Carbonell Chantelle, Hutchinson John M, Hilsden Robert J, Yang Huiming, Brenner Darren R
Department of Oncology, University of Calgary, Calgary, AB, Canada.
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Cancer Control. 2024 Jan-Dec;31:10732748241307360. doi: 10.1177/10732748241307360.
Screening and early detection is one of the most effective approaches to reduce the population-level impact of cancer. Novel approaches to screening such as multi-cancer early detection tests (MCEDs) may further reduce cancer incidence and mortality. Many MCEDs detect fragments of circulating DNA containing mutations that originated from tumour cells, thereby informing both the presence of cancer and the cell-type of origin. In this review, we examine the current evidence of MCEDs as a potential tool to improve population-based cancer outcomes. We review the role of MCEDs to address low participation rates, disparities among underserved populations, changing epidemiology of common cancers, and the absence of screening tests for many cancer types. MCEDs have the potential to increase participation in cancer screening programs, as they may be less invasive than other procedures, and can screen for multiple cancer types in one appointment. Additionally, due to the lack of specialized collection equipment needed for these tests, underscreened populations and targeted populations could gain greater access to screening. Finally, because MCEDs can detect cancer types without screening tests that are moderately common and increasing in western populations, efficacious tests for these sites could alleviate the cancer burden and improve patient outcomes. While these tests offer great promise, considerable limitations and evidence gaps must be addressed. Notable limitations include scenarios where early detection does not improve survival outcomes, the costs and impact on health care resources for false positives, and false reassurance with subsequent lack of adherence to existing screening protocols.
筛查和早期检测是降低癌症对人群影响的最有效方法之一。多癌早期检测测试（MCED）等新型筛查方法可能会进一步降低癌症发病率和死亡率。许多MCED检测含有源自肿瘤细胞突变的循环DNA片段，从而既告知癌症的存在又告知起源的细胞类型。在本综述中，我们研究了MCED作为改善基于人群的癌症结局的潜在工具的现有证据。我们回顾了MCED在解决参与率低、服务不足人群之间的差异、常见癌症流行病学变化以及许多癌症类型缺乏筛查测试方面的作用。MCED有可能提高癌症筛查项目的参与度，因为它们可能比其他程序侵入性更小，并且可以在一次预约中筛查多种癌症类型。此外，由于这些测试所需的专门采集设备缺乏，筛查不足的人群和目标人群可以更方便地进行筛查。最后，由于MCED可以检测出西方人群中中等常见且发病率不断上升的癌症类型，而无需进行筛查测试，针对这些部位的有效测试可以减轻癌症负担并改善患者结局。虽然这些测试前景广阔，但必须解决相当多的局限性和证据空白。显著的局限性包括早期检测不能改善生存结局的情况、假阳性对医疗资源的成本和影响，以及随后因缺乏对现有筛查方案的依从性而产生的错误安慰。
