June 11, 2026 | A single laboratory-developed blood test, years in the making at The University of Texas MD Anderson Cancer Center, could soon be a clinical reality for determining the risk of nine different cancers. In collaboration with UT MD Anderson, Quest Diagnostics is developing and validating the test based on a handful of circulating protein biomarkers associated with high risk for one or more of the cancers, including colorectal, lung, breast, pancreatic, ovarian, liver, prostate, esophageal, and stomach.
The simple and affordable multiplex test could join cholesterol screenings as a routine part of annual primary care wellness exams, including for individuals too young to qualify for available cancer screening tests, according to Samir Hanash, M.D., Ph.D., professor of clinical cancer prevention at UT MD Anderson, whose lab developed the foundational multi-cancer stratification risk model. Blinded validation of the biomarker panel started with risk assessment for lung cancer in a multitude of cohorts.
One of the top concerns currently is the rising incidence of early-onset colorectal cancer, in part because those affected aren’t being screened, he says. When the cancer is first detected, it’s often at an advanced stage when it is not particularly responsive to treatment, making it a leading cause of cancer-related death in younger adults.
A positive cancer blood test, based on genetic predisposition or the protein biomarker panel being developed by Quest, might prompt follow-up with a colonoscopy procedure irrespective of age, says Hanash. Additional information from medical and family history, as well as environmental factors and exposures, could help inform the risk assessment.
The same scenario would apply to people identified as being at risk for breast or lung cancer who might instead get a mammogram or low-dose CT scan. But most young people are ineligible for covered screening because the risk to that population is low, he continues.
Beyond risk assessment, several multi-cancer early detection blood tests are now on the market, but they primarily detect circulating cancer DNA, which is comparatively expensive, not intended to personalize risk, and may lack well-established protocols for clinical follow-up. They have also primarily been validated in older populations, as the multiplex test being developed by Quest initially will be. The long-term goal is reportedly to validate and refine the test’s utility across broader age demographics.
A test to detect cancer appropriate for people in their 30s at the population level would need to have “incredible specificity” to avoid over-diagnosing cancer in that age group, says Hanash. “The problem is when you put the threshold at such a high specificity, like 99.9%, then almost by definition the test is unlikely to be sensitive enough to pick up the cancer at an early stage.”
A tremendous amount of effort and funding has been invested in trying to reduce death due to cancer, and the cornerstone is an understanding of who is at risk and the risk factors, he says. It creates a basis for intervening to reduce the incidence of cancer with, for example, a vaccine “hopefully in the foreseeable future.”
“If you cannot prevent it, the next [best] thing is to detect it early” and, if this is not possible, better treatments are needed, says Hanash. Work is needed at every stage of this cancer continuum, not a singular focus on treatments with “wonder drug” status.
Hanash will be presenting on the topic of risk assessment as a foundation for cancer screening and interception at the upcoming Next Generation Dx Summit in Washington, D.C. The reality is that cancer-related diagnostics, despite all the hype, are on a trajectory not unlike progress in aviation that started with Charles Lindbergh’s slow-speed transatlantic flight and decades later spanned to high-speed, supersonic jets, he says.
The growing incidence of young onset cancers, the colorectal variety among them, comes with many overlapping concerns, says Hanash. Not the least of these is what is driving the medical phenomenon.
Since the genetics of the U.S. population haven’t changed over the past decade or two, the focus has been largely on early-life exposures and lifestyle shifts, he says. A related and rapidly evolving line of research is whether cancer in the younger age group has the same molecular underpinnings as late-onset cancer, even for the same tumor type.
The Hanash lab is interested in a blood test identifying who is at risk for cancer whether they’re in their 20s or well past retirement, he notes. One benefit is that people flagged as being at risk for one cancer or another could start getting screened for that cancer at an earlier age. Another is that they could address lifestyle factors contributing to their risk, such as obesity or dietary habits.
