Alternative endpoints to mortality in cancer screening trials

The reliance on mortality endpoints in cancer screening trials is not always compatible with the need to accelerate progress in outcomes for patient and public benefit. Evaluation of novel cancer screening technologies, such as multi-cancer early detection (MCED) tests, could be expedited by using alternative metrics that are measurable earlier than mortality. These include endpoints based on cancer stage at diagnosis, such as reduction in late-stage cancer incidence, and endpoints following cancer diagnosis, such as eligibility for curative therapy. Innovative trial designs with earlier measures that complement cancer mortality are needed to realise the potential benefits of novel screening technologies such as MCEDs more rapidly.