PurposeTo evaluate mammography uptake and subsequent breast cancer diagnoses, as well as the prospect of additive cancer detection via a liquid biopsy multi-cancer early detection (MCED) screening test during a routine preventive care exam (PCE).MethodsPatients with incident breast cancer were identified from five years of longitudinal Blue Health Intelligence® (BHI®) claims data (2014-19) and their screening mammogram and PCE utilization were characterized. Ordinal logistic regression analyses were performed to identify the association of a biennial screening mammogram with stage at diagnosis. Additional screening opportunities for breast cancer during a PCE within two years before diagnosis were identified, and the method extrapolated to all cancers, including those without recommended screening modalities.ResultsClaims for biennial screening mammograms and the time from screening to diagnosis were found to be predictors of breast cancer stage at diagnosis. When compared to women who received a screening mammogram proximal to their breast cancer diagnosis (0-4 months), women who were adherent to guidelines but had a longer time window from their screening mammogram to diagnosis (4-24 months) had a 87% increased odds of a later-stage (stages III or IV) breast cancer diagnosis (p-value <0.001), while women with no biennial screening mammogram had a 155% increased odds of a later-stage breast cancer diagnosis (p-value <0.001). This highlights the importance of screening in the earlier detection of breast cancer. Of incident breast cancer cases, 23% had no evidence of a screening mammogram in the two years before diagnosis. However, 49% of these women had a PCE within that time. Thus, an additional 11% of breast cancer cases could have been screened if a MCED test had been available during a PCE. Additionally, MCED tests have the potential to target up to 58% of the top 5 cancers that are the leading causes of cancer death currently without a USPSTF recommended screening modality (prostate, pancreatic, liver, lymphoma, and ovarian cancer).ConclusionThe study used claims data to demonstrate the association of cancer screening with cancer stage at diagnosis and demonstrates the unmet potential for a MCED screening test which could be ordered during a PCE.

e22516 Background: Cancer is the second leading cause of death in the United States. Survival varies by cancer type, but treatment of earlier stage cancer is consistently associated with improved survival relative to treatment of later stage cancers, highlighting that earlier detection is critical to improving patient outcomes. While most current cancer screening modalities require dedicated clinic visits, a multi-cancer liquid biopsy (i.e. a blood test) could enable screening for multiple cancers during routine physical exams. Methods: Five years of longitudinal data for 750,000 individuals from the Blue Health Intelligence national database were used to identify mammography utilization and breast cancer diagnoses. We identified incident cases and used univariate ordinal logistic regression to evaluate the association of breast cancer screening with earlier stage at diagnosis. We then identified all other incident cancers and characterized physical exam utilization in the two years prior to diagnosis. Results: Absence of claims for biennial screening mammograms as well as longer times from screening to diagnosis were associated with more advanced stage at breast cancer diagnosis. Women who were not screened (N = 400) had 155% increased odds of a later-stage (stage III or IV) breast cancer diagnosis when compared with women who were screened via mammography (N = 1,365) ( p < 0.001). Elapsed time from the most recent screening mammogram to breast cancer diagnosis was also significantly associated with cancer stage. Women with a longer time lapse ( > 4 months) between their most recent screening mammogram and diagnosis (N = 356) had 87% increased odds of a later-stage breast cancer diagnosis (p < 0.001). This is consistent with guidelines emphasizing the importance of screening to detect early-stage cancers. Among all incident breast cancer cases, 23% (N = 400) had no evidence of a screening mammogram in the two years before diagnosis. However, 49% (N = 196) of these women did have a routine physical examination during that same period. On this basis, we estimate that an additional 11% of breast cancer cases could have been screened for if a liquid biopsy test was utilized during those physical exams. Extending this analysis to include all incident cancer cases, 60% (N = 5,022) of the cohort had a routine physical exam in the two years prior to their cancer diagnosis. Conclusions: Our analyses confirm the association of cancer screening with earlier stage at diagnosis for breast cancer. Further, this research suggests opportunities to screen for and potentially intercept 60% of all incident cancer cases by incorporating a multi-cancer blood-based test into routine care. Given the importance of improving early cancer detection rates, additional clinical work extending the initial conclusions presented here is warranted.