Dr Jessica Lloyd and Dr Sowmiya Moorthie, of Cancer Research UK (CRUK), discuss multi-cancer tests, their potential use in screening, their challenges and uncertainties
Single assays (laboratory tests) that can detect multiple cancers, provide an exciting shift in early detection, diagnosis and treatment that could improve cancer outcomes. There are various terms used to describe these assays, such as multi-cancer early detection tests (MCEDs) or multi-cancer detection tests (MCDs). At CRUK, we use the term multi-cancer test (MCT) to incorporate all potential uses of liquid biopsies in the multiple-cancer context. These potential uses include asymptomatic screening as well as supporting healthcare professionals to diagnose people who present with symptoms suggestive of cancer earlier, selecting the most appropriate treatment options once there is a diagnosis, and tracking disease progression and recurrence.
We are excited by the potential of these technologies to improve early diagnosis by picking up significant cancers at a stage when there are more treatment options, either leading to improved survival or quality of life for patients. This includes the potential to transform cancer screening by making it possible to screen for many cancers with a single assay or amending current screening programmes. However, it is important to ensure that these technologies are assessed and implemented in an appropriate way to achieve this goal.
Research and development in this space is occurring at a fast pace and several research trials are taking place worldwide. This means MCTs are attracting a huge amount of interest from both the media and policymakers.
Cancer Research UK explainer articles
There is a considerable amount of discussion among the cancer community of how best to use MCTs and whether they add value. That is why CRUK is writing an MCT explainer series to explain the technology behind them and discuss all the opportunities, challenges, and current uncertainties associated with MCTs.
In the first article in the series, we discuss how MCTs could be used in screening programmes.
The hope is that these tests could eventually screen for cancers that are not covered by individual screening programmes, including less-common cancers, that they could find more types of cancer earlier, and help people to live longer, better lives. That prospect is, however, many years away. Much more evidence is needed before we can know if available assays are suitable for use as part of a national screening programme. To be suitable for screening, MCTs would need to show good diagnostic accuracy for early-stage, clinically significant cancers, while generating low numbers of false negative and false positive results.
To date, while many different MCTs are in development, they have mainly been trialled in people who have already been diagnosed with cancer. The UK National Screening Committee (UK NSC) has stated that it would need good evidence of them working effectively for people who are apparently healthy and have no symptoms.
Research trials that can provide this sort of evidence for screening are large and complex. It is important that a robust framework is established to help decide which tests could be introduced in screening, and when. That is why we are encouraged that the UK NSC has set up a task group to review the evidence and formulate its position on the evaluation of MCTs for screening.
In the meantime, watch out for future articles in our CRUK series on MCTs. We’ll be looking more closely at their many potential uses and consider some of the most important issues and considerations for implementation by the health system.
- The UK NSC task group on multi-cancer detection tests met for the first time on 17 July. We will provide updates on its work via this blog.
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