Multi-cancer early detection:from promise to practice and the next frontierOA

The paradigm of cancer screening is poised for a transformation from single-cancer,modality-specific tests toward a unified approach enabled by liquid biopsy.Multi-cancer early detection(MCED)tests,which analyze circulating biomarkers such as cell-free DNA(cf DNA)from a single blood draw,offer revolutionary potential to detect a broad spectrum of cancers simultaneously,many of which lack standard screening methods.Although technological advancements in methylation and fragmentomics have shown promising performance in case-control studies,major challenges remain regarding real-world sensitivity and the critical need to detect precancerous lesions.This article explores the evolving landscape of MCED technologies;highlights the imperative of targeting precancerous conditions as the next frontier;and outlines the foundational pillars,encompassing natural history studies,risk stratification,pragmatic endpoint evaluation,and health economic modeling,which will be essential for its responsible integration into public health strategies to ultimately decrease the global cancer burden.