Should Multi-Cancer Early Detection Testing Replace Guideline-Recommended Colorectal Cancer Screening? A Comparative...

Area of Science:

• Oncology
• Public Health
• Biomedical Informatics

Background:

• Colorectal cancer (CRC) screening, including colonoscopy and fecal immunochemical testing (FIT), reduces mortality by enabling early detection and removal of precancerous lesions.
• Multicancer early detection (MCED) blood tests aim to identify multiple cancers early but offer limited preventive capabilities.
• The comparative effectiveness of MCED's broad detection versus CRC screening's preventive potential is not fully understood.

Purpose of the Study:

• To compare the effectiveness of MCED-only screening strategies against established CRC screening methods (colonoscopy, FIT) using microsimulation.
• To evaluate the impact on late-stage CRC diagnoses and life-years gained.

Main Methods:

• Microsimulation modeling was employed, utilizing CRC-SPIN v3.0 for CRC outcomes and MCEDsim for non-CRC cancers, calibrated with SEER incidence data.
• Simulations compared annual FIT, decennial colonoscopy, and MCED-only strategies under various assumptions of MCED sensitivity and preclinical duration.
• Key metrics included reduction in late-stage CRC diagnoses and life-years gained relative to no screening.

Main Results:

• Colonoscopy and FIT reduced late-stage CRC diagnoses by 26% and 25%, respectively.
• Annual MCED screening reduced late-stage diagnoses by 20%-32%, depending on assumptions.
• MCED-only strategies yielded 33%-51% of the life-years gained compared to colonoscopy across different scenarios.

Conclusions:

• Current MCED tests are not recommended as replacements for guideline-recommended CRC screening due to the loss of preventive benefits from precursor lesion removal.
• MCED screening may serve as a valuable adjunct to existing CRC screening protocols.
• Further research is needed to optimize MCED's role in comprehensive cancer screening strategies.