# Indicators to identify cancer screening providers with suboptimal case detection: A scoping review

## TL;DR

This paper reviews how cancer screening programs measure detection rates and finds that many methods give misleading results, suggesting a need for better tools.

## Contribution

The study identifies inconsistencies in current performance indicators for cancer screening and highlights the need for improved methodologies.

## Key findings

- Many measures used to assess cancer screening performance can provide misleading or uninterpretable estimates.
- No single measure is universally adopted across European cervical and colorectal cancer screening programs.
- Further methodological development is needed to improve the accuracy of performance monitoring in cancer screening.

## Abstract

Several international guidelines consider sensitivity (of test, episode, or programme) and related measures of the detection of prevalent cases of target disease to be among key performance indicators for quality control of routine cancer screening programmes and use them to identify suboptimal providers. We aimed to describe the variability encountered in real‐world settings around the measurement of these quantities in cervical and colorectal cancer screening, where the target for disease detection includes preinvasive disease. We performed a scoping review of grey literature, including international guidelines, annual statistical reports, and other official documents from European cervical and colorectal screening programmes. From the reviewed material, we extracted information on 20 measures used for this purpose. Some measures have been adopted in several programmes, but none have been used in all, not even within the same cancer type. While many of the methods might appear plausible for the intended use, our analysis showed that when applied to routinely collected data they may provide misleading or uninterpretable estimates of the ability of individual providers and the service as a whole to detect prevalent cases. Screening programmes should be cautious in their choice and interpretation of these measures. Further methodological development is required to better support policymakers and quality control managers in prioritising measures that are fit for purpose in routine cancer screening programmes.

What's new?

Quality control of cancer screening programs is essential to maintaining high public health standards. Here, the authors reviewed monitoring of case detection in cervical and colorectal cancer screening programs in Europe, and evaluated its effectiveness. They analysed 20 different measures used for this purpose and showed that many of them provide false or misleading estimates of detection ability. They conclude that further methodological development is needed to improve performance monitoring of cancer screening programs.