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Peter Vedsted

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

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisTidsskriftartikelForskningpeer review

DOI

  • Fiona M Walter, The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK. fmw22@medschl.cam.ac.uk.
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  • Matthew J Thompson, Department of Family Medicine, University of Washington, Seattle, USA.
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  • Ian Wellwood, The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK.
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  • Gary A Abel, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK.
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  • William Hamilton, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, UK.
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  • Margaret Johnson, The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK.
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  • Georgios Lyratzopoulos, Department of Behavioural Science and Health, Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, University College London, London, UK.
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  • Michael P Messenger, National Institute of Health Research (NIHR) Leeds In Vitro Diagnostic Cooperative (IVDC), Leeds Centre for Personalised Medicine and Health, University of Leeds, Leeds, UK.
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  • Richard D Neal, Professor of Primary Care Oncology, Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Leeds, UK.
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  • Greg Rubin, Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK. Electronic address: lindsay.pennington@ncl.ac.uk.
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  • Hardeep Singh, Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA.
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  • Anne Spencer, Health Economics Group, University of Exeter, St Luke's Campus, Exeter, EX1 2LU, Devon, UK.
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  • Stephen Sutton, The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK.
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  • Peter Vedsted
  • Jon D Emery, Centre for Cancer Research and Department of General Practice, University of Melbourne, 10th floor, Victorian Comprehensive Cancer Centre, 305 Grattan St, Melbourne, VIC, 3010, Australia.

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.

OriginalsprogEngelsk
Artikelnummer586
TidsskriftBMC Cancer
Vol/bind19
Nummer1
Antal sider11
ISSN1471-2407
DOI
StatusUdgivet - 2019

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