Warwick researchers help shape new national guidance for cancer screening
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 programme 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, who is funded by the National Institute for Health and Care Research (NIHR) 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
Randomised 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 programmes 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 programmes.
Where a randomised trial demonstrates a significant reduction in late-stage disease, and where mortality differs meaningfully by stage, this may support early planning, modelling, 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 programme 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 organised programme. 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 emphasises that evidence requirements will differ depending on the intended use case, whether population-wide screening, targeting high-risk groups, or alongside existing programmes for breast, bowel and cervical cancer. This intended use must be clearly specified from the outset as scaling back or withdrawing an established screening programme 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 modelling. 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.
ENDS
The two statements are published today in the BMJ:
- Surrogate outcomes - https://doi.org/10.1136/bmj-2026-089868
- MCD tests - https://doi.org/10.1136/bmj-2026-629407
Notes to Editors
For more information please contact:
Matt Higgs, PhD | Media & Communications Officer (University of Warwick Press Office)
Email: Matt.Higgs@warwick.ac.uk | Phone: +44(0)7880 175403
Background
The UK NSC makes recommendations to ministers and the NHS on population screening programmes. Its decisions are based on a rigorous assessment of evidence, and new programmes are only recommended where clear evidence shows screening does more good than harm at a reasonable cost. As new technologies, particularly MCD tests, move closer to potential clinical use, these position statements aim to ensure evaluation frameworks keep pace, supporting innovation while maintaining the standards of evidence needed to protect patients.
About the University of Warwick
Founded in 1965, the University of Warwick is a world-leading institution known for its commitment to era-defining innovation across research and education. A connected ecosystem of staff, students and alumni, the University fosters transformative learning, interdisciplinary collaboration and bold industry partnerships across state-of-the-art facilities in the UK and global satellite hubs. Here, spirited thinkers push boundaries, experiment and challenge convention to create a better world.
About the UK NSC
The UK National Screening Committee (UK NSC) advises ministers and the NHS in the 4 UK countries about all aspects of screening and supports implementation of screening programmes. UK NSC is part of the Department of Health and Social Care, the Welsh Government, The Scottish Government, and the Department of Health (Northern Ireland).
About the National Institute for Health and Care Research
The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research.
We do this by:
- funding high quality, timely research that benefits the NHS, public health and social care
- investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services
- partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research
- attracting, training and supporting the best researchers to tackle complex health and social care challenges
- collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system
- funding applied global health research and training to meet the needs of the poorest people in low- and middle-income countries
NIHR is funded by the Department of Health and Social Care.
Our work in low- and middle-income countries is principally funded through UK international development funding from the UK government.