Multicancer Early Detection Forum, February 2021
A new frontier in cancer screening is leveraging liquid-based detection, which look for signals of cancer in blood, urine, or stool samples, to create multi- rather than single-cancer screens. For those organizations focused on advancing multicancer early detection (MCED), the ambition is to develop blood tests, that could potentially be ordered annually, to screen healthy individuals for early signals of cancer, catch cancer earlier, and ultimately save more lives.
This emerging technology represents a paradigm shift in cancer detection: moving from screening select individuals at higher risk of developing specific cancers to screening the broader population for 10–50 possible cancers at once. MCED has the potential to reduce mortality through earlier detection and treatment of cancer and its advocates believe the technology has the potential to significantly improve public health. However, this shift is not without challenges—namely, defining the clinical utility, value, and efficacy of MCED and preparing health systems for the systematic changes in cancer-care workflow.
Throughout the second half of 2020, Tapestry Networks engaged primary care and oncology healthcare stakeholders in discussions to understand the key concerns facing the adoption of MCED and established the need for a focused and inclusive consortium to address these issues. This work culminated in the December 2020 MCED Forum, where participants coalesced around what approaches could be taken by a multistakeholder, public-private consortium to address MCED challenges and laid the groundwork for such a consortium to take shape.
Key takeaways from the MCED Forum are as follows:
There is a need for a public-private consortium dedicated to MCED. Participants overwhelmingly agreed that MCED represents a paradigm shift in cancer detection and that for the broader healthcare community to accept these technologies, it will require a proactive—rather than reactive—review of potential hurdles.
The consortium should prioritize the dual challenges of defining and evaluating clinical utility and establishing care pathways for clinical implementation, keeping in mind the need to educate clinicians and the public on MCED. Focus areas for the clinical utility workstream could include defining pragmatic endpoints, modeling the consequences of MCED, and using real-world evidence to evaluate MCED’s clinical utility. Focus areas for the care pathway workstream could include developing a stepwise approach to disseminating care pathway guidance, exploring the link between pathways and reimbursement, and evaluating existing roadblocks to current screening recommendations. Participants continued to debate the appropriate value message of MCED but agreed that education should be included in the consortium’s work to ensure there is a “common language” and better understanding of MCED across stakeholders.
The mission statement and guiding principles should address concerns regarding the consortium’s ability to succeed, including key questions on credibility. The consortium’s credibility—or potential lack thereof—is a source of many risks and challenges facing its work. Defining a mandate too broadly could also reduce the likelihood of the consortium’s success. Participants suggested developing a “tightly defined mission statement” to guide the consortium’s actions and delineate it from other efforts in the space. They also indicated that prioritizing the guiding principles of integrity, health equity, objectivity, inclusivity, transparency, simplicity, and productivity would provide the consortium with the tools needed to proactively address success risks.
The consortium should launch with a small and agile steering committee tasked with further defining the consortium’s structure and laying the groundwork for an inclusive membership. Specifically, this steering committee will be tasked with refining the consortium’s mission, guiding principles, and end goals; designing initial workstreams and identifying the projects within them; identifying an institutional home for the consortium; establishing additional governing bodies; securing sufficient seed funding and developing approaches for longer-term support; and exploring the creation of a public advisory group.