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The Vanguard Study is exploring the use of blood tests called multi-cancer detection MCD tests to screen for multiple cancers at once in adults aged 45 to 75 without cancer. The study aims to understand how these tests perform as cancer screening tools and how patients and doctors respond to test results. It also seeks to assess the feasibility of recruiting participants and collecting necessary data for a future larger trial. Participants are randomly assigned to one of three groups two groups receive different MCD tests Shield or Avantect with blood samples collected at enrollment and after one year, while a control group undergoes blood collection without MCD testing. Some sites provide test results to participants, and those with abnormal results are advised to follow up with their clinicians. After the one-year intervention period, all participants are monitored passively for up to 10 years. Throughout the study, participants complete questionnaires and provide blood samples as scheduled. Researchers collect medical record information and track follow-up adherence, test result return times, and diagnostic outcomes for abnormal results. The study measures feasibility outcomes, cancer detection accuracy, participant anxiety, and other effects related to the screening process. Participant follow-up and data collection may continue for up to 10 years after the intervention period ends.