Multicancer Early Detection: A Fellow’s Perspective With Waqas Haque, MD, MPH
Expert Perspectives · Keira Smith · 2025-07-29
Advancements in medical technology are transforming cancer screening, with multicancer early detection (MCED) testing leading the way. Dr. Waqas Haque, a Hematology/Oncology Fellow at the University of Chicago, recently shared his perspectives on i3 Health’s CME activity, Optimizing Cancer Screening with MCED Technologies: From Science to Practical Application. With MCED testing moving from research to real-world practice, Dr. Haque discussed the science, challenges, and future of these innovative tests, as well as the importance of staying up to date on emerging advances with continuing education.
This interview is also available as a podcast. Listen here!
Click the links below for the full CME activity!
And view the slide decks here for Module 1, Module 2, and Module 3.
What Is Multicancer Early Detection?
MCED refers to a new class of tests designed to screen for multiple types of cancer simultaneously, often through a single blood draw. “The point of these tests is really to detect cancer at its earliest stage, even before symptoms appear, by identifying things such as circulating tumor DNA or methylation patterns,” Dr. Haque explained. The goal is to improve treatment outcomes and reduce cancer mortality by catching malignancies earlier than ever before.
The Need for MCED
Despite progress in cancer screening, most cancers still lack effective early detection methods. “Between 70% and 80% of patients who develop cancer actually die from cancers that don’t have a standard screening test,” Dr. Haque noted, highlighting the need for broader approaches. He emphasized that MCED could be transformative, especially for hard-to-detect cancers like pancreatic and ovarian, and that the simplicity of a blood draw could make screening more accessible.
Key Statistical Concepts
Implementing MCED requires understanding several statistical principles. Dr. Haque pointed out, “One thing that people should really think about is the concept of number needed to screen (NNS). In theory, this would actually be lower for multicancer detection because you’re screening for all kinds of cancers.” He also stressed the importance of positive predictive value (PPV), sensitivity, and specificity, noting, “If you’re screening for multiple cancers, PPV should also be higher with MCED, but you have to look at the false positive rate as well.” These concepts are crucial for clinicians to interpret test results and counsel patients appropriately.
Challenges and Limitations
While MCED holds promise, it also presents challenges. Dr. Haque posed, “What if you get multiple reads for a possible suspected cancer? Which one could it actually be? Do you have to do testing for all of those to rule all of them out?” He also discussed the risk of detecting indolent cancers that may never become clinically significant, and the anxiety that can result from ambiguous or false positive results. “In the PATHFINDER study, there was a median of 79 days from a positive MCED test result to time of resolution. You can imagine that induces a lot of anxiety,” he said. Implementation hurdles, such as insurance coverage and follow-up logistics, remain to be addressed.
Evaluating Long-Term Impact
Ultimately, the value of MCED will be measured by its ability to save lives. “The long-term purpose of screening tests is to save lives, but it can take a long time to actually figure that out the outcome,” Dr. Haque explained. He highlighted the concept of “stage shift”—finding cancers at earlier, more treatable stages—and cautioned about lead time bias, where earlier detection does not always translate to longer survival.
Implementation Considerations for Clinicians
Dr. Haque emphasized the importance of user experience and patient selection. “What people often do not focus on is user experience: Are we having a streamlined path? If someone has a positive test, does the doctor know how to explain that to the patient?” He also stressed targeting higher-risk patients to maximize the benefit of MCED.
The Importance of Ongoing Education
As MCED technologies evolve, staying informed is essential. “Just by taking a few extra hours or even a few extra minutes to learn about this technology, you’ll be able to be better informed about the statistics and some of the logistics that go into these tests, and you’ll be able to discuss it better with your patients in the clinic,” Dr. Haque advised.
Key Takeaways
- MCED tests can detect multiple cancers early, often with a single blood draw.
- Understanding statistical concepts like NNS, PPV, sensitivity, and specificity is crucial for interpreting results.
- Challenges include ambiguous results, overdiagnosis, patient anxiety, and implementation logistics.
- User experience and careful patient selection are key to successful adoption.
- Ongoing education will help clinicians stay current as MCED technologies and guidelines evolve.
About Dr. Haque
Waqas Haque, MD, MPH, is a Hematology/Oncology Fellow at the University of Chicago. He recently completed his Internal Medicine Residency at New York University (NYU) in a Clinical Investigator Track. Dr. Haque has balanced his patient care work with a variety of research projects. During his fellowship training at the University of Chicago, he plans to further his work in innovative clinical trial design, value-based care delivery to cancer patients, and clinical investigation.