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This is a large, well-designed negative trial. In more than 142,000 adults aged 50 to 77 in England, adding three annual rounds of the Galleri multicancer blood test to usual care did not reduce stage III/IV diagnoses across 12 prespecified cancers. There's an intriguing but non-significant trend toward fewer stage IV cancers, so longer follow-up is the real story to watch, and safety wasn't an issue (fewer than 1% had trial-related adverse events, none serious). For now this doesn't support routine MCED screening outside a trial, so have that conversation ready when patients ask about ordering it.