Blood test did not reduce late-stage cancer

Adding multicancer blood testing did not reduce late-stage cancer diagnosis.
*Randomized controlled screening trial; Oxford Centre Level 2.

Citation

Sasieni P, Johnson P, Round T, et al. Effect of Screening with Multicancer Early-Detection Test on Late-Stage Cancer Diagnosis. New England Journal of Medicine. 2026. doi:10.1056/NEJMoa2505723

Background

Single-cancer screening misses most cancers. This trial tested whether adding a blood test for many cancers reduces late-stage diagnoses.

Patients

142,250 adults aged 50 to 77 years in England. Excluded: cancer diagnosis or treatment within 3 years, or current assessment for possible cancer.

Intervention

Annual blood testing for a cancer signal for up to 3 rounds, added to usual care.

Control

Usual care; blood samples were stored but not tested.

Outcome

Primary: stage III or IV cancer among 12 prespecified cancer types. Key secondary: stage IV cancer.

Follow-up Period

Three annual screens; median 17 months after the third round.

Results

Primary analyses were intention-to-treat. Stage III or IV cancer among the 12 cancers was not reduced: incidence rate ratio 1.03 (95% CI 0.92 to 1.14). Stage IV cancer was also not significantly reduced: incidence rate ratio 0.86 (95% CI 0.74 to 1.00). Trial-related adverse events occurred in less than 1%; none were serious.

Significant finding Intervention vs control Effect Approximate number needed
Stage I or II cancer, 12 cancers; post hoc 647 vs 559 participants Relative risk 1.16 (95% CI 1.03 to 1.30) About 808 screened for 1 additional diagnosis
Stage I, II, or III cancer, 12 cancers; post hoc 1007 vs 846 participants Relative risk 1.19 (95% CI 1.09 to 1.30) About 442 screened for 1 additional diagnosis

Usual care was the current available screening approach. The primary combined outcome was offset by more stage III cancers, especially in round 1.

Limitations

Follow-up was short for a screening trial, and mortality benefit was not tested. More early diagnoses may include overdiagnosis or earlier detection without proven survival gain. Safety after referral was incompletely captured. The sponsor helped design, conduct, and report the trial.

Funding

Funded and sponsored by Grail; sponsor involved in reporting.

Clinical Application

Do not adopt this multicancer blood test for routine screening solely on these results; await longer follow-up showing meaningful patient benefit.