On 17 June 2026, Cancer Research UK convened a session for health system leaders and policymakers to raise awareness of the UK National Screening Committee’s (UK NSC) newly published position statement on surrogate outcomes in cancer screening trials.
The event was chaired by Professor Sir Mike Richards (Former National Cancer Director and Care Quality Commission (CQC) Chair, NHS England), and the speakers were Professor Anne Mackie (Director of Screening, UK NSC), Dr Sarah Batson (Assistant Professor, University of Warwick), Dr Tasmin Sommerfiled (Scottish Director of Screening, Screening Oversight and Assurance Scotland) and Dr Lisa Douet (National Institute for Health and Care Research Scientific Advisor).
The event report summaries the key discussion points, themes and next steps from the session.
Rapid scientific advancements are spurring the development of new technologies that have the potential to optimise or create new cancer screening programmes. There’s a real appetite across the cancer community to accelerate the adoption of these new technologies. However, a major barrier is the many years it takes to generate the evidence required to determine if a new or optimised screening tool or pathway is fit for purpose and reduces cancer-specific mortality.
That’s why there’s a growing interest in surrogate outcomes. They seek to indicate effectiveness before mortality outcomes become available, thereby enabling more rapid assessments of screening interventions. However, the use of surrogate outcomes in screening is a highly debated topic.
In May 2026, the UK NSC published a position statement on surrogate outcomes in cancer screening trials, which may change how new screening programmes are assessed, recommended, and implemented. Cancer Research UK’s event in June set out to explore the implications of the position statement for future screening policies and evaluation practices.
A central theme of the session was the need to balance a desire to accelerate the adoption of promising screening interventions with the robust evidence required to demonstrate those interventions are beneficial. While cancer-specific mortality remains the gold-standard outcome for evaluating screening programmes, surrogate outcomes such as stage at diagnosis, tumour characteristics and biomarkers may provide earlier indications of effectiveness. However, current evidence is insufficient for surrogate outcomes to replace mortality in determining the overall benefit of new screening programmes.
Discussions highlighted that the relationship between the most promising surrogate outcome to date (a reduction in late-stage diagnosis) and mortality varies by cancer type. This challenge is particularly relevant for emerging technologies such as multi-cancer detection (MCD) tests.
Speakers explored how health systems can make evidence-based decisions on proposed screening intervention in the face of uncertainty. Discussions highlighted a growing need for adaptive systems and reversible implementation. In-service evaluations (ISEs) are a key approach that enable evidence generation in real-world settings while retaining the flexibility to modify or withdraw programmes as evidence evolves.
Speakers and delegates also identified opportunities to strengthen the planning and implementation of screening programmes. These included improving data infrastructure and access, strengthening coordination across relevant stakeholders supporting horizon scanning to inform Ministerial planning, maintaining public trust through clear communication, and building readiness for future screening innovations.
The event helped to crystalise and communicate key messages from the UK NSC position statement:
Surrogate outcomes cannot yet replace mortality as the primary outcome in trials of new cancer screening programmes.
Stage-based measures are currently the most practical surrogates in screening but are limited. A reduction in late-stage disease is an encouraging metric but may not translate into lower mortality across all cancers.
Surrogate outcomes can inform the evaluation of new screening programmes as part of the standard multicriteria considerations assessments that are conducted.
If a randomised controlled trial shows a significant reduction in late-stage disease, and mortality meaningfully differs by stage, this may be sufficient to initiate supporting research and start building implementation infrastructure while awaiting longer term mortality data.
Methodological advances, together with adaptive and reversible implementation strategies, may enable earlier evidence informed decision making while ensuring that screening delivers net benefit.
Presentations and discussion teased out some of the potential implications of the UK NSC position statement and next steps for screening policy and practice.
Cancer-specific mortality remains the most appropriate outcomes for screening evaluations.
We should strengthen and expand the use of ISEs in screening policy. ISEs enable us to generate evidence on proposed changes to screening programmes in a real-world setting, when there is uncertainty about the potential harms and benefits.
Health systems should adopt more agile and adaptive evaluation approaches to keep pace with rapidly evolving technologies such as AI and MCD tests.
Investment is needed in integrated, system-wide data platforms that capture the full screening pathway and support both service delivery and research.
Further alignment is needed between the UK NSC, NHS, NIHR, policymakers, third sector and researchers in areas such as horizon scanning, research prioritisation, and data sharing.
Policymakers across all UK nations should be supported with a clear view of upcoming screening innovations and their resource implications.
It’s essential to maintain public trust when changing screening pathways. Stronger use of behavioural science and communication strategies is needed to clearly convey the benefits and harms of screening and manage expectations, especially when programmes are modified or withdrawn.
Read the event report for a full summary of the talks, key themes from the discussion and next steps.
Read the report in full