The impact of multicancer early detection tests on cancer stage shift: A 10-year microsimulation model

Early detection of cancer improves survival following diagnosis. However, routine screening is limited to a few cancer types. Multicancer early detection (MCED) tests could revolutionize cancer screening by simultaneously detecting multiple cancer types. This study evaluates the potential impact of an MCED test on stage shift in the US general population.

A microsimulation model of 14 solid tumor cancer types that account for nearly 80% of cancer incidence and mortality was developed. The model was calibrated to reproduce annual incidence rates reported in the Surveillance, Epidemiology, and End Results database. Cancer diagnosis could arise from standard-of-care procedures or annual MCED testing. MCED sensitivities were derived from a large, multicenter, prospective, case control study. Ten-year disease progression was simulated for 5 million US adults aged 50 to 84 years. The primary outcome was stage shift resulting from MCED testing.

Over 10 years, supplemental MCED testing led to a 10% increase in Stage I diagnoses, 20% increase in Stage II diagnoses, 34% increase in Stage III diagnoses, and 45% decrease in Stage IV diagnoses, relative to the standard of care alone. The largest absolute reductions in Stage IV diagnoses were in lung (400 vs. 765 per 100,000), colorectal (96 vs. 236), and pancreatic (89 vs. 211) cancer. The largest relative reductions were in cervical (83%), liver (74%), and colorectal (59%) cancer.

MCED testing has the potential to substantially reduce late-stage cancer diagnoses, improve outcomes across multiple cancer types, and address a critical gap in screening.