Researchers shape guidance for cancer screening

by Matt Higgs, University of Warwick

edited by Gaby Clark, reviewed by Robert Egan

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University of Warwick researchers have played a central role in developing new position statements from the UK National Screening Committee (UK NSC), setting out how emerging cancer screening technologies should be evaluated before being introduced to patients.

Published today in the BMJ, the statements covering surrogate outcomes in cancer screening trials and multi-cancer detection (MCD) tests, set out principles to guide researchers, test developers and funders as interest in new screening technologies grows rapidly.

The statements make clear that surrogate outcomes (early signals of potential benefit) cannot replace mortality as the definitive measure of whether a screening program works. They also establish that evaluating MCD tests is substantially more complex than assessing single-cancer tests, and that the evidence required must reflect that complexity.

Professor Sian Taylor-Phillips, Professor of Population Health at the University of Warwick, lead for Warwick Screening, and member of the UK NSC, said, "We want people to have access to effective cancer screening as quickly as possible, but only where the evidence shows it does more good than harm. This means making sure that any new cancer screening saves lives and doesn't give people incorrect test results or treatment that they do not need.

"These position statements highlight the importance of considering the right evidence to inform policy decisions and using reversible rollout strategies to speed up evidence generation. Cancer screening, and multi-cancer detection in particular, is a fast-moving field, and we're committed to being open and adapting as the science develops."

On surrogate outcomes

Randomized controlled trials (RCTs) demonstrating a reduction in mortality from cancer screening can take decades, and by the time results arrive the technology and treatments involved have often moved on. There is growing interest in surrogate outcomes as a faster, less expensive route to decision-making.

The UK NSC's position is that surrogate outcomes can inform evaluations of new screening programs as part of standard assessments of benefits and harms but cannot yet replace mortality as the definitive trial outcome. Reliable, screening-specific methods to support the use of surrogate outcomes in place of mortality with confidence do not currently exist. It remains uncertain whether improvement in surrogate outcomes, such as reductions in late-stage disease, consistently translate into reductions in cancer mortality across different cancer types.

The statements make clear that even a surrogate perfectly predicting cancer mortality would not be sufficient. Screening decisions must weigh the full picture of benefits and harms, including false positives, overdiagnosis, quality of life, and potential effects on participation in existing screening programs.

Where a randomized trial demonstrates a significant reduction in late-stage disease, and where mortality differs meaningfully by stage, this may support early planning, modeling, and the development of implementation infrastructure while longer-term mortality data mature. Any such steps must be taken cautiously, with limitations clearly acknowledged and continued evaluation built in from the outset.

The UK NSC sets out a program of next steps to develop this area further, including better validation methods for surrogate outcomes in screening contexts and evaluation of their applicability across different population groups. The next steps also include the development of adaptive or reversible implementation models, such as phased rollout with predefined criteria for continuation or withdrawal as mortality evidence emerges.

On multi-cancer detection tests

MCD tests, which identify several cancers simultaneously from a single blood sample, have the potential to transform screening, but no country has yet introduced one within an organized program. The NHS Galleri Trial, which has recruited 140,000 participants in England, represents one of the most advanced efforts to evaluate whether that could change.

The cancers targeted by MCD tests differ significantly in their natural history, existing screening pathways, and balance of benefits and harms. Therefore, the UK NSC emphasizes that evidence requirements will differ depending on the intended use case, whether population-wide screening, targeting high-risk groups, or alongside existing programs for breast, bowel and cervical cancer. This intended use must be clearly specified from the outset as scaling back or withdrawing an established screening program is extremely difficult.

A particular concern is that MCD tests may preferentially detect more aggressive cancers, potentially creating the appearance of benefit through reductions in late-stage diagnoses without a corresponding reduction in deaths. This means surrogate outcomes must be interpreted with particular caution in the MCD context.

Assessments must go beyond detection rates to consider false positives, diagnostic burden, equity, acceptability and cost-effectiveness, and will require a portfolio of evidence combining trial data, qualitative research, implementation studies and economic modeling. Results should also be reported by individual cancer type where possible, even where trials lack statistical power for rarer cancers, as this helps identify which cancers drive overall benefit.

Publication details

Sarah Batson et al, UK National Screening Committee position statement on evidence required for multicancer detection tests, BMJ (2026). DOI: 10.1136/bmj-2026-089868

Sarah Batson et al, UK National Screening Committee position statement on surrogate outcomes in cancer screening trials, BMJ (2026). DOI: 10.1136/bmj-2026-629407

Journal information: British Medical Journal (BMJ)

Key medical concepts

Multi-Cancer Detection TestMortalityRandomized Controlled Trial

Clinical categories

OncologyPreventive medicine Provided by University of Warwick Who's behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news. Full profile →

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