OBJECTIVES: Emerging blood-based multi-cancer early detection (MCED) tests offer the promise of revolutionizing early cancer detection. We evaluated the potential effectiveness of MCED screening in identifying early stages of 12 specific cancers, which represent 70% of all cancer incidence in the US.

METHODS: We developed Simulation Model for MCED (SiMCED), a microsimulation model of 12 solid tumor cancer types: breast, colorectal, endometrial, esophageal, gastric, kidney, liver, lung, ovarian, pancreatic, prostate, and urinary bladder. Transitions between cancer stages (I-IV) were driven by cancer- and stage-specific dwell times synthesized from published literature and empirical estimates. Sensitivity of MCED test was drawn from a recent case-control study on average risk American adults. The model was calibrated to reproduce yearly incidence rates of diagnosis via usual care as captured in the National Cancer Institute’s (NCI’s) Surveillance, Epidemiology, and End Results (SEER) database. Using a lifetime horizon, we simulated 50 million US individuals aged 50 to 84 years. Diagnosis of cancer can arise from usual care or MCED. MCED was applied annually or biennially to individuals aged <85 years. The model accounted for unobserved cancer incidence rates by age, sex, and stage.

RESULTS: The estimated unobserved incidence of cancer in early stages (I and II) varied between 14% (breast) to 70% (lung and ovarian). MCED screening annually and biennially was projected to reduce Stage IV diagnoses by 26-44% and 14-27% respectively, while increasing early-stage diagnoses by 12-22% and 8-14%, with varying MCED sensitivity levels. The overall increase in cancer diagnoses was between 4% and 6%.

CONCLUSIONS: Our study suggests that MCED test could be an effective tool for early cancer detection, which is associated with improved survival and quality of life. However, the real-world impact of MCED tests and their cost-effectiveness require further investigation.