UK's NHS will not expand trial of multi-cancer early detection tests

June 11, 2024

Screening tests for only four cancers -- breast, colorectal, cervical and lung -- have been proven to lengthen life and prevent premature death. Multi-cancer early detection tests, which seek to detect ‘free cell’ genetic material from cancers in blood samples, are a promising way to detect cancers earlier when they are treatable. Multi-cancer early detection tests could also decrease death from some deadly cancers that are almost always detected when they have spread widely, such as pancreatic, ovarian, and brain cancer.

No multi-cancer early detection test is currently approved by the Food and Drug Administration, although some genetic tests are approved to monitor patients undergoing cancer treatment.  These screening tests are not covered by most health insurance plans, although some employers provide coverage. Currently over half of people with a “positive signal” are not found over the following year to have cancer. These tests currently cost about $900 per person, and some vendors suggest repeating them annually.

The National Health Service of the United Kingdom has just analyzed the first year of a three-year trial of Grail, which enrolled 140,000 in England. They have released no numbers from the study, although they decided not to expand the offering to an additional million English people over age 50 based on the preliminary data. The study will be completed in 2026, although data analysis might mean the results might not be published that year.

It is highly unlikely that multi-cancer early detection tests will lower total medical expenditures even when the price of these tests comes down. Here is data on the cost per “quality adjusted life year” saved by the four types of cancer screening recommended by the US Preventive Services Task Force (USPSTF). These tests are considered cost effective (they cost less than $100,000 per QALY), but they are not cost saving.

Sources: Breast Cancer: Rim, 2019 LINK,  Cervical cancer, Sawaya, 2019 LINK, Colorectal Cancer, Aziz 2022 LINK, Lung cancer, Grover 2023 LINK  All are estimates; for instance, lung cancer range was $10-$90,000 per QALY

There are vaccinations and treatments that can prevent cancer!  HPV vaccinations administered in adolescence dramatically lowers the rate of future cervical cancer and head and neck cancer in middle age and beyond. Hepatitis B vaccine and Hepatitis B or C treatment can prevent many cases of kidney cancer. These are proven ways to reduce the toll of cancer, although adoption of these vaccines in the US is too low.

Sources: HPV Vaccine, CDC MMWR 17-year-old children up to date 2022  LINK; Hep B vaccine: NCQA Commercial PPO 2022 LINK;Hep C Treatment CDC MMWR among commercially insured  2019-20 LINK 

Implications for employers:

-       It’s no surprise that the first year of this trial did not demonstrate the ability to save lives. The first mammography trial that demonstrated that mammograms saved lives began in 1963 and was published in 1971.

-       Employers should not expect multi-cancer early detection tests to lower total medical costs. Employers offer health insurance to improve and lengthen lives, not to save money.

-       Multi-cancer early detection tests might well represent the future of cancer screening. Continuing to collect data to determine their benefit will help be sure that we add them to screening routines when that is of high value.

-       Employers can continue to promote cancer screening and immunizations recommended by the USPSTF.

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