Triaging suspected cancer with a multi-cancer early detection blood test

Along the spectrum of promising clinical applications of ctDNA across the various stages of cancer, blood-based genotyping in advanced cancer to guide targeted therapies, and more recently, molecular residual disease detection to improve patient selection for adjuvant therapy in stage II colon cancer, are the only indications with sufficient evidence to be integrated into routine clinical care.1,2 Among the many other potential applications of ctDNA, a multi-cancer ctDNA test for early detection of multiple cancer types in otherwise healthy individuals, represents the most substantial opportunity to improve cancer survival. [...]the MCED tests should provide information on which organ the cancer signal is originating from to help direct further investigations. Large-scale efforts including prospective trials (eg, NCI-Vanguard, NHS-Galleri [NCT05611632], PATHFINDER [NCT04241796], PATHFINDER2 [NCT05155605], and ASCEND [NCT04213326]) are now testing single-omic and multi-omic platforms using a diverse range of circulating markers, such as methylation patterns, fragmentation patterns, error-reduction massive parallel sequencing, and protein markers.3–6 A 2023 meta-analysis7 of 12 case-control and cohort studies in an asymptomatic population reported an encouraging pooled moderate sensitivity of 0·623 and high specificity of 0·975.