Journal Article

P184 Modelled impact of a multi-cancer early detection screening programme on the demand for diagnostic endoscopy in England

Halliday, Katharine, Hiom, Sara, Martin, Joanne, Gray, Ewan, Ellis, Libby, McPhail, Sean, Jones, David, Hamilton, Willie, Millar, Andrew

2025

Overview

IntroductionMulti-cancer early detection (MCED) tests screen simultaneously for two or more cancer types using a biological specimen, e.g., blood. Modelling predicts that an MCED screening programme could reduce late-stage cancer incidence and cancer mortality. To realise these benefits, people with a ‘Cancer Signal Detected’ MCED test result need timely access to diagnostic testing and subsequent care. We estimate the likely shifts in demand for diagnostic endoscopy, imaging and other modalities relative to current national usage in England were MCED screening introduced in the future.MethodsWe modelled annual diagnostic demand using (1) estimates of the volume of people who would be referred for diagnostic investigation if an MCED screening programme was added to usual care in England, for adults aged 50–79 years (using the Galleri® MCED test [GRAIL, Inc., Menlo Park, CA, USA]), and (2) the distribution and accuracy of the predicted Cancer Signal Origin (CSO; the tissue type or organ predicted to be associated with the cancer signal) reported by the MCED test. A decision tree model was used to predict diagnostic activity by modality. We compared predicted usage with current total annual usage using routine NHS datasets, including the NHS Monthly Diagnostic Waiting Times and Activity data set for 2023–24.ResultsFollowing the initial introduction of MCED screening, we estimated an annual increase in usage of colonoscopy of 0.49% per million persons screened (equivalent to an additional ~3000 procedures, from 656k to 659k) and an increase in gastroscopy of 0.28% (~2000 additional procedures, from 723k to 725k). In an established MCED screening programme (steady state), the annual increase in usage attenuated to 0.16% for colonoscopy per million persons screened (~1000 additional procedures) and 0.10% for gastroscopy (~700 additional procedures). Of the diagnostic modalities examined, the largest relative increase in use was for endoscopy. This resulted from a large predicted number of gastrointestinal CSOs, due in part to a high test sensitivity for gastrointestinal cancers.ConclusionsOur modelling estimates that there is likely to be a small increase in demand for diagnostic endoscopy if an MCED screening programme is added to usual care in England. This increase is likely to persist to a lesser extent in the long term. The burden of meeting this additional demand would be shared between NHS Hospital Trusts across 21 Cancer Alliances in England. Our model captures only the immediate impact of MCED screening, and does not account for a future reduction in demand for endoscopy in symptomatic individuals because cancers are diagnosed before clinical presentation. NHS workforce and capacity planning should consider future developments in cancer screening, including the potential addition of a national MCED screening programme.

• Publisher: BMJ Publishing Group LTD
• Subject: Cancer / Cancer screening / Colon / Colonoscopy / Endoscopy / Gastroscopy / Medical screening / Sensitivity analysis