PERSONALIZED VERSUS GENERAL MULTI-CANCER DETECTION - AN EXPLORATORY, SIMULATION-BASED, BURDEN-BENEFIT ANALYSIS
Author(s)
Reinier Meester, MSc, PhD1, Niels Dunnewind, MSc2, Freek van Delft, MSc, PhD3, David K. Edwards, 5th, PhD1, Signe Fransen, MSc1, Erik Koffijberg, MSc, PhD3.
1Freenome Holdings, Inc, San Francisco, CA, USA, 2Independent consultant, Rotterdam, Netherlands, 3University of Twente, Enschede, Netherlands.
1Freenome Holdings, Inc, San Francisco, CA, USA, 2Independent consultant, Rotterdam, Netherlands, 3University of Twente, Enschede, Netherlands.
OBJECTIVES: Multiomic tests are an emerging option for early cancer detection. Optimal test configurations may differ based on intended use. In this analysis, we explore the burden and benefit of personalized vs general multi-cancer detection (PCD vs MCD) strategies.
METHODS: A novel discrete-event simulation model was developed utilizing age, sex and site-specific incidence, stage and survival data from the U.S. Surveillance Epidemiology and End Results program (SEER; 2010-2015), and reconstructed preclinical disease progression. Hypothetical annual MCD (20% sensitivity, 99.5% specificity) in adults aged 40-80 y was compared to annual PCD (40% [40-60%] sensitivity, 90% specificity) in screening-eligible adults for lung, colorectal, and breast cancer or high-risk adults for 9 other priority cancers (10% population, relative risk=5 [3-7] per site). MCD follow-up was limited to 3 exams based on cancer signal origin. Outcomes included lifetime cancer cases, deaths, required tests, follow-up exams, and exams per life-year gained (LYG), with 95% credible intervals reflecting uncertainty in cancer-related model parameters.
RESULTS: Per 1000 population, without screening, an estimated 336 (335-337) adults developed one of the 12 cancers, 143 (142-144) were diagnosed in stage III-IV, and 148 (147-148) died from the disease. MCD detected 107 (99-114) cancers, reduced stage III-IV diagnoses by 31% (29-33%), deaths by 21% (20-22%) and yielded 544 (504-577) LYG, while requiring 33,117 (33,061-33,167) tests and 637 (624-647) follow-up exams. By contrast, PCD detected 79 (70-86) cancers, reduced stage III-IV diagnoses by 37% (35-38%), deaths by 28% (27-29%), yielded 631 (592-656) LYG, and required 25,996 (25,934-26,043) tests and 5002 (4990-5010) exams - i.e., 51 (42-62) additional follow-up exams per LYG vs MCD. The ratio roughly doubled with weaker risk criteria and halved with higher sensitivity.
CONCLUSIONS: MCD and PCD may meaningfully improve cancer outcomes but have different associated burden-benefit tradeoffs. More research and discussion are needed to determine optimal approaches for different populations and cancers.
METHODS: A novel discrete-event simulation model was developed utilizing age, sex and site-specific incidence, stage and survival data from the U.S. Surveillance Epidemiology and End Results program (SEER; 2010-2015), and reconstructed preclinical disease progression. Hypothetical annual MCD (20% sensitivity, 99.5% specificity) in adults aged 40-80 y was compared to annual PCD (40% [40-60%] sensitivity, 90% specificity) in screening-eligible adults for lung, colorectal, and breast cancer or high-risk adults for 9 other priority cancers (10% population, relative risk=5 [3-7] per site). MCD follow-up was limited to 3 exams based on cancer signal origin. Outcomes included lifetime cancer cases, deaths, required tests, follow-up exams, and exams per life-year gained (LYG), with 95% credible intervals reflecting uncertainty in cancer-related model parameters.
RESULTS: Per 1000 population, without screening, an estimated 336 (335-337) adults developed one of the 12 cancers, 143 (142-144) were diagnosed in stage III-IV, and 148 (147-148) died from the disease. MCD detected 107 (99-114) cancers, reduced stage III-IV diagnoses by 31% (29-33%), deaths by 21% (20-22%) and yielded 544 (504-577) LYG, while requiring 33,117 (33,061-33,167) tests and 637 (624-647) follow-up exams. By contrast, PCD detected 79 (70-86) cancers, reduced stage III-IV diagnoses by 37% (35-38%), deaths by 28% (27-29%), yielded 631 (592-656) LYG, and required 25,996 (25,934-26,043) tests and 5002 (4990-5010) exams - i.e., 51 (42-62) additional follow-up exams per LYG vs MCD. The ratio roughly doubled with weaker risk criteria and halved with higher sensitivity.
CONCLUSIONS: MCD and PCD may meaningfully improve cancer outcomes but have different associated burden-benefit tradeoffs. More research and discussion are needed to determine optimal approaches for different populations and cancers.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR148
Topic
Clinical Outcomes, Medical Technologies, Methodological & Statistical Research
Disease
Oncology