Weighing the new tools against the evidence

The edition in brief

In the NHS-Galleri trial, 142,250 people aged 50–77 in England were randomised to a multicancer early-detection blood test or usual care. The test did not reduce the primary endpoint of stage III or IV cancer across 12 cancer types (incidence rate ratio 1.03, 95% CI 0.92–1.14); a secondary signal for stage IV disease (0.86, 0.74–1.00) was borderline. It does not yet replace standard screening. MATTERHORN, a phase 3 trial in 948 patients with resectable gastric or gastro-oesophageal junction adenocarcinoma, found perioperative durvalumab added to FLOT chemotherapy improved overall survival (hazard ratio 0.78, 95% CI 0.63–0.96), a new standard option. A target-trial-emulation study of 666,283 UK hip replacements found robotic surgery gave no better five-year implant survival or revision risk than conventional surgery (revision hazard ratio 0.96), with only a lower rate of malposition-related revision (0.53) at substantially higher cost — an observational comparison. A clinic pearl: treat the older patient's medication review as a chance to deprescribe, since benefit and harm shift with age and renal function. Finally, the STAREE trial randomised 9,971 community-dwelling adults aged 70 or older, without cardiovascular disease, diabetes or dementia, to atorvastatin 40 mg or placebo: cardiovascular events fell (hazard ratio 0.70, 95% CI 0.61–0.82) but disability-free survival — freedom from death, dementia or persistent disability — did not improve (0.94, 0.84–1.05) over a median 5.9 years. Statins still prevent events in healthy older adults, but the hoped-for gain in independent, disability-free life did not materialise.