America Can’t Afford to Lose the Early Cancer Detection Race to China
Innovative U.S. companies have pioneered the breakthrough technology of multi-cancer early detection (MCED), developing diagnostic tests that can reliably screen for the presence of scores of cancers from a simple blood draw. MCED is poised to revolutionarily transform the world’s cancer screening paradigm—vitally important when one in two women, and one in three men, are likely to develop cancer at some point in their lifetimes—potentially yielding tremendous health and economic benefits for society. Unfortunately, the United States has lagged in crafting a policy environment supporting MCED adoption and encouraging innovation. Meanwhile, nations worldwide are embracing MCED’s potential, led by China, where numerous innovative MCED competitors have emerged, supported by aggressive government policies seeking to stimulate the growth of MCED firms and accelerate the adoption of their diagnostics. As such, U.S. leadership in this vital sector stands at risk, and the United States has experienced too many instances of pioneering new technologies and industries, only to see its leadership frittered away across a range of high-tech sectors, from semiconductors and solar panels to televisions and medical devices. The United States simply can’t afford to squander its lead in MCED by allowing regulatory roadblocks to remain in the way of the industry’s further development. Therefore, policymakers should pay renewed attention to their transformative potential and pass supportive legislation such as the Medicare Multi-Cancer Early Detection Screening Coverage Act.
Unfortunately, the scourge of cancer remains unchecked. It remains one of America’s, and global society’s, greatest health challenges, responsible for being the second-most common cause of death in the United States and cause of one in six deaths globally. A significant part of the challenge remains that cancers are caught too late: indeed, in the United States, about 80 percent of cancers are found only when a patient appears with problematic symptoms, compared to 20 percent detected through screening. One reason cancer-screening-detection rates remain so low is that there are only five types of cancer which have screening options available today: breast, cervical, colorectal, prostate, and “high-risk” lung. The vast majority of other cancers—including blood, head and neck, pancreatic, ovarian, and liver cancers—have had no validated screening options, until now.
Enter multi-cancer early detection technology. MCEDs, leveraging a new slate of biological and informational technologies—including genome sequencing, big data analytics, and artificial intelligence/ machine learning (AI/ML)—hold the potential to screen for signals for as many as 50 or more cancers simultaneously with a very high rate of accuracy and the ability to trace the detected cancer to its likely tissue of origin with a high degree of confidence.
The power of MCED tests to transform individual health, public health, and health economics is truly immense. In particular, that’s because cancers are far more survivable if detected sooner. Overall, cancer patients’ survival rates are 5 to 10 times greater when cancer is detected at an early stage rather than at a late one. In fact, when cancer is diagnosed after it has spread, the five-year cancer-specific survival rate is 21 percent, compared with 89 percent when the cancer is diagnosed early and still localized. MCEDs can enable us to aspire to a world where, in perhaps a decade, 75 percent of cancers could be screen-diagnosed, with roughly half of that each coming from MCED and single-cancer (i.e., colon or breast cancer) screens.
Cancer is the second-most-costly disease in the United States, accounting for an estimated 5 to 11 percent of the total U.S. health care budget each year. Yet, if cancers could be detected earlier, some of these costs could be mitigated, particularly because cancer care costs far more in later than earlier stages of the disease. In fact, overall, treatment of metastatic cancer is twice as costly as non-metastatic care. One study concluded that earlier diagnosis of cancers could generate $26 billion in cost savings annually, equivalent to 17 percent of total estimated yearly expenditures on cancer treatment. In short, early cancer detection could significantly transform the economics of cancer healthcare.
As such, nations around the world are recognizing the tremendous potential of MCED. The United Kingdom’s National Health Service, for instance, has launched an effort to enroll over 140,000 British citizens aged 50 or over into a population-level MCED screening program that may eventually enroll up to 1 million Brits as the country embarks on a mission to diagnose three-quarters of all cancers at an early stage by 2028.
But no government has embraced MCED more than China, whose government views the technology both as a growth industry and the answer to China’s own burgeoning cancer burden (where the country encounters 4.8 million new cancer cases and 2.57 million cancer deaths annually). Indeed, a number of innovative, highly competitive Chinese MCED players have emerged, including BurningRock Dx, SeekIn, Berry Oncology, Singlera Genomics, and GeneSeeq.
China’s MCED competitors have leveraged the country’s strengths in genome sequencing—the country now being the world’s leader in genome sequencing capacity—which has given Chinese companies the ability to become increasingly viable players in the field of precision diagnostics and development of accurate, cost-effective, DNA-related diagnostic tests. Moreover, China’s national biotech strategy affords MCED developers access to low-cost state capital, academic biobanks, and other resources. China has also promised to add several precision drugs and molecular-diagnosis products to its national medical-insurance list, ensuring that companies’ research costs will be recouped if they lead to a product. China is doing so because it understands that committing the government as a procurer of such early detection technologies will help build companies and markets.
