Progress with Prudence: Navigating New Multi-Cancer Tests

New, minimally invasive tests intended to indicate a range of cancers from a blood draw could help reduce mortality, lift quality of life and trim treatment costs. Still, the complexity of cancer testing requires that innovations meant to complement existing diagnostics be properly evaluated and paired with data-driven strategies to ensure we get the most from these developing technologies.  

The long shadow of cancer, responsible for nearly one in six deaths globally, is a big reason we are so attentive to promising advances against this complex group of diseases. In the 20th century, chemotherapy drugs helped us fight back. We've since added immunotherapies and more targeted treatments. Healthy behaviours remain an important tool in helping prevent cancer, as well.

The recent emergence of so-called Multi-Cancer Early Detection tests (MCEDs) is adding to optimism that cancer screening innovations could provide an additional boost. MCEDs, which require only a routine sample of blood or other biological fluids, are designed to indicate the possible presence of a variety of cancers, potentially earlier than traditional diagnostic technology.

The hope is, this could lead to timelier, more effective interventions that improve outcomes while limiting treatment costs.

Earlier this year, Swiss Re Institute published "Multi-cancer early detection: Cancer screening beyond today's boundaries" to foster a better understanding of MCEDs' potential to help lower cancer morbidity and mortality while encouraging a thoughtful approach to their broader deployment. The aim is straight-forward: to maximise MCED benefits while minimising negative consequences that could arise, should they be adopted prematurely.

The optimism over this new technology must be paired with a data-driven approach based on clinical trials and evolving real-world experience. There must be a robust discussion to ensure public expectations are realistic and doctors aren't pressured into ordering MCED tests where benefits do not outweigh costs.

This technology is still in its early stages. While some MCEDs are available if ordered by a doctor, they have yet to win broad regulatory approval in many countries. In seeking approval, test makers would have to prove their products are safe, that they reliably inform clinical decision making, and are, ideally, cost effective.

The most robust approach in proving the effectiveness of MCEDs is through clinical trials, such as one being run by the UK's National Health Service (NHS) with 140,000 volunteers. Other countries like the US are also actively engaging with manufacturers, to improve study designs under Food and Drug Administration (FDA) guidance, to benefit future trials.

These efforts reflect a solid start.

Still, it will likely take years to fully understand outcomes of studies, the complexities of which US cancer prevention officials have called "staggering". In the meantime, there is uncertainty about MCEDs' ability to reliably detect early stage cancers. False positives could mean invasive, painful interventions that waste time and healthcare resources while adding to costs and distress. Equally, false negatives might be harmful if a person assumes they don't have cancer, when in fact they do.

A positive MCED signal also still requires traditional investigations such as imaging and a tissue biopsy to confirm a diagnosis. However, positive MCED test results that fail to identify where in the body a cancer originates create challenges, such as requiring a battery of non-specific testing. Without the knowledge of how or where to begin treatment, yet with a signal that cancer may be present, patients and health care professionals could be left in limbo.

Without question, there is significant enthusiasm over MCEDs' promise. In the US Congress, for instance, lawmakers are considering requiring Medicare reimbursement for FDA approved MCED tests. Manufacturers' valuations have also soared on optimism that their tests will eventually become standard tools for oncologists. For life re/insurers like Swiss Re, improved cancer screening that leads to more effective treatments would also be a very welcome prospect.

This is especially relevant, given recent trends: over the last decade, we've seen a plateauing of life expectancy including in the US and the UK. Advances against cancer, through better screening and diagnostics, could help restore a more positive mortality trajectory. In their recent report, my Swiss Re colleagues Dr Debbie Smith and Dr Tobias Schiergens highlight how almost half of cancer-related deaths could be avoided if current medical advances, including early cancer detection, were more widely applied.

Still, enthusiasm for a new technology shouldn't overshadow the fact that it must also reliably demonstrate that its deployment can contribute to lifting quality of life and boosting cancer survival – or, as we put it at Swiss Re, helping people live longer, healthier lives.

Our industry's underwriting and claims definitions are likely to be affected by technologies that change disease detection and classification, especially if a positive result cannot be validated by traditional diagnostic methods. As MCED tests' commercial availability expands and they are increasingly used in clinical settings, insurers must also consider their impact on disclosures and potential for anti-selection.

Insurers have already begun their own MCED pilot projects, exploring possible benefits for policyholders who are at a higher risk of developing cancer. Initial results have yet to be released, and any improvements to mortality rates will also likely take many years to develop.

On a personal level, we all understand the hopes many people have for MCED tests to improve cancer care and survival. Still, we need to approach this carefully. As this technology develops, doctors, researchers, regulators, and other stakeholders including in our industry are well advised to invest the time and resources necessary to determine how it can support meaningfully improved outcomes.