For decades, we have known a simple truth: finding cancer early saves lives. When cancer is detected at stage 1, survival often exceeds 90%; at stage 4, survival can fall below 20–30%. Yet nearly 70% of U.S. cancer deaths come from cancers with no routine screening test. Nowhere is this gap more deadly than in Kentucky and our neighboring Southeastern states, where cancer rates and cancer deaths rank among the highest in the country.
A breakthrough is finally within reach. A new class of blood-based tests—multicancer early detection (MCED)—can detect molecular cancer signals in a single blood sample, often before symptoms appear. These tests can screen for dozens of cancers simultaneously, including some of the most lethal and hardest to detect.
For Kentucky, this is a historic opportunity.
Cancer is part of daily life for too many families in Kentucky. Late-stage diagnoses remain common, and preventable deaths remain far too frequent.
A major driver is tobacco. Kentucky consistently ranks near the top in cigarette and smokeless tobacco use. Tobacco drives at least 16 cancers, including esophageal, bladder, pancreatic, stomach, kidney, liver, and cervical cancers. In effect, tobacco use has created a multicancer problem in Kentucky, and MCED offers a multicancer solution: the ability to scan the body broadly for tobacco-associated cancers before they spread.
What MCED is—and is not
MCED technology is built on the same cell-free DNA principles used in non-invasive prenatal testing (NIPT), which has been safely used millions of times over the past decade. Some leading MCED platforms can also predict tissue of origin with approximately 93% accuracy when cancer is present, guiding follow-up testing. Others require imaging to determine the source of a signal.
Equally important is what MCED does not do:
- MCED does not replace standard screenings, including mammography, Pap tests, colonoscopy, stool-based genomic testing, prostate screening, or low-dose CT for lung cancer.
- MCED does not detect colon polyps. Those require stool-based testing or colonoscopy to prevent colorectal cancer.
- MCED does not detect every cancer. No screening test can, and MCED performance varies by cancer type, tumor biology, and stage.
- MCED expands early detection to the 70% of cancers for which no screening currently exists—including pancreatic, ovarian, liver, and many head and neck cancers.
- A positive MCED test always requires diagnostic follow-up.False positives are rare (approximately 1 in 200 tests).
- MCED does not detect brain or CNS tumors.
- MCED is intended for people at elevated risk, a risk that increases with age, especially after 50.
- MCED does not replace current cancer screenings—it fills a dangerous gap we have never been able to address.
Access must reach all Kentuckians
If MCED is to make a difference, it must be accessible in primary care, where nearly every Kentuckian begins their prevention journey. Cancer does not discriminate, and early detection should not depend on your ZIP code, your insurance plan, or how close you live to a major medical system.
Ensuring broad, equitable MCED access — from community health centers to independent practices to integrated health systems — is essential to enable these tools to save lives at scale. With coordinated planning among public health, primary care networks, payers, and community partners, Kentucky can ensure MCED access for everyone who needs it.
Even after FDA approval, current law prevents Medicare from covering MCED tests. Without congressional action, millions of older adults—including more than a million Kentuckians—will not have access.
The MCED Screening Coverage Act (H.R. 842 / S. 339) would fix this by allowing Medicare to cover MCED tests once they demonstrate clinical benefit. Nearly 400 lawmakers have cosponsored, making it one of the most widely supported bills in Congress. Because private insurers often follow Medicare policy, this legislation is the key to national access.
Kentucky has already proven that bold cancer prevention policy saves lives—our successes in colorectal and lung cancer screening are national models. MCED represents the next frontier. If we act now, the Southeast can once again lead the nation in early detection.
Cancer will not wait. Neither should we.
Whitney Jones, MD is a Louisville Gastroenterologist and founder of Colon Cancer Prevention Project. He has served as a medical advisor and consultant to GRAIL, LLC, and participates in broader cancer prevention and early-detection initiatives with multiple public and private partners. No organization reviewed or approved this article before publication.
