The UK, like many other countries, has systematic screening programmes for breast, cervical and colorectal (bowel) cancer, and work is under way to scale up and transform the Targeted Lung Health Check programme into a national targeted screening programme for lung cancer.
Together, these 4 cancers are responsible for nearly 40% of all deaths from cancer each year in the UK.
That leaves many cancers we do not have screening programmes for. One possible way to tackle this could be to use multi-cancer detection tests (MCDs) in screening.
MCDs aim to detect whether someone has a cancer, usually from a blood sample. The cancers included and the exact methods used vary between tests.
The hope is that MCDs could help pick up cancers at a stage when their diagnosis might lead to a cure or improve the person’s quality of life.
What we are doing
The UK National Screening Committee (UK NSC) has not made any recommendations on the use of MCDs for screening in the UK as there is no evidence yet that their use in a screening programme does indeed prevent deaths from cancer or improve quality of life.
However, MCDs are a potentially transformative type of technology that raise big questions. While we await evidence of whether MCDs might be effective, we are supporting stakeholders and working to understand these technologies and their possible impact on screening through multiple strands of work.
Horizon scanning
A wide range of MCDs are currently under development. To keep abreast of developments and support research that can be used to guide screening decisions, the UK NSC regularly engages with relevant groups, including test developers, research funders, and the NHS.
UK NSC MCDs task group
The UK NSC is bringing together a task group of researchers, clinical and public health experts, and patient and public members. This group will help to review evidence and formulate the committee’s position on the evaluation of MCDs for screening and a road map for their development.
Review of evaluation methods
The UK NSC uses formal criteria when it assesses the evidence for proposed screening programmes. The evaluation of MCDs presents additional complexity because these tests are novel and screen for multiple cancers simultaneously.
We have therefore commissioned work to review different methods for the evaluation of MCDs, from which we will derive a position statement.
Ethics
The use of a single test to screen for multiple cancers raises many ethical questions. For example, there might be different benefits and harms when screening for different cancers using the same test.
What would constitute an acceptable balance between those individuals who might benefit from the test compared to those who might be harmed?
The UK NSC has developed an ethical framework to support decision-making with regards to proposed and existing screening programmes. Building on our methods review, the committee will convene a task group of individuals with expertise in ethics, primary care, public health, oncology, statistics, and patient and public voice members.
This group will support the UK NSC and its sub-committees to understand and address any ethical implications of these tests.
Road map
Screening programmes are complicated. Who should be screened, and at what point? If screened, what is the diagnostic pathway for each cancer? What strategies might be cost-effective? What infrastructure would need to be developed to roll out a screening programme? How do we generate useful information over many years to evaluate MCDs?
Bringing together these strands of work, the UK NSC will develop a road map that integrates the different aspects into a possible MCD screening programme structure. This will support stakeholders engaged in the research and development of these tests in answering policy-relevant questions.
We will keep you updated as the work progresses on how to assess the use of MCDs in screening.
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