With multi-cancer early detection (MCED) tests gaining increasing media attention and interest from patients, providers, insurers, and reinsurers alike, numerous questions have arisen surrounding these diagnostic tests. This article aims to address many of the frequently asked questions surrounding these relatively new studies and the associated implications for various stakeholders involved.

What is a Multi-cancer Early Detection Test?

MCED screens for signs of cancer in the blood. These tests can survey evidence of multiple cancers in a single specimen. The goal is to identify cancer at an earlier stage than would occur without such a screen.

How Does MCED Work?

As a cancer grows, it stimulates a response from the host immune system. This response generates proteins that circulate in the blood. Some of these proteins indicate cancer. Cancer cells may release their own proteins directly into the blood.

Cancer cells also release DNA that differs from normal tissue. The DNA contains chemical modifications called methylation and sequence mutations.

Using artificial intelligence, analysis of the proteins and/or the DNA identifies a pattern associated with the presence of cancer and sometimes the site of origin.

Why Consider Use of MCED?

A cancer begins as a single cell which grows abnormally. It can take years or even decades before the cancer becomes apparent. Earlier detection improves outcomes.

A life insurance company might consider offering an MCED test to improve projected mortality on their inforce block and/or to provide a value-added service to their customers.

What MCEDs Are Available in the U.S.?

Only Grail’s Galleri and Exact Sciences’ Cancerguard are commercially available at present. Others are projected to come to market over the next few years. These include, but are not necessarily limited to, MCaST from Quest Diagnostics and Enlighten from Proteotype Diagnostics.

What Does MCED Cost?

Grail’s Galleri and Exact Sciences’ Cancerguard have list prices of $949 and $689, respectively. Like most healthcare services, though, prices vary among purchasers, and many providers are offering Galleri for $749 (which is the price we use for the cost-benefit analysis below).

Is it a Good Idea to Offer MCED?

A decision on implementation of any test requires assessment of the balance of benefits against the costs and risks. This is true whether it is a personal decision about cancer screening, or a corporate decision about a potential service to policyholders.

We can use Galleri’s published evidence as an example to assess the potential effectiveness of the test and illustrate the decision process.

Of note, as part of the follow‑up study PATHFINDER 2, Grail presented a PPV of 61.6% at the European Society for Medical Oncology (ESMO) Congress in October 2025. For the purposes of our analyses here, we have used the data from the PATHFINDER study published in the Lancet in October 2023.

What Are the Benefits?

The mortality benefit remains uncertain until additional follow‑up is available. The maximum benefit would be to assume early mortality for the 35 cancers that Galleri found in a population of 6,621 people. This overstates the mortality benefit for several reasons:

• More than half of the cancers were Stage 3‑4. For those cases, the test would not have accelerated diagnosis by very much.
• Early stage at diagnosis does not always result in cure.
• Some cancers would not have progressed (clinically insignificant cancer or overdiagnosis).
• The insured population has lower prevalence of cancer compared to PATHFINDER, because of the increased risk characteristics. That means fewer cancers discovered on tests in the insured population.
• Testing below age 50 would further lower the prevalence.

Importantly, a life insurance carrier might derive ancillary benefits, such as increased customer satisfaction for the opportunity to screen for cancer, potentially resulting in improved persistency.

What Are the Costs?

PATHFINDER demonstrates that the number of tests to detect one cancer in this population is 189. At the price of $749 each, the cost of the tests alone would be $141,561. To detect one early-stage cancer requires 473 tests, which totals $357,277. A program will have additional financial costs for administration.

Beyond financial considerations, there are other costs associated with screening. Some of these items include:

• Positive results lead to a clinical workup to determine if cancer can be confirmed.
  Most people had blood tests and imaging after a positive test. Among the false positives, 28% had non-surgical procedures and 2% had surgery. This adds up to considerable expense and some risk of morbidity or even mortality. Out-of-pocket cost could be substantial for the customer.
• Another cost is the emotional cost for customers.
  False positive results required a median of 162 days to reach a conclusion. The time stretched to nearly a year for some participants. That is a long time to suffer with anxiety. Anxiety does not even end with the workup, because some “false” positive results could be cancers that did not manifest within the one-year limit of the study.

What Else Might a Life Insurance Carrier Consider?

Face Amounts and Ages – The most financial benefit comes from larger policies and older issue ages where cancer prevalence is higher.

Excluding Customers – We have seen some companies express concerns over providing valueadded benefits only to certain groups of customers. There is a reputational risk with this decision that any insurance company should consider.

Re‑Test Decision – Each company will need to decide whether to offer the test again to customers in the future. Offering a re‑test too soon would reduce the number of cancers detected and may not make sense from a cost/benefit perspective. However, customers may come to expect or request additional testing in future years from their insurance company.

What Does the Future Hold For MCED Tests?

This is an exciting and rapidly evolving time for MCED test development and innovation. New tests, with performance trials that can be evaluated in a similar fashion as PATHFINDER, will likely become commercially available soon. Further observation will surely narrow the potential uncertainty regarding benefit, and future tests will undoubtedly improve and become more effective.

As additional information and data become available on Galleri (e.g., a published article on PATHFINDER 2 results), Cancerguard, and potential new entrants into the MCED testing space, the above analyses will be updated. Please reach out to a Gen Re representative for more information regarding MCED tests, or to start a discussion with one of our experts.

Endnote

1. Lancet. 2023 Oct. 7;402(10409):1251–1260. doi: 10.1016/S0140-6736(23)01700-2