OBJECTIVES: The majority of cancers do not have recommended screening tests, and many cancers are detected late and with poorer prognosis. MCED testing could increase early cancer detection. This modeling study explores how long-term benefits of MCED are distributed among the detected cancers.

METHODS: We developed a Markov model comparing annual MCED plus standard of care (SoC) screening (11 anatomic sites representing 74% of total cancer incidence) with SoC alone (4 anatomic sites – lung, breast, colorectal, prostate) in adults 50-79 years of age in the US. MCED performance in those cancers was based on data from Liu et al (2020). SEER data informed survival by stage at detection. SoC adherence was from the Behavioral Risk Factor Surveillance System. MCED adherence was set to 100%. MCED false positives resulted in diagnostic workups and reduced quality of life. To understand the incremental value of simultaneously detecting multiple cancers, the lifetime impact per person screened of MCED on life years (LYs) and quality adjusted life-years (QALYs) was reported for each cancer.

RESULTS: The individual cancer with the greatest QALY gain (lung) yielded 0.028 QALYs/screening program participant, including a loss of <0.001 QALYs associated with false positives from the MCED test. A further 0.051 QALYs was realized from detection of the remaining 3 modeled cancers with SoC screening, with no additional loss from false positives. The cancers considered without current screening (lymphoid, head & neck, pancreas, liver, stomach, ovarian, esophagus) represented a further 0.057 QALYs. In sum, across the cancers studied here, MCED + SoC resulted in 0.164 more LYs and 0.136 more QALYs than SoC alone.

CONCLUSIONS: Maximizing the breadth of cancers detected is essential to achieving the health economic benefits of MCED as capturing both cancers missed by current screening and unscreened cancers contribute significantly to the potential long-term benefits of multi-cancer early detection.