The Vanguard Study: Testing a New Way to Screen for Cancer

PRIMARY OBJECTIVES: I. Assess the feasibility of recruitment and adherence to protocol-required baseline and follow-up data and blood collection. II. Assess the feasibility of achieving representative enrollment across participating recruitment sites. SECONDARY OBJECTIVES: I. To assess the impact of participant blinding on willingness to participate, adherence to protocol required baseline and follow-up data, blood collection, and rates of standard of care screening. II. To determine the timeliness of returning test results to participants. III. To understand the factors contributing to lack of diagnostic resolution of an abnormal MCD test. IV. To examine the effects of participant characteristics, including cancer risk factors and social determinants of health, on all aspects of feasibility. V. To estimate the proportion of participants receiving an MCD test outside of the trial. VI. To assess the feasibility of a staggered introduction of the second MCD assay intervention arm. VII. To estimate the proportion of abnormal MCD tests that are diagnostically resolved, and the time to resolution. VIII. To compare the proportion of participants who receive standard of care screening during follow-up between the intervention and control arms. IX. To assess the accuracy of tissue of origin prediction for each MCD assay. X. To estimate the incidence of complications related to diagnostic evaluation of an abnormal MCD test result. XI. To assess the effect of an abnormal MCD test and diagnostic workup on anxiety and cancer worry. XII. To evaluate the clinical diagnostic performance of the MCD assays. EXPLORATORY OBJECTIVES: I. To estimate rates of late-stage cancer, and the distribution of cancer stage. II. To estimate assay-targeted cancer-specific mortality of each MCD assay, all cancer-specific mortality, and all-cause mortality. III. To develop preliminary estimates of the total and incremental budget impact of MCD testing compared to current screening practice from the payor perspective. IV. To develop preliminary estimates of the economic burden and impact of MCD testing from the participant perspective. V. To assess the willingness of participants who reported military service to describe military-related environmental exposures by completing the Military Exposure Questionnaire. OUTLINE: Participants are randomized to 1 of 3 arms. ARM I: Participants undergo blood collection for Shield MCD testing at enrollment and after one year on study. Participants at unblinded sites are provided results of tests and those with abnormal results follow up with their clinician for additional testing. Participants at blinded sites are provided abnormal results and will follow up with their clinician for additional testing. ARM II: Participants undergo blood collection for Avantect MCD testing at enrollment and after one year on study. Participants at unblinded sites are provided results of tests and those with abnormal results follow up with their clinician for additional testing. Participants at blinded sites are provided abnormal results and will follow up with their clinician for additional testing. ARM III (Control): Participants undergo blood collection at enrollment and after one year on study. After completion of study intervention, participants are followed passively up to 10 years.