Sasieni, P;
Smittenaar, R;
Hubbell, E;
Broggio, J;
Neal, RD;
Swanton, C;
(2023)
Modelled mortality benefits of multi-cancer early detection screening in England.
British Journal of Cancer
, 129
pp. 72-80.
10.1038/s41416-023-02243-9.
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Abstract
Background: Screening programmes utilising blood-based multi-cancer early detection (MCED) tests, which can detect a shared cancer signal from any site in the body with a single, low false-positive rate, could reduce cancer burden through early diagnosis. Methods: A natural history (‘interception’) model of cancer was previously used to characterise potential benefits of MCED screening (based on published performance of an MCED test). We built upon this using a two-population survival model to account for an increased risk of death from cfDNA-detectable cancers relative to cfDNA-non-detectable cancers. We developed another model allowing some cancers to metastasise directly from stage I, bypassing intermediate tumour stages. We used incidence and survival-by-stage data from the National Cancer Registration and Analysis Service in England to estimate longer-term benefits to a cohort screened between ages 50–79 years. Results: Estimated late-stage and mortality reductions were robust to a range of assumptions. With the least favourable dwell (sojourn) time and cfDNA status hazard ratio assumptions, we estimated, among 100,000 screened individuals, 67 (17%) fewer cancer deaths per year corresponding to 2029 fewer deaths in those screened between ages 50–79 years. Conclusion: Realising the potential benefits of MCED tests could substantially reduce late-stage cancer diagnoses and mortality.
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