[Multi-cancer screening? A proactive ethical exploration]

Multi-cancer early detection (MCED) is a new development within cancer screening. A blood test combined with analysis of circulating tumor DNA could lead to early detection of multiple cancer types simultaneously, potentially reducing cancer-related mortality. While this sounds promising, a proactive ethical reflection on the possibilities and potential consequences of MCED in population screening is essential for its responsible implementation. In this article, we explore the ethics of MCED offered as population screening using the bioethical principles of beneficence and maleficence (proportionality), autonomy and justice. Proportionality of MCED screening requires that benefits outweigh harms. To respect autonomy, meaningful choices and understandable information need to be offered. Distributive justice requires at a minimum fairness in both the implementation and costs of screening. MCED screening does not currently meet these requirements, due to limited validity of MCED tests and potential harmful consequences of MCED introduction on both the individual and societal level.