China’s push toward MCED leadership fits as a part of China’s overall effort to become a much more significant player in the global biopharmaceutical industry, and in the oncology sector in particular. Indeed, China’s share of global drugs under development has increased from just 1 percent in 2005 to 12 percent in 2020, while its share of all oncology drugs under development spiked from just 2 percent to 18 percent over that timeframe. Meanwhile, China’s share of value added in the global biopharmaceutical industry jumped four-fold from 2002 to 2019, from a meager 5.6 to robust 24 percent.
Those who would dismiss China’s potential to flourish into becoming a significant competitor in the global MCED and broader biopharmaceutical industry might also have once laughed off America’s chances. Indeed, for most of the post-World War II era, the United States was a global also ran in biomedical innovation, with European-headquartered drug companies creating twice as many new-to-the-world drugs as American ones through the 1970s, and less than 10 percent of new drugs being introduced first in the United States well through the late 1980s.
But the United States wrested that leadership from Europe; in fact, over the past 25 years, the share of global biopharmaceutical R&D and new drug development occurring in Europe and the United States totally inverted. This was no accident: it was the result of a set of conscientious, intentional public policies designed to make America the world leader in biopharmaceutical innovation, thanks to policies such as the Hatch-Waxman and Bayh-Dole Acts, the Orphan Drug Tax Credit, and the Prescription Drug User Fee Act (PDUFA), as well as robust public- and private-sector investment in biomedical R&D.
But similarly, the United States has seen far too many cases where leadership in advanced-technology industries have been wrested from it. Consider that China’s solar panel industry, barely extant before 2006, has grown to dominate over 80 percent of global production. In that case, aggressive Chinese subsidization instigated overcapacity and a global glut that saw world prices for solar panels crash by 80 percent from 2008 to 2013, subsequently knocking out over 500 Western solar competitors. Elsewhere, the United States has seen its share of global semiconductor manufacturing decline by 70 percent from 1990 to 2020, a decline so precipitous it triggered the $52 billion CHIPS package. As ITIF has written, the United States has seen this sad playbook unfold far too often, losing leadership in other high-tech sectors such as chemicals, TVs and display, and even medical devices. Once lost, bringing a sector back becomes a difficult and expensive process.
The message for policymakers is clear: U.S. leadership in advanced technology industries is never assured or guaranteed; it requires constant stewardship from policymakers to ensure the country maintains a supportive and enabling policy environment in which private-sector innovation can flourish without relying overwhelmingly on subsidies.
This is crucial with respect to MCED technology for several reasons. First, MCED entails significant national security implications. In particular, advanced cancer screening requires collecting personal genomic data; Chinese dominance in the MCED market could lead to vital patient information falling into the wrong hands or being misused (especially concerning in light of China’s unremitting efforts to hack or otherwise pilfer Americans’ genetic data). Indeed, this was precisely the raison d'être for the House’s recently passed BIOSECURE Act, which would prohibit contracting with certain Chinese biotechnology companies deemed potential national security risks.
Second, if Chinese players were to come to dominate the MCED field, they could dictate pricing, access, and distribution of the next generation of genomic healthcare tools. Highly uncomforting would be a scenario where the United States or its allies and partners came to rely on a foreign adversary for cancer-screening tools, ones which could be restricted in times of geopolitical tension.
Beyond that, loss of U.S. leadership in the sector would sacrifice potentially thousands of high-paying jobs and deprive the United States from benefitting in spillover effects derived from ancillary technologies being developed in the sector.
Accordingly, it’s time for U.S. policymakers to redouble their efforts to ensure a supportive policy environment for the U.S. MCED ecosystem without mimicking China’s subsidy approach. And perhaps the best way they could achieve that would be through alacritous passage of the bipartisan Medicare Multi-Cancer Early Detection Screening Coverage Act. The legislation, which already has 318 sponsors in the House and 63 in the Senate, creates the authority for the Centers for Centers for Medicare & Medicaid Services (CMS) to use an evidence-based process to cover blood-based MCED tests and future test methods once approved by the U.S. Food and Drug Administration (FDA). The legislation, which affirms that multi-cancer detection tests are designed to complement, not replace, existing screening methods, would ensure Medicare beneficiaries are eligible to benefit on a timely basis from MCED screening technologies, once FDA-approved.
The United States cannot afford to relinquish its pioneering leadership in the revolutionary MCED field. Prompt Congressional passage of the Medicare Multi-Cancer Early Detection Screening Coverage Act would go a long way to ensuring that doesn’t happen.
