Providing independent clinical excellence since 2005
Posted on Sunday November 1, 2026 in Diagnostic & Health Screening
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For many years, cardiovascular disease has been the principal focus of preventive medicine. At our cardiovascular clinic, advanced coronary CT imaging, coronary calcium scoring, and detailed lipid assessment including ApoB and lipoprotein(a) allow us to identify coronary atherosclerosis long before it causes symptoms. With appropriate lifestyle interventions and effective lipid-lowering treatment, we can substantially reduce cardiovascular risk.
This progress raises an important question. If we become increasingly successful at preventing cardiovascular disease, what other threats to long-term health should we be addressing? For many patients, particularly those in middle age and beyond, the answer increasingly includes cancer.
Cancer is different from cardiovascular disease. While treatments have advanced enormously, the stage at which cancer is diagnosed remains an important determinant of treatment options and prognosis for many tumour types. A small, localised cancer may be amenable to curative surgery; the same cancer, once it has spread to distant organs, may be considerably more difficult to treat.
But finding cancer earlier does not automatically mean that a screening programme will save lives. A screening test must identify cancers early enough to change their outcome, without causing disproportionate harm through false alarms, unnecessary investigations or treatment of cancers that might never have become clinically significant. Many cancers have no established population screening programme, not simply because we lack imaging technology, but because no strategy has been shown to deliver sufficient benefit when applied to large numbers of asymptomatic people.
One of the most interesting developments in preventive oncology is the emergence of multi-cancer early detection blood tests. The best-known example is Galleri, developed by GRAIL, which analyses patterns of DNA methylation in cell-free DNA circulating in the bloodstream. Rather than searching for one particular tumour, it looks for molecular patterns associated with more than 50 cancer types and can suggest the likely tissue of origin, helping to direct subsequent investigations.
Two important studies published in September 2026 clarify both its potential and its limitations. The PATHFINDER 2 study, published in Nature Medicine, evaluated Galleri in 32,007 adults aged 50 and over without clinical suspicion of cancer. A positive result had a predictive value of 60.3% — roughly six in ten positive results led to a confirmed cancer diagnosis. Specificity was 99.64%, meaning false positives were relatively uncommon. However, overall 12-month sensitivity was 39.3%: a substantial proportion of cancers diagnosed during follow-up had not been identified by the blood test.
The NHS-Galleri trial, published in the New England Journal of Medicine, provides an even more important test of clinical benefit. This randomised trial included approximately 142,000 participants aged 50–77. It did not meet its primary endpoint: there was no statistically significant reduction in combined stage III and IV cancer incidence after three rounds of screening. The incidence rate ratio for stage IV cancer was 0.86, suggesting fewer diagnoses of the most advanced cancers in the screening group, but this secondary result requires cautious interpretation. We do not yet have convincing randomised evidence that earlier detection translates into fewer cancer deaths.
A national healthcare system must establish that benefits justify costs and risks before introducing a test to millions of people — entirely reasonable given the evidence position. But an individual considering a comprehensive private health assessment may approach the question differently. Informed individual preferences have a legitimate place in preventive healthcare, provided uncertainties and potential harms are explained clearly.
We are therefore making Galleri available as an optional investigation, subject to eligibility assessment and pre-test counselling. We do not offer it as a substitute for NHS screening, nor for investigating symptoms. For asymptomatic patients, we explain what the test can and cannot detect, the possibility of false-positive and false-negative results, and the fact that it has not yet been shown to reduce cancer mortality. Offering a test should never be confused with recommending it for everyone.
Galleri represents an important step in the scientific journey toward earlier cancer detection, although the NHS trial reminds us how much remains to be established. We believe the future of preventive healthcare lies in combining proven interventions with carefully evaluated innovation, and giving patients the information they need to make informed choices about both.
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