Evaluating diagnostic strategies for early detection of cancer: the CanTest Framework
Walter, F; Thompson, MJ; Wellwood, I; et al.Abel, G; Hamilton, W; Johnson, M; Lyratzopoulos, G; Messenger, M; Neal, R; Greg, R; Hardeep, S; Spencer, AE; Sutton, S; Vedsted, P; Emery, J
Date: 14 June 2019
Article
Journal
BMC Cancer
Publisher
BioMed Central
Publisher DOI
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 ...
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.
Institute of Health Research
Collections of Former Colleges
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