Background

Multi-cancer early detection (MCED) next-generation-sequencing blood tests represent a potential paradigm shift in screening.

Methods

We estimated the impact of screening in the US and UK. We used country-specific parameters for uptake, and test-specific sensitivity and false-positive rates for current screening: breast, colorectal, cervical and lung (US only) cancers. For the MCED test, we used cancer-specific sensitivities by stage. Outcomes included the true-positive:false-positive (TP:FP) ratio; and the cost of diagnostic investigations among screen positives, per cancer detected (Diag_cost). Outcomes were estimated for recommended screening only, and then when giving the MCED test to anyone without cancer detected by current screening plus similarly aged adults ineligible for recommended screening.

Results

In the US, current screening detects an estimated 189,498 breast, cervical, colorectal and lung cancers. An MCED test with 25–100% uptake detects an additional 105,526–422,105 cancers (multiple types). The estimated TP:FP (Diag_cost) was 1.43 ($89,042) with current screening but only 1:1.8 ($7060) using an MCED test. For the UK the corresponding estimates were 1:18 (£10,452) for current screening, and 1:1.6 (£2175) using an MCED test.

Conclusions

Adding an MCED blood test to recommended screening can potentially be an efficient strategy. Ongoing randomised studies are required for full efficacy and cost-effectiveness evaluations.

中文翻译：

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评估多癌症早期检测基因组血液测试对人口健康的影响，以补充美国和英国现有的筛查

 背景

多癌症早期检测（MCED）下一代测序血液检测代表了筛查领域潜在的范式转变。

 方法

我们估计了美国和英国筛查的影响。我们使用国家特定参数进行吸收，并使用测试特定敏感性和假阳性率进行当前筛查：乳腺癌、结直肠癌、宫颈癌和肺癌（仅限美国）。对于 MCED 测试，我们按阶段使用癌症特异性敏感性。结果包括真阳性：假阳性（TP：FP）比率；以及针对检测到的每种癌症进行筛查阳性的诊断调查的成本（诊断_成本）。仅对推荐筛查的结果进行了估计，然后对当前筛查未检测到癌症的任何人以及不符合推荐筛查资格的类似年龄的成年人进行 MCED 测试时进行了估计。

 结果

在美国，目前的筛查发现了大约 189,498 例乳腺癌、宫颈癌、结直肠癌和肺癌。摄取率为 25-100% 的 MCED 测试可额外检测出 105,526-422,105 种癌症（多种类型）。当前筛查的估计 TP:FP（诊断_成本）为 1.43（89,042 美元），但使用 MCED 测试仅为 1:1.8（7060 美元）。对于英国，当前筛查的相应估计值为 1:18（10,452 英镑），使用 MCED 测试的相应估计值为 1:1.6（2175 英镑）。

 结论

在推荐的筛查中添加 MCED 血液检测可能是一种有效的策略。需要进行持续的随机研究以进行全面的疗效和成本效益评估。