LargE SCALe eArly deTectIon Of caNcer (ESCALATION)

Early detection and interception of cancer can reduce morbidity, mortality, loss of quality of life, and high health care cost. Blood circulating tumor DNA (ctDNA)-based multi-cancer early detection (MCED) tests have shown promising results in selected series. What this means for the Dutch situation, including the acceptance by screenees, the attitude of healthcare professionals towards MCED tests, early Health Technology Assessment (HTA) and comparison to established cancer screening programs is unclear. A blood-bank sample collection, processing logistics and donor population at screening age provide an excellent experimental setting to explore the merits of multi-cancer ctDNA-based screening in the Netherlands, and a potential path towards implementation in the future. Moreover, combined quantifiable genetic (polygenic) risk scores (PRS) and environmental (exposome) risk scores (ERS) can increase the predictive value of cancer screening tests.

The ESCALATION partners aim to collect blood from ~125,000 blood-bank donors >50 years of age. By linking to the national cancer registry, we expect to identify n=1,500 cases (i.e. diagnosis of cancer < 1 year). In a nested case-control study of n=6000, matched 1:3, we will measure ctDNA, PRS and ERS.


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