Evaluating diagnostic strategies for early detection of cancer : The CanTest framework

Journal article


Walter, Fiona M., Thompson, Matthew J., Wellwood, Ian, Abel, Gary A., Hamilton, William, Johnson, Margaret, Lyratzopoulos, Georgios, Messenger, Michael P., Neal, Richard D., Rubin, Greg, Singh, Hardeep, Spencer, Anne, Sutton, Stephen, Vedsted, Peter and Emery, Jon D.. (2019). Evaluating diagnostic strategies for early detection of cancer : The CanTest framework. BMC Cancer. 19(1), p. Article 586. https://doi.org/10.1186/s12885-019-5746-6
AuthorsWalter, Fiona M., Thompson, Matthew J., Wellwood, Ian, Abel, Gary A., Hamilton, William, Johnson, Margaret, Lyratzopoulos, Georgios, Messenger, Michael P., Neal, Richard D., Rubin, Greg, Singh, Hardeep, Spencer, Anne, Sutton, Stephen, Vedsted, Peter and Emery, Jon D.
Abstract

Background
Novel diagnostic triage and testing strategies to support early detection of cancer could improve clinical outcomes. Most apparently promising diagnostic tests ultimately fail because of inadequate performance in real-world, low prevalence populations such as primary care or general community populations. They should therefore be systematically evaluated before implementation to determine whether they lead to earlier detection, are cost-effective, and improve patient safety and quality of care, while minimising over-investigation and over-diagnosis.

Methods
We performed a systematic scoping review of frameworks for the evaluation of tests and diagnostic approaches.

Results
We identified 16 frameworks: none addressed the entire continuum from test development to impact on diagnosis and patient outcomes in the intended population, nor the way in which tests may be used for triage purposes as part of a wider diagnostic strategy. Informed by these findings, we developed a new framework, the ‘CanTest Framework’, which proposes five iterative research phases forming a clear translational pathway from new test development to health system implementation and evaluation.

Conclusion
This framework is suitable for testing in low prevalence populations, where tests are often applied for triage testing and incorporated into a wider diagnostic strategy. It has relevance for a wide range of stakeholders including patients, policymakers, purchasers, healthcare providers and industry.

Keywordscancer; diagnostic strategies; early detection; diagnosis; conceptual framework; primary care
Year2019
JournalBMC Cancer
Journal citation19 (1), p. Article 586
PublisherBiomed Central Ltd
ISSN1471-2407
Digital Object Identifier (DOI)https://doi.org/10.1186/s12885-019-5746-6
PubMed ID31200676
Scopus EID2-s2.0-85067307432
PubMed Central IDPMC6570853
Open accessPublished as ‘gold’ (paid) open access
Page range1-11
FunderCancer Research UK
National Institute for Health Research (NIHR)
National Health and Medical Research Council (NHMRC)
Department of Veterans Affairs, United States of America
Agency for Health Care Research and Quality
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online14 Jun 2019
Publication process dates
Accepted23 May 2019
Deposited05 Dec 2022
Grant IDC8640/A23385
C18081/A18180
CIN 13–413
R01HS022087
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