their adoption in early cancer population
screening programmes.
Considerable attention has been paid to the potential benefits that MCDs could present by
improving cancer survival, particularly that of rarer cancers, through early detection.
Balanced against these benefits has been a focus on the possible harms from false
positives; inaccurate predictions of, or indeed inability to, predict the cancer site; and cases
where a cancer is detected by an MCD but is too small to be seen on imaging [2,3].
Most discussion has considered the overall – aggregate – benefits and harms of an MCD
programme. However, cancers behave remarkably differently both between individuals and
cancer types. Despite this, the benefits and harms accruing to each type of cancer with
strategies that uses a single multi-cancer screening test has had relatively little emphasis.
In this analysis, we discuss how differences in disease natural history could affect one
potential harm, overdiagnosis, when screening for multiple cancers simultaneously. We
argue that a focus on aggregate, all-cancer, metrics to evaluate MCDs will obscure
differences between cancers that are clinically and policy relevant. Building on this, we
discuss the benefits and challenges of approaches that balance the translation of a
promising MCD screening programme against the further research that may be required to
inform robust policy.
date: 2025-02-25
date_type: published
publisher: BMJ Publishing Group
official_url: https://doi.org/10.1136/bmj-2024-081098
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 2365737
doi: 10.1136/bmj-2024-081098
medium: Electronic
lyricists_name: Callender, Thomas
lyricists_name: Pashayan, Nora
lyricists_id: TCALL19
lyricists_id: NPASH45
actors_name: Kaltenbacher, Brigitte G
actors_id: BGKAL87
actors_role: owner
full_text_status: public
publication: The BMJ
volume: 388
article_number: e081098
event_location: England
issn: 0959-535X
citation:        Callender, Thomas;    Payne, Katherine;    Pashayan, Nora;    Mackie, Anne;      (2025)    Screening for multiple cancers: evaluation must go beyond aggregate measures.                   The BMJ , 388     , Article e081098.  10.1136/bmj-2024-081098 <https://doi.org/10.1136/bmj-2024-081098>.       Green open access   
 
document_url: https://discovery.ucl.ac.uk/id/eprint/10206230/1/Callender1_overdiagnosis-manuscript-r3-clean.pdf