# Early detection roadmap: organ screening → blood tests for many cancers

Source: https://onco.cc/roadmaps/early-detection-roadmap/  
OnCo record `early-detection-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

From mammograms and colonoscopies to a single blood draw that might screen for dozens of cancers, with the FDA's first decision imminent.

## Summary

Starting from organ-specific screening proven over decades, the Pap smear, mammography, colonoscopy and FIT, PSA and low-dose CT after NLST, this roadmap follows the cfDNA and methylation science behind the CCGA study, Galleri, Cologuard and Epi proColon. The current step covers pivotal trials and first approvals, with NHS-Galleri, PATHFINDER 2, Shield as the first FDA-approved blood test for colorectal screening and GRAIL's PMA filing, leading to FDA and NHS decisions and Medicare coverage. The speculative end is annual multi-analyte blood screening with tissue-of-origin-directed imaging. The route links mammography, MCED, liquid biopsy, methylation profiling, AI in radiology and whole-body MRI, and is pointed to by pancreatic and cervical cancer and the late-detection bottleneck.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-04

## Sources

- PATHFINDER: the first prospective test of a multi-cancer blood test in people without symptoms (The Lancet 2023): https://doi.org/10.1016/S0140-6736(23)01700-2
- DETECT-A: a blood test plus PET-CT found treatable cancers in 10,000 women with no symptoms (Science 2020): https://doi.org/10.1126/science.abb9601

## Connected records

- roadmaps: [Cancer prevention roadmap: tobacco control and vaccines → biomarker-guided chemoprevention → interception in carriers](https://onco.cc/roadmaps/prevention-roadmap/), [Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation](https://onco.cc/roadmaps/colorectal-roadmap/), [ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment](https://onco.cc/roadmaps/ctdna-tests/), [Diagnostics roadmap: stains → gene panels → blood tests that decide treatment](https://onco.cc/roadmaps/diagnostics-roadmap/), [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/), [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/), [Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question](https://onco.cc/roadmaps/pancreatic-roadmap/), [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/)
- ideas: [Decide who is screened for lung cancer by individual risk, not by pack-years](https://onco.cc/ideas/idea-lung-screening-eligibility-by-risk-not-pack-years/), [Judge a prostate screening programme on metastatic presentation, not on incidence or mortality](https://onco.cc/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/), [Run the ENDPAC score on every new diabetes diagnosis after 50 and scan the high scorers](https://onco.cc/ideas/idea-pdac-new-onset-diabetes-risk-score-pathway/), [Surveillance for every germline carrier found by universal testing, inside a registry rather than a research exception](https://onco.cc/ideas/idea-pdac-surveillance-for-every-germline-carrier/), [Treat lung cancer in never-smokers as its own disease, with its own detection programme](https://onco.cc/ideas/idea-lung-never-smoker-disease-its-own-programme/), [Treat screening uptake, not test sensitivity, as the thing to optimise, and settle the age extension with a trial rather than a model](https://onco.cc/ideas/idea-crc-screening-uptake-and-age-extension/), [UK gap: match endoscopy capacity and quality to the faecal immunochemical test thresholds the NHS has already set](https://onco.cc/ideas/idea-crc-uk-colonoscopy-capacity-and-fit-threshold/)
- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors](https://onco.cc/cancers/ipmn-cystic-precursors/), [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [AI in radiology](https://onco.cc/technologies/radiology-ai-screening/), [CT (computed tomography)](https://onco.cc/technologies/ct/), [DNA methylation profiling](https://onco.cc/technologies/methylation-profiling/), [Liquid biopsy (ctDNA)](https://onco.cc/technologies/liquid-biopsy/), [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/), [Proteomics & phosphoproteomics](https://onco.cc/technologies/proteomics/), [Whole-body MRI](https://onco.cc/technologies/whole-body-mri/)
- drugs: [Galleri](https://onco.cc/drugs/galleri/), [Shield](https://onco.cc/drugs/shield/)
- trials: [NHS-Galleri](https://onco.cc/trials/nhs-galleri/), [PATHFINDER 2](https://onco.cc/trials/pathfinder-2/)
- companies: [Exact Sciences (Abbott)](https://onco.cc/companies/exact-sciences/)
- terms: [Positive predictive value (PPV)](https://onco.cc/terms/ppv/), [Stage shift](https://onco.cc/terms/stage-shift/)
- key papers: [ERSPC: screening and prostate cancer mortality in a randomised European study](https://onco.cc/key-papers/paper-schroder-erspc-screening-mortality-nejm-2009/), [Lead-Time Trajectory of CA19-9 as an Anchor Marker for Pancreatic Cancer Early Detection](https://onco.cc/key-papers/paper-fahrmann-ca19-9-lead-time-gastroenterology-2021/), [Measurement of prostate-specific antigen in serum as a screening test for prostate cancer](https://onco.cc/key-papers/paper-catalona-psa-screening-test-nejm-1991/), [NHS-Galleri: design of the largest randomised trial of a multi-cancer blood test](https://onco.cc/key-papers/paper-nhs-galleri-design-cancers-2022/), [PLCO: mortality results from a randomised prostate cancer screening trial](https://onco.cc/key-papers/paper-andriole-plco-prostate-screening-nejm-2009/), [Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial](https://onco.cc/key-papers/paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011/), [Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement](https://onco.cc/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/)
- bottlenecks: [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)

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