Multi-Cancer Early Detection (MCED) Tests Are Not Currently Recommended for Average-Risk Adults
There are no established guidelines recommending multi-cancer early detection (MCED) tests for adults at average risk for cancer. Current evidence-based cancer screening focuses on single-cancer screening tests that have demonstrated mortality reduction through rigorous clinical trials.
Current Evidence-Based Cancer Screening Recommendations
The American Cancer Society provides specific screening recommendations for individual cancer types, not multi-cancer screening panels 1, 2:
Breast Cancer Screening
- Women aged 45-54 years: Annual mammography 1
- Women aged 40-44 years: Option to begin annual screening 1
- Women aged ≥55 years: Transition to biennial screening or continue annually 1
Cervical Cancer Screening
- Ages 21-29 years: Pap test every 3 years 1
- Ages 30-65 years: HPV test plus Pap test every 5 years (preferred) or Pap test alone every 3 years 1
- After age 65: Discontinue if adequate prior negative screening 1
Colorectal Cancer Screening
- Starting at age 45 years for average-risk adults 1
- First-tier options: Colonoscopy every 10 years or annual fecal immunochemical test (FIT) 3
- Second-tier options: CT colonography every 5 years, FIT-fecal DNA test every 3 years, or flexible sigmoidoscopy every 5-10 years 3
Lung Cancer Screening (High-Risk Only)
- Ages 50-80 years with ≥20 pack-year smoking history and current smoker or quit within past 15 years 4
- Annual low-dose CT (LDCT) reduces lung cancer mortality by 20-24% 5, 4
- This is not average-risk screening—requires specific smoking history criteria 4
Why MCED Tests Are Not Recommended
The evidence base supporting cancer screening requires demonstration of:
- Mortality reduction in randomized controlled trials
- Acceptable harm-to-benefit ratio
- Cost-effectiveness
Single-cancer screening tests like colonoscopy, mammography, and cervical cytology have met these criteria through decades of research 6. A 10-percentage point increase in uptake of these established screening tests could prevent approximately 1,010 lung cancer deaths, 11,070 colorectal cancer deaths, 1,790 breast cancer deaths, and 1,710 cervical cancer deaths over the lifetimes of eligible US residents 6.
Critical Pitfalls to Avoid
- Do not substitute unvalidated MCED tests for evidence-based single-cancer screening 1
- Do not delay established screening while pursuing experimental multi-cancer tests 2
- Recognize that early detection alone does not equal mortality benefit—overdiagnosis and false positives can cause significant harm 4
The Path Forward
Focus clinical efforts on maximizing uptake of proven screening tests rather than adopting unvalidated multi-cancer screening approaches 6. Implement reminder systems, reduce organizational barriers, and address access issues including insurance coverage to improve screening rates for established tests 2.