# A ten-dollar blood test for the five cancers that kill most people in poorer countries

Source: https://onco.cc/ideas/idea-prev-lmic-five-cancer-methylation-test/  
OnCo record `idea-prev-lmic-five-cancer-methylation-test` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Most cancer deaths are in low and middle income countries, where scans and endoscopies are scarce. A cheap methylation blood test tuned to liver, stomach, oesophageal, cervical and breast cancer could fill the gap.

## Summary

Most cancer deaths occur in low and middle income countries where scans and endoscopies are scarce, so this idea develops a narrow-panel targeted-methylation blood test, run on low-cost sequencing or PCR, tuned to liver, stomach, oesophageal, cervical and breast cancer at a marginal cost of around ten dollars. Current MCEDs cost far more and target the US cancer mix; narrowing the target set and using PCR cuts cost, and liver and gastric cancers shed methylated DNA relatively well. A positive result would lead to ultrasound or endoscopy. The test is case-control development then a prospective 20,000-person cohort in a high-incidence region, with IARC as a partner. Speculative in maturity, it addresses The hardest cancers are found late and Most of the world has almost no cancer care.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A five-cancer assay with marginal cost of $10 or less achieves at least 60% stage I-II sensitivity for liver, gastric and oesophageal cancer at 99% specificity, and is cost-effective at LMIC thresholds.
- Rationale: Narrowing the target set and using PCR rather than deep sequencing sharply cuts cost; liver and gastric cancers shed methylated DNA relatively well.
- Proposed test: Case-control development, then a prospective 20,000-person cohort in a high-incidence region.
- Maturity: speculative
- Actor: philanthropy

## Sources

- Bottleneck evidence (The hardest cancers are found late): Crosby et al., Early detection of cancer (Science 2022): https://doi.org/10.1126/science.aay9040

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/)
- technologies: [DNA methylation profiling](https://onco.cc/technologies/methylation-profiling/), [Multi-cancer early detection (MCED)](https://onco.cc/technologies/mced/)
- institutions: [International Agency for Research on Cancer (IARC / WHO)](https://onco.cc/institutions/iarc/)
- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [The hardest cancers are found late](https://onco.cc/bottlenecks/b-early-detection/)
- key papers: [Early detection of cancer](https://onco.cc/key-papers/paper-crosby-science/)
- roadmaps: [Global access and affordability roadmap: essential medicines and generics → biosimilars and frugal trials → reliance, pooling and homegrown innovation](https://onco.cc/roadmaps/global-access-roadmap/)

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