Mandatory interval-cancer audit for every blood-based screening test
When a screening test misses a cancer, we should know. Linking every negative result to the cancer registry and publishing what was missed, by stage, should be a condition of use.
Cervical and breast programmes audit interval cancers routinely; commercial blood tests do not. Propose that authorisation or reimbursement for MCED and single-cancer blood tests requires registry linkage of all negatives, with annual publication of stage-specific sensitivity, interval cancer rates, and test-negative cancers by subtype.
- Most lethal cancers are found late · Screening exists for only a few cancers. Pancreatic, ovarian, liver, oesophageal and most lung cancers are found when cure is unlikely.
- Biomarkers are not validated or standardised · Tests that decide who gets a drug are often not validated prospectively and are measured differently in every lab.
- Weak real-world evidence and registries · We do not reliably know what happens to patients after approval, so we cannot tell which drugs deliver in practice.
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Shares Shield, Multi-cancer early detection (MCED), Most lethal cancers are found late, Liquid biopsy (ctDNA).
- IdeaAutomatic weekly linkage of cancer registries to deaths, prescriptions and imaging
Shares SEER (Surveillance, Epidemiology, and End Results), Weak real-world evidence and registries, Real-world evidence.
- IdeaRecord and publish the symptom-to-diagnosis interval for every cancer, by hospital
Shares SEER (Surveillance, Epidemiology, and End Results), Weak real-world evidence and registries, Most lethal cancers are found late.
- IdeaMulti-cancer blood test as the first step for patients with non-specific symptoms
Shares Galleri, Multi-cancer early detection (MCED), Most lethal cancers are found late.
- IdeaBank yearly blood from cancer survivors so future tests can be validated
Shares SEER (Surveillance, Epidemiology, and End Results), Multi-cancer early detection (MCED), Most lethal cancers are found late, Liquid biopsy (ctDNA).
- IdeaEmulate the trial in real-world data first to decide which trials to run
Shares SEER (Surveillance, Epidemiology, and End Results), Weak real-world evidence and registries, Real-world evidence.
- IdeaOffer the blood test for bowel cancer only to people who refuse stool tests or colonoscopy
Shares Shield, Most lethal cancers are found late, Liquid biopsy (ctDNA).
- IdeaLet MCED trials read out on late-stage incidence, with mortality follow-up mandated
Shares Galleri, Multi-cancer early detection (MCED), Most lethal cancers are found late, Liquid biopsy (ctDNA).