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DETECT-A was the first prospective study to give a multi-cancer blood test to people with no symptoms and act on the result: 10,006 women had the test, positives were confirmed by PET-CT, and 26 cancers were found by the blood test, with about 1% of women sent for imaging that found nothing and 0.22% having an invasive procedure that was not needed.
The Johns Hopkins and Geisinger study enrolled 10,006 women aged 65 to 75 with no history of cancer, tested their blood for mutations in cell-free DNA and for protein markers (the CancerSEEK assay), repeated positives on a second sample, and sent confirmed positives for whole-body PET-CT. The blood test detected 26 cancers, PET-CT localised most of them, and 15 of the 26 were confined to the organ or regional; with standard screening the study population also had 24 cancers found by mammography or colonoscopy. About 1% of participants had a false-positive result that led to imaging and 0.22% had a futile invasive diagnostic procedure; 99% of those tested were not led to an unnecessary procedure, and the authors reported that the test did not reduce uptake of standard screening (Lennon 2020). For pancreatic cancer the study is the proof that a blood-first pathway is workable at population scale, and the reminder that sensitivity for early-stage disease, not specificity or safety, is the limiting factor: the methylation test that followed reads 16.8% sensitivity at stage I across cancers (the CCGA term), and CA 19-9 rises only about two years before diagnosis.
Showing the technology this term belongs to: Multi-cancer early detection (MCED).
A blood test can find early, treatable cancers in people who feel well, including cancers for which no screening exists. It is not a replacement for mammography or colonoscopy but a possible addition. Larger randomised trials are needed to show benefit outweighs harm.
The proof of principle for multi-cancer blood tests that include pancreas; the sensitivity figures come from known cancers, not from screening.
Shares Stage shift, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center, Pancreatic ductal adenocarcinoma and the tag pancreatic-molecular.
Shares Pancreatic ductal adenocarcinoma and the tag pancreatic-molecular.
Shares Pancreatic ductal adenocarcinoma and the tag pancreatic-molecular.
Shares Pancreatic ductal adenocarcinoma and the tag pancreatic-molecular.
Shares Pancreatic ductal adenocarcinoma and the tag pancreatic-molecular.
Shares Nickolas Papadopoulos, Cell-free DNA (cfDNA), Bert Vogelstein, Johns Hopkins Hospital / Sidney Kimmel Comprehensive Cancer Center.
Shares CCGA: the Circulating Cell-free Genome Atlas behind the Galleri methylation test, Cell-free DNA (cfDNA), Multi-cancer early detection (MCED), Circulating tumour DNA (ctDNA).
Shares Positive predictive value (PPV), Stage shift, Multi-cancer early detection (MCED), Liquid biopsy (ctDNA).