Teaching pack: Early Detection & Screening

This section groups the ways of finding cancer before it causes symptoms, when it is most curable: established population screening with mammography, colonoscopy, low-dose CT, HPV testing and PSA, plus blood-based multi-cancer early detection and risk-adapted AI screening that aim to reach cancers with no screening test today. Technologies filed here include low-dose CT lung screening, colorectal cancer screening, HPV DNA testing and self-sampling, mammography and tomosynthesis, whole-body MRI, MCED and DNA methylation profiling. It also covers surveillance of high-risk groups, such as pancreatic surveillance and HCC surveillance in cirrhosis, dermoscopy and AI skin analysis, and the procedures that follow a positive screen, including endoscopic resection and colposcopy.

• AI polyp detection in colonoscopy: Real-time software that highlights polyps on the colonoscopy screen, helping doctors find more of the growths that could become bowel cancer.
• AI-assisted mammography screening: Software that reads screening mammograms alongside or before radiologists, catching more cancers and cutting the reading workload in large trials.
• Breast cancer after chest radiotherapy in childhood, and the screening that follows: A girl who had radiotherapy to the chest carries a risk of breast cancer by age 50 of about 30 per cent. It is not only about dose: a low dose to the whole lung gave a higher standardised incidence than a high dose to a smaller field, because volume matters. Surveillance is recommended from early adulthood, decades before ordinary screening starts.
• Breast MRI coils and abbreviated breast MRI: Breast MRI is the most sensitive breast scan, done lying face down with the breasts in a special coil. Abbreviated protocols cut the scan from half an hour to a few minutes, which makes MRI screening of women with dense breasts or high risk affordable.
• Breath and volatile-organic-compound detection: Smelling cancer: measuring the trace chemicals a tumour puts into exhaled breath.
• Capsule endoscopy (PillCam, EndoCapsule, CapsoCam): A camera the size of a large vitamin pill that the patient swallows; it photographs the whole small intestine, which ordinary endoscopes cannot reach, and newer versions look at the colon as an alternative to colonoscopy for people who cannot or will not have one.
• Cell-free DNA methylation tests: Blood tests that read chemical marks on fragments of DNA shed by tumours; the marks tell cancer DNA from normal DNA and hint at where the cancer is.
• cfDNA fragmentomics: Fragmentomics reads the sizes and positions of DNA fragments in blood, not the mutations. Cancer cells die messily and leave a recognisable fragmentation pattern.
• Circulating tumour cell capture: Fishing whole cancer cells out of a blood sample to count them or study them; the count is prognostic in breast, prostate and colorectal cancer.
• Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood): Finding and removing polyps before they become cancer. Colonoscopy prevents cancer; stool and blood tests catch it early and get more people screened.

• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · A cancer with a visible precursor, and the first proof that finding it early saves lives (historic)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · Total mesorectal excision, and radiotherapy before the operation (historic)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · Chemotherapy after the operation, and how small the benefit is when the nodes are clear (historic)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · The screening programmes, and the discovery that uptake is the whole game (current)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · Antibodies, and the two things that decide whether they work (current)
• Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation · The genome, the subtypes and the hypermutated sixth (historic)
• ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment · A curiosity in plasma (historic)
• ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment · Proof that blood tracks the tumour (historic)
• ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment · Regulators accept a blood genotype (historic)
• ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment · Tumour-informed residual disease tests reach the clinic and the payer (current)
• ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment · Randomised trials: sparing treatment works, adding it is harder (current)
• ctDNA tests roadmap: from a curiosity in plasma to blood tests that decide treatment · The first drug approval that depends on a ctDNA result (current)
• Early detection roadmap: organ screening → blood tests for many cancers · Organ-specific screening proven (historic)
• Early detection roadmap: organ screening → blood tests for many cancers · cfDNA and methylation science (historic)
• Early detection roadmap: organ screening → blood tests for many cancers · Pivotal trials and first approvals (current)
• Early detection roadmap: organ screening → blood tests for many cancers · Decision and integration (emerging)
• Early detection roadmap: organ screening → blood tests for many cancers · Speculative (speculative)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Surgery arrives, and the cancer is found by accident (historic)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Staging by depth, then by side (historic)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · The incidental cancer pathway: re-resect from T1b, but who, when and how much (current)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · A borrowed chemotherapy standard (historic)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Adjuvant capecitabine and second-line FOLFOX, from UK trials (current)
• Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials · Radiotherapy: one single-arm trial and a nomogram (historic)
• Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch · The cause is named, and cancer epidemiology is invented to name it (historic)
• Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch · Cytotoxic chemotherapy, and the ceiling it hit (historic)
• Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch · EGFR, ALK, and the invention of precision oncology in solid tumours (historic)
• Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch · Low-dose computed tomography earns its place, and chest radiography loses its (historic)
• Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch · Immunotherapy, and the trouble with PD-L1 as a gate (historic)
• Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch · Stage III, and treatment moving to either side of the operation (current)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · One operation, and still the only cure (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · A blood marker with a blind spot and an oncogene in nearly every tumour (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Gemcitabine, and chemotherapy after surgery (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Combination chemotherapy for metastatic disease (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Genomes, subtypes and the inherited five percent (historic)
• Pancreatic cancer roadmap: from Whipple's operation to gemcitabine, FOLFIRINOX, adjuvant chemotherapy, PARP inhibition, KRAS inhibition, vaccines and the surveillance question · Adjuvant modified FOLFIRINOX, and the neoadjuvant question (current)
• Paths to cures: interception, eradication, control · What already prevents cancer (historic)
• Paths to cures: interception, eradication, control · Vaccinating and monitoring people who do not yet have cancer (emerging)
• Paths to cures: interception, eradication, control · Removing every cell, and knowing that you did (current)
• Paths to cures: interception, eradication, control · Killing the last cell, wherever it is hiding (emerging)
• Paths to cures: interception, eradication, control · Living with cancer as a chronic disease (current)
• Paths to cures: interception, eradication, control · Steering resistance instead of waiting for it (emerging)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · A cancer is shown to depend on a hormone, and systemic cancer therapy begins (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · A blood test arrives, and an epidemic of diagnoses follows it (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · Does treating localised disease help? Three trials, three answers, one rule (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · The screening trials disagree, and the policy swings twice (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · Chemotherapy works, a little, and then the receptor drugs arrive (historic)
• Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch · The genome: a quiet sequence, a rearranged structure, and one actionable fifth (historic)
• Radical oncology: what could change the war by 2035 · Ideas already being tested against a control arm (current)
• Radical oncology: what could change the war by 2035 · Living drugs, logic gates, and designed proteins reach decision points (emerging)
• Radical oncology: what could change the war by 2035 · Radiation and radiopharmaceuticals get a second act (emerging)
• Radical oncology: what could change the war by 2035 · Monitoring becomes continuous and selection becomes spatial (emerging)
• Radical oncology: what could change the war by 2035 · Writing to the genome and the epigenome inside a tumour (speculative)
• Radical oncology: what could change the war by 2035 · Treating the soil rather than the seed (speculative)

• Funen faecal occult blood screening trial (phase 3, n=61,933): Colorectal cancer mortality: 0.82 mortality ratio vs 1 mortality ratio
• CALGB 140503 (Alliance) (phase 3, n=697): Disease-free survival at 5 years: 63.6% vs 64.1%, HR 1.01
• NLST & NELSON (low-dose CT screening) (phase 3, n=53,454): NLST: relative reduction in lung cancer mortality: 20%
• MASAI (Mammography Screening with Artificial Intelligence) (phase 3, n=105,934): Cancer detection rate (interim analysis): 6.1 per 1,000 screened vs 5.1 per 1,000 screened
• Minnesota Colon Cancer Control Study (phase 3, n=46,551): Cumulative colorectal cancer mortality at 13 years: 5.88 deaths per 1,000 vs 8.33 deaths per 1,000 vs 8.83 deaths per 1,000
• Mumbai VIA cervical screening trial (Tata Memorial) (phase 3, n=151,538): Cervical cancer mortality (rate ratio): 0.69

1. What single change would most improve outcomes across all cancers, and what evidence supports it?
   Answer

   Prevention and early detection: HPV vaccination has driven cervical cancer toward elimination in vaccinated cohorts, tobacco control and screening (mammography, colonoscopy, low-dose CT) have proven mortality benefits, and early-stage disease is where surgery cures; MCED blood tests aim to extend this but are unproven.
2. What is the Galleri test and where does it stand with the FDA?
   Answer

   GRAIL's methylation-based multi-cancer early detection blood test for more than 50 cancers; PMA submitted January 2026 on PATHFINDER 2 and NHS-Galleri data, FDA advisory committee 23 September 2026. NHS-Galleri missed its primary stage III-IV reduction endpoint (stage IV fell ~14%).
3. What is positive predictive value and why does it matter for a cancer screening blood test?
   Answer

   The chance that a positive result is truly cancer. With a low-prevalence disease even a highly specific test yields many false positives; Galleri's PPV in PATHFINDER 2 was around 40-60%, so roughly half of positives lead to a diagnostic workup that finds no cancer.
4. What is the readout calendar event on 23 September 2026?
   Answer

   The FDA advisory committee (Molecular and Clinical Genetics Panel) reviewing GRAIL's Galleri multi-cancer early detection PMA.

• NCI: Cancer screening: https://www.cancer.gov/about-cancer/screening