As cancer rates continue to increase in the United States, health systems are central in helping to manage this challenge. Cancer remains a leading cause of death in the U.S., with a roughly 50% rise in cancer cases predicted by 2050. While early detection and screening have helped contribute to a steady reduction in cancer mortality, estimates suggest that only 14% of cancers are detected through a recommended screening. Furthermore, 70% of cancer cases and deaths are due to cancers that have no recommended screening.*
Multi-cancer early detection testing can help uncover many cancer types using a single blood draw, providing a scalable, proactive solution to address the unmet need in screening for cancers that lack routine screening guidelines. This convenient approach complements guideline-recommended single-cancer screening and offers the potential to shift cancer diagnoses to earlier stages—when treatment may be more effective and more cost-effective, and survival rates are higher.
For health systems, multi-cancer testing provides a system-level opportunity that may help reduce the impact of late-stage cancer diagnoses and associated costs.
Key Considerations
As this sort of testing gains momentum nationwide, it’s critical for healthcare leaders to fully understand the clinical, operational and financial elements of implementation and follow-up care for patients with positive multi-cancer early detection test results.
Clinical
Multi-cancer early detection testing has the potential to expand detection to many additional cancer types, although it’s not a replacement for guideline-recommended single-cancer screenings. Since this technology can identify cancer signals before symptoms appear, it could contribute to substantial reductions in late-stage cancer incidence and, in the longer term, mortality.
While guideline-recommended screenings exist for breast, cervical and colorectal cancers for the general population and lung cancer in smokers, this testing enables systems to enhance early detection opportunities, especially for aggressive cancers for which standard screening is not currently available—such as pancreatic, liver and ovarian cancers.
In addition, modeling data predict that this testing could reduce stage IV cancer incidence by up to 42% and cancer-related mortality by 17% over a 10-year horizon.
Some of these tests are commercially available today, including the Cancerguard™ test from Exact Sciences. Health systems should consider the unique aspects of each test and its accompanying support features when considering implementation.
Operational
A positive multi-cancer early detection test result prompts a diagnostic journey that should be efficient, rapid and reliable, clearly mapped to avoid diagnostic delays and inconsistencies from one patient to the next. Test developers have proposed two distinct approaches to confirm and localize a suspected cancer after a positive multi-cancer test result.
One approach harnesses molecular prediction to determine the most likely site or sites of the suspected tumor. This molecular prediction is often referred to as molecular tissue of origin or cancer signal of origin. A modeling study showed that molecular prediction pathways may extend the diagnostic journey in patients with a false-positive result or an incorrectly localized true-positive result. Based on published performance results, the study found a molecular prediction diagnostic strategy to be less efficient than an imaging-based diagnostic strategy.
Another approach centers on a structured standardized imaging strategy to provide diagnostic resolution. Imaging-based pathways—such as promptly pursuing computed tomography with intravenous contrast of the neck (soft tissue), abdomen and pelvis and, if necessary, positron emission tomography/CT—have been shown to be effective and efficient in a prospective clinical trial and are predicted to be more efficient and reduce diagnostic burden for patients with positive multi-cancer tests.
Financial
Currently, no multi-cancer early detection tests have U.S. Food and Drug Administration approval, creating challenges for reimbursement and broader accessibility. While some patients in traditional care settings may be willing to self-pay, this testing may be an excellent fit for health systems offering concierge medicine or executive health programs.
Strategic implementation of this technology may also enable health systems to assess its impact and value before expanding its availability to a broader population. This testing may also help health systems provide proactive support for patients receiving preventive care, thus ensuring systems can continue to support the full patient journey. Introducing this testing systemwide may help support early-stage diagnosis when cancers are more treatable, potentially impacting late-stage costs.
Multi-cancer early detection testing may not only be a major scientific advancement, it can also be a strategic lever for the transformation of cancer care at a population level. As part of the shift from reactive to proactive cancer care, health systems have a unique opportunity to lead in innovation by providing it to their patients.
Working together with industry, it’s now possible for the first time to detect more cancers, treat patients earlier, and improve outcomes by implementing it across health systems everywhere.
* Based on modeling data derived from numerous sources including self-reported surveys. Includes assumptions on detectability of certain cancer types. Does not include all cancer types or screening methods.
Tomasz Beer, MD, FACP, is vice president/chief medical officer, Multi-Cancer Early Detection, Exact Sciences, Madison, Wis.
A Premier Corporate Partner of ACHE, Exact Sciences will collaborate with health systems to help improve risk profiling, treatment plans, and patient adherence and outcomes. For more information, go to ache.org/ExactSciences.