Soon, a third option will be a vaccine to keep the cancer in check. Vaccines in trials are mostly designed to intercept or prevent recurrence by teaching the immune system to hunt and destroy precancerous and microscopic cancer cells. But a preventive colon cancer vaccine for high-risk individuals is in early-stage clinical development.
The value of a blood test designed to identify individuals at risk for cancer, versus one intended to detect cancer, is that the specificity need not be as “fantastically high,” points out Hanash. That reduced specificity makes it a much more sensitive test, so that more people are targeted for preventive steps and early-detection screenings.
In terms of performance, any test applied at the population level should be beneficial, including on a cost basis, he says. The goal, in this respect, is cost effectiveness from a public health perspective—for example, a test that identifies people at an early stage of cancer when treating it is less expensive, in addition to reducing the death toll.
Determining the mortality benefit of a test targeting cancer in a young age group takes hundreds of millions of dollars and many years of follow-up, say Hanash, noting that such studies have been done (e.g., the benefits of low-dose CT screening for individuals with a smoking history in the National Lung Cancer Screening Trial). The mortality benefit of his lab’s multi-cancer stratification risk model was demonstrated for lung cancer in older individuals several years ago by leveraging data from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial conducted between 1993 and 2001 by the National Cancer Institute (Journal of Clinical Oncology, DOI: 10.1200/JCO.22.02424).
The study revealed a big difference between the lung cancer mortality of individuals whose samples showed a positive signal from the four-protein risk panel for lung cancer versus those who tested negative. “The interpretation of this is had they been tested at the time the blood was collected, and been identified to be at risk, then they would have been screened for lung cancer ... before their lung cancer became so advanced that they died of it,” Hanash shares.
Proteomic blood testing transitioned from primarily lung cancer to a multi-cancer model around June 2025, when Quest Diagnostics announced the collaboration to develop the multi-cancer stratification test. A series of other cancer-specific studies are expected to start publishing soon.
UT MD Anderson serves nearly 200,000 patients each year and well over 1,000 of the cases being diagnosed and treated are early onset cancers, with breast, colorectal, and lung cancers topping that list, Hanash reports.
In addition to seeing patients, Hanash has spent much of the past 15 years working on the development of a blood test that can determine a person’s risk for lung cancer. “Right now, screening for lung cancer is limited to smokers ... who have smoked for 20 pack years or longer,” he says. But unlike in China and some European countries, in the United States the smoking rate is at an all-time low, meaning a huge proportion of lung cancers are being diagnosed in people who either never smoked or are light smokers who don’t meet the eligibility criteria for screening with low-dose CT.
The long search for molecules detectable in blood and indicative of cancer risk turned up a small number of proteins that are collectively very good at determining an individual’s risk for lung cancer, including people ineligible for screening, says Hanash. Most recently, he and his colleagues also uncovered an association between microplastics and death due to lung cancer, again using samples from the PLCO Cancer Screening Trial (Clinical Cancer Research, DOI: 10.1158/1078-0432.CCR-25-3846).
It remains puzzling why people exposed to the same chemical might go on to develop a different type of cancer, Hanash says. But his “genetics 101” suspicion is that the underlying phenotype is determined by the genes predisposing someone to a certain cancer (e.g., lung, breast, or colon) times their exposure to some kind of carcinogen.
Blood relatives of cancer patients also deserve more attention than they’re currently receiving, which concerns Hanash and his colleagues. Family members rightfully wonder if they should be worried about their own health and cancer risk, he says.
In the case of hereditary cancer mutations, it makes sense for them to seek genetic testing to learn if they have susceptibility. There might also be addressable lifestyle factors or some common exposures that resulted in their relative’s cancer diagnosis that warrants investigation.
On the diagnostic front, Hanash says, progress is apt to happen in somewhat of a circular fashion. That’s because it can take a decade or more to learn if the tests being developed today are going to reduce cancer deaths. By then, there’s likely to be a more effective test on the market. The good news is that, while testing benefits can’t be demonstrated overnight, there is “some sort of constant improvement.”