GRAIL Bio UK Ltd, a subsidiary of GRAIL, LLC, London, UK
Queen Mary University of London, London, UK.
J Epidemiol Community Health. 2024 May 9;78(6):345-353. doi: 10.1136/jech-2023-220834.
Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation.
We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates.
The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation.
For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups.
NCT05611632.
在英国，社会经济贫困地区的癌症负担更高，癌症筛查参与率更低，这导致了更差的健康结果和更短的预期寿命。由于多癌早期检测（MCED）试验对预后不良癌症的敏感性更高，以及在经历更大贫困的人群中癌症负担更大，因此 MCED 筛查计划在这些人群中可能具有更大的相对收益。我们在不同的筛查参与水平下，对英格兰不同贫困群体中 MCED 筛查的潜在差异获益进行了建模。
我们应用拦截多癌筛查模型，利用英格兰国家癌症登记和分析服务提供的癌症发病率和生存率数据，来估计在 24 种癌症类型中，MCED 筛查计划按贫困程度划分，对晚期诊断和癌症死亡率的降低程度。我们评估了改变每个贫困群体中参与年度筛查的人数比例对这些估计的影响。
MCED 筛查计划的模型获益是巨大的：在最贫困和最贫困的群体中，晚期诊断的减少分别为每 100000 人 160 和 274 例。癌症死亡率的减少分别为每 100000 人 60 和 99 例。在每个参与水平上，获益在最贫困群体中最大，随着筛查参与率的降低而减弱。
为了获得最大的人群获益并减少健康不平等，MCED 实施策略应侧重于加强公平、知情的参与，使所有社会经济贫困群体都能平等参与。
NCT05611632。
