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Evaluating diagnostic strategies for early detection of cancer : The CanTest framework
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
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
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.
Keywords
cancer, diagnostic strategies, early detection, diagnosis, conceptual framework, primary care
Date
2019
Type
Journal article
Journal
BMC Cancer
Book
Volume
19
Issue
1
Page Range
1-11
Article Number
Article 586
ACU Department
School of Allied Health
Faculty of Health Sciences
Faculty of Health Sciences
Collections
Relation URI
Source URL
Event URL
Open Access Status
Published as ‘gold’ (paid) open access
License
CC BY 4.0
File Access
Open