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. 2023 Apr 11;115(4):375-384.
doi: 10.1093/jnci/djad028.

Test performance metrics for breast, cervical, colon, and lung cancer screening: a systematic review

Kevin Selby  1 , Mai Sedki  2 , Emma Levine  3 , Aruna Kamineni  4 , Beverly B Green  4   5 , Anil Vachani  6 , Jennifer S Haas  7 , Debra P Ritzwoller  8 , Jennifer M Croswell  9 , Kabiru Ohikere  2 , V Paul Doria-Rose  9 , Katharine A Rendle  10 , Jessica Chubak  4 , Jennifer Elston Lafata  11 , John Inadomi  12 , Douglas A Corley  2
Affiliations

Test performance metrics for breast, cervical, colon, and lung cancer screening: a systematic review

Kevin Selby et al. J Natl Cancer Inst. .

Abstract

Background: Multiple quality metrics have been recommended to ensure consistent, high-quality execution of screening tests for breast, cervical, colorectal, and lung cancers. However, minimal data exist evaluating the evidence base supporting these recommendations and the consistency of definitions and concepts included within and between cancer types.

Methods: We performed a systematic review for each cancer type using MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 2010 to April 2020 to identify guidelines from screening programs or professional organizations containing quality metrics for tests used in breast, cervical, colorectal, and lung cancer screening. We abstracted metrics' definitions, target performance levels, and related supporting evidence for test completeness, adequacy (sufficient visualization or collection), accuracy, and safety.

Results: We identified 11 relevant guidelines with 20 suggested quality metrics for breast cancer, 5 guidelines with 9 metrics for cervical cancer, 13 guidelines with 18 metrics for colorectal cancer (CRC), and 3 guidelines with 7 metrics for lung cancer. These included 54 metrics related to adequacy (n = 6), test completeness (n = 3), accuracy (n = 33), and safety (n = 12). Target performance levels were defined for 30 metrics (56%). Ten (19%) were supported by evidence, all from breast and CRC, with no evidence cited to support metrics from cervical and lung cancer screening.

Conclusions: Considerably more guideline-recommended test performance metrics exist for breast and CRC screening than cervical or lung cancer. The domains covered are inconsistent among cancers, and few targets are supported by evidence. Clearer evidence-based domains and targets are needed for test performance metrics.

Registration: PROSPERO 2020 CRD42020179139.

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Conflict of interest statement

Katharine Rendle reports grant funding from Pfizer and AstraZeneca (outside this work) and paid scientific advisory from Merck (outside this work). Debra Ritzwoller reports grant funding from Pfizer, outside of this work, paid to her institution. The other authors have no relevant conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram to identify articles with test performance quality metrics. Titles and abstracts were identified using search strategies for breast, cervical, colorectal, and lung cancer screening. CINAHL = Cumulative Index to Nursing and Allied Health Literature.
Figure 2.
Figure 2.
Objectives of high-quality screening and corresponding test performance quality metrics. Metrics in brackets without specified organ types are not currently suggested in included guidelines. BCa = breast cancer; CCa = cervical cancer; CRC = colorectal cancer; LCa = lung cancer.
See this image and copyright information in PMC

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