Скрининг онкозаболеваний по анализу крови?

dok_zlo — 16.05.2025

Objectives. Screening for multiple cancers in a single blood test is potentially transformative. The objective of this review was to assess the benefits, harms, and accuracy of screening with blood-based multicancer screening tests (MCST) in asymptomatic adults.

Data sources. Medline, Cochrane Library, trial registries, relevant government and commercial websites through December 2024; surveillance was conducted through March 31, 2025.

Study Selection. Eligible designs included controlled studies for benefit outcomes (e.g., cancer mortality, cancer detection, quality of life), controlled and uncontrolled studies for harm outcomes (e.g., psychosocial distress, adverse events, decrease in standard-of-care screening), and test accuracy studies conducted in external validation populations.
Data Extraction and Synthesis. One investigator extracted data and a second checked for accuracy. Two reviewers independently rated risk of bias for included studies using predefined criteria. Results were synthesized narratively.

Results. The search yielded 12,043 unique records. No controlled studies evaluated the benefits of screening. One cohort study reported that receipt of standard-of-care lung cancer screening was similar between a group that received the MCST and a group that was eligible but did not receive it (odds ratio, 1.58; 95% CI, 0.47 to 5.31). This same study reported no serious adverse events among the 108 women with false-positive results, but 101 had unnecessary radiation exposure from positron emission tomography–computed tomography scans.

Twenty studies (total N=109,177) reported on test accuracy for 19 MCSTs that used various biomarkers (cell-free DNA or RNA, proteins, other) and analytic approaches. Of these, 13 high risk-of-bias studies used case-control designs to estimate sensitivity from cases with known cancer and specificity from cancer-free controls (diagnostic performance). Seven studies (5 high risk of bias, 2 unclear risk of bias) reported prediagnostic performance from testing cancer-free, asymptomatic cohorts with followup over 6 months to 1.5 years to ascertain cancer status. Accuracy outcomes varied widely across tests, subgroups, and study designs. The sensitivity for the detection of cancer ranged from 0.095 to 0.998, specificity ranged from 0.657 to 1.0, and area under the curve (AUC) ranged from 0.52 to 1.0. Sensitivity and AUC were lower in prediagnostic performance studies compared with diagnostic performance studies.

Limitations. English-language studies only; heterogeneity precluded quantitative synthesis.

Conclusions. We identified no controlled studies of MCSTs that reported on benefits of screening (e.g., mortality, cancer detection, quality of life), though some studies are ongoing. The accuracy of MCSTs varied by test and study design; evidence was insufficient to evaluate harms of screening.

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Скрининг онкозаболеваний по анализу крови?

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