Cancer is appearing in Americans earlier than ever before. However, many younger people are missing out on their screenings, which can lead to later-stage diagnoses with worse outcomes.
Blood-based tests that can detect multiple cancers early — namely Exact Sciences’ Cancerguard test and Grail’s Galleri test — are gaining attention as a way to help change that trajectory. However, there is still limited evidence about how these tests should be integrated into healthcare — and what it could look like for health systems to use them as a tool to improve patient outcomes.
Endeavor Health — a health system with nine hospitals and more than 300 clinics in the Chicago area — is trying to answer those questions through a large-scale study involving the Cancerguard test. The genetic-based test can detect signals from cancer types responsible for more than 80% U.S. diagnoses, including commonly fatal types like ovarian, lung, pancreatic, liver, esophageal and stomach.
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Last fall, Endeavor enrolled its thousandth patient in the study. The health system and its sister study site, Baylor Scott & White Health in Texas, aim to enroll up to 25,000 participants over a five-year period.
Endeavor is conducting this research because there isn’t enough evidence yet to justify widespread use of blood-based multi-cancer tests in routine screening, said Peter Hulick, one of the study’s lead authors. He is the health system’s chair of personalized medicine and director of its center for personalized medicine.
“We didn’t have enough data yet to have a complete rollout and just offer this test as you would a mammogram or high cholesterol test. We wanted a structured protocol because there are still some questions we need to answer before I think we can say definitively these tests are going to be a net benefit for patients,” he explained.
Endeavor and Exact Sciences are comparing the study participants’ outcomes with a matched cohort of nonparticipants to evaluate whether the test improves early cancer detection — particularly for cancers like ovarian and pancreatic that lack effective screening tools. The study is also examining potential downsides, such as anxiety from positive test results and the risk that patients might skip established screenings like mammograms or colonoscopies.
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A key research focus has been balancing early detection with minimizing false positives, as well as tracking how dependable negative test results are over time, Hulick pointed out.
He noted that it is too early to draw conclusions, as trial participants will be followed for five years, with testing every three years.
Hulick also highlighted operational challenges, saying there is still work to be done to figure out how to best integrate the program into busy primary care workflows.
Ultimately, he said the goal of this research is to determine whether multi-cancer blood testing can shift care toward earlier-stage diagnoses, improve outcomes and expand options for high-risk patients. He views genetics-based tests like Cancerguard and Galleri as potentially transformative tools in personalized medicine — but stressed that evidence is still needed to justify widespread health system rollouts or insurance coverage.
Photo: Nitat Termmee, Getty Images