The Impact of Multi-Cancer Early Detection Tests on Cancer Mortality: A 10-Year Microsimulation Model

ABSTRACT Purpose Early detection of cancer can improve survival following diagnosis. However, routine screening is limited to a few cancer types. Multi-cancer early detection (MCED) tests could substantially expand cancer screening by simultaneously detecting multiple cancer types. This modeling study evaluates the potential impact of an MCED test on cancer outcomes in the US general population. Methods We developed a microsimulation model of 14 solid tumor cancer types which account for nearly 80% of cancer incidence and mortality. 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 (SoC) procedures or annual MCED testing. MCED sensitivities were derived from a case-control clinical validation study. We simulated the 10-year life course of 5 million US adults aged 50-84 years. The primary outcome was cancer mortality reduction due to MCED testing. Results In the best case with perfect uptake and adherence, MCED testing added to the SoC led to a 23% decrease in 10-year cancer mortality relative to the SoC alone, translating to 668,600 cancer deaths averted over 10 years. The largest mortality reductions, in absolute terms, were observed for lung (160; 802 versus 962 per 100,000), colorectal (118; 168 versus 284), and pancreatic (50; 238 versus 288) cancer. The largest relative reductions were in cervical (52%), colorectal (41%), and breast (34%) cancer. The population-level life-year gain was 7,158 years per 100,000. Conclusion MCED testing has the potential to substantially reduce cancer-related deaths, improve outcomes across multiple cancer types.