Front Oncol. 2021 Jun 15;11:688455. doi:
10.3389/fonc.2021.688455. eCollection 2021.


Christine Hathaway 1 , Peter Paetsch 2 , Yali Li 1 , Jincao Wu 1 , Sam Asgarian 1 , Alex Parker 1 , Alley Welsh 1 , Patricia Deverka 3 , Ariella Cohain 1


  • 1 Thrive, An Exact Sciences Company, Cambridge, MA, United
  • 2 Blue Health Intelligence, Chicago, IL, United
  • 3 Deverka Consulting, LLC, Apex, NC, United


Purpose: To 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).

Methods: Patients 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.

Results: Claims 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).

Conclusion: The 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.

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