A new article has been published in Nature Medicine on the ethics of Multi-Cancer Detection tests (MCDs). It is authored by 3 members of the UK National Screening Committee (UK NSC) MCD Task Group, Dr Tom Callender, Prof Anne-Marie Slowther and Prof Anne Mackie.
The paper builds on evidence review work commissioned by the UK NSC and is part of a group of projects considering MCDs that the UK NSC Evidence Team is coordinating.
MCDs can look for signs of several different cancers at once, most commonly using a blood sample. This new approach could change how we screen for cancer, as current UK screening programmes only check for one type of cancer at a time, such as breast or bowel cancer. However, introducing MCD testing raises important ethical questions.
Read the full article in Nature Medicine.
The paper explores the ethical challenge of testing for many cancers with a single test. When considering a cancer screening programme, the UK NSC weighs up the possible benefits of screening against the possible harms. Possible benefits include catching cancer early and improving survival, while possible harms include false positive and false negative results, as well as overdiagnosis, and overtreatment – the treatment of cancers that would never have caused harm.
This process of assessing benefits and harms is potentially particularly challenging for MCDs because not all cancers detected by the test will benefit equally from early detection. For some cancers, screening may do more harm than good.
Evaluating MCDs therefore involves assessing benefits and harms both collectively across all cancers detected and individually by cancer type. If the detection of certain cancers by an MCD shows no benefit or causes harm, any modification of the test or filtering of the screening results would raise questions about withholding information and respecting patient autonomy.
The paper also highlights other ethical considerations relating to:
- the potential impact on existing single-cancer screening programmes
- challenges around informed consent for a complex multi-condition test
- healthcare inequalities
- the efficient use of public resources
Ethics is just one of several strands of work that the UK NSC MCD Task Group is considering when discussing the potential use of MCD tests in screening.
We will keep you updated on progress of the work via this blog.
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