The future of cancer screening: Earlier detection

Tom Beer, M.D., is chief medical officer and vice president, multi-cancer early detection, at Exact Sciences.

We live in a time of constant, groundbreaking strides in cancer treatment. But what if more cancers were caught early enough to make a meaningful difference in survival rates?  

Before the Pap smear cervical cancer screening test was introduced in 1941, cervical cancer was one of the most common causes of death from cancer for women in the United States. The introduction of the first cancer screening test marked a pivotal moment in medical history: For the first time, cancer could be detected before it made itself known.  

Today, the American Cancer Society reports that with screening, it’s now far more common for health care professionals to diagnose cervical pre-cancers than invasive cervical cancer.¹ They are finding abnormal cells or cancer at early stages, when the cancer is preventable or more successfully treated.  

That represents tremendous progress. Widespread screening, augmented by the preventive human papillomavirus (HPV) vaccine, has delivered a dramatic decrease in cervical cancer mortality.² In fact, the American Cancer Society convened a national roundtable to contemplate cervical cancer’s eradication.  

Screening advancements have delivered us to this moment. And that begs the question: What if this kind of progress — or even a fraction of this progress — were possible for other cancers? I am joining a panel discussion at HLTH 2024 to explore this idea.   

Only four cancers with recommended screening

The United States Preventive Services Task Force (USPSTF) recommends routine screening for only four common cancers: breast, cervical, colorectal, and lung.³ People of average risk are only screened for three of those cancers. The last major breakthroughs in screening arrived about a decade ago, with 2013’s imaging-based tests for lung cancer in people at high risk and, in 2014, the introduction of the Cologuard^® test, the first noninvasive colorectal cancer screening test for people of average risk.   

Despite our progress, the statistics are sobering. Currently, an estimated one in seven of all cancers in the United States is through screening.⁴ This reveals a glaring gap in our health care system. It’s true that two of the cancers with recommended screening tests are intended only for females. Yet if somehow everyone were able to be screened for all four of the cancers with recommended screening tests, detection could be possible for about one-third of the cancers that lead to death. Lung cancer — the leading cause of cancer mortality — prompts particular concern. It has low screening rates among those at high risk and often goes undetected in non-smokers.⁵  

The promise of multi-cancer screening 

An encouraging development is multi-cancer early detection (MCED) technology, which has the potential to revolutionize how health care approaches cancer screening. It has the potential to extend screening’s reach to nearly all tumor-based cancers — markedly further than the four cancers with recommended screening tests.  

Complementing existing screening tests, MCED testing may help identify more cancers on a larger scale and earlier. Treatments for early-stage cancers tend to be more effective and less toxic than those for advanced stages, making timely diagnosis essential.^6,7 Modeling studies performed by Exact Sciences suggest that implementing MCED testing could lead to a significant reduction in stage 4 cancer burden.⁸  

To that end, Exact Sciences is working to broaden cancer screening beyond the few recommended types routinely targeted. Addressing one cancer at a time is impractical, as many cancers are individually rare but collectively grow the overall cancer burden. Developing single-organ screening tests would be inefficient and would overwhelm patients and health systems. Exact Sciences believes that a more comprehensive approach using MCED testing in addition to currently recommended screenings is the only workable solution. 

That said, a responsible approach is critical. As with any screening test, multi-cancer screening may bring harm along with benefits. MCED test implementation will require careful attention to specificity and efficiency, ensuring that patients aren’t burdened with unnecessary procedures or anxiety. It’s also critical to ensure that all who would benefit from MCED testing have access to it and that health care professionals understand how MCED testing may impact patient care. 

Through a collaboration with Baylor Scott & White and Endeavor Health, Exact Sciences is studying that question. Launched in August 2024, the multi-site MCED Falcon Registry real-world evidence study will enroll up to 25,000 patients to evaluate the clinical performance, patient and provider experience, and psychological impact of MCED testing over a five-year period with the Exact Sciences MCED test.⁹ The study will provide valuable insights to help inform the development of future MCED tests, such as Exact Sciences’ Cancerguard™ test in development.  

The Exact Sciences team is convinced that the future of cancer screening includes MCED testing. In the coming months, we anticipate rigorous scientific work and considerable challenges. But looking 10 years ahead, do we believe that we will still be primarily screening for breast, colorectal, cervical, and lung cancer as we do today, with no other recommended cancer screenings? At Exact Sciences, we certainly do not. No cancer treatment is as effective as earlier detection, and Exact Sciences is committed to advancing this vital cause.  

The information provided is not clinical, diagnostic, or treatment advice. You should consult with a qualified health care professional about any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.  

The Exact Sciences MCED test is an investigational device. The test is for patients who have 
consented and enrolled in the Falcon Registry study. It has not been cleared or approved by the U.S. Food and Drug Administration or other national regulatory authority. 

The Cancerguard™ test is under development. The features above describe current development goals. The test has not been cleared or approved by the U.S. Food and Drug Administration or any other national regulatory authority. 

References

1. American Cancer Society, What is Cervical Cancer?, 2024

2. Eun TJ, Perkins RB. Screening for Cervical Cancer. Med Clin North Am. 2020 Nov;104(6):1063-1078. 

3. USPSTF. A & B Recommendations. Accessed October 14, 2024.

4. NORC at the University of Chicago. New Research Highlights Just One In Seven Diagnosed Cancers Found By A Recommended Screening Test. Accessed November 1, 2023. Limitations: Based on modeling data derived from numerous sources including self-reported surveys. Includes assumptions on detectability of certain cancer types. Does not include all cancer types or screening methods. 

5. American Lung Association, State of Lung Cancer, 2022.

6. American Cancer Society. Cancer Prevention & Early Detection Facts & Figures 2023-2024.

7. Lee EM, Jiménez-Fonseca P, Galán-Moral R, Coca-Membribes S, Fernández-Montes A, Sorribes E, García-Torralba E, Puntí-Brun L, Gil-Raga M, Cano-Cano J, Calderon C. Toxicities and Quality of Life during Cancer Treatment in Advanced Solid Tumors. Curr Oncol. 2023 Oct 19;30(10):9205-9216. doi: 10.3390/curroncol30100665. PMID: 37887565; PMCID: PMC10605504.

8. Data on file. 

9. Falcon Real World Evidence Registry, ClinicalTrials.gov. Identifier: NCT06589310. Last post: September 19, 2024. Accessed October 14, 2024. https://clinicaltrials.gov/study/NCT06589310