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Background Cancer screening trials have required large sample sizes and long time-horizons to demonstrate cancer mortality reductions, the primary goal of cancer screening. We examine assumptions and potential power gains from exploiting information from testing control-arm specimens, which we call the "intended effect" (IE) analysis that we explain in detail herein. The IE analysis is particularly suited to tests that can be conducted on stored specimens in the control arm, such as stored blood for multicancer detection (MCD) tests. Methods We simulated hypothetical MCD screening trials to compare power and sample size for the standard vs IE analysis. Under two assumptions that we detail herein, we projected the IE analysis for 3 existing screening trials (National Lung Screening Trial [NLST], Minnesota Colon Cancer Control Study [MINN-FOBT-A], and Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial—colorectal component [PLCO-CRC]). Results Compared with the standard analysis for the 3 existing trials, the IE design could have reduced cancer-specific mortality P values 6-fold (NLST), 33-fold (MINN-FOBT-A), or 260 000-fold (PLCO-CRC) or, alternately, reduced sample size (90% power) by 25% (NLST), 47% (MINN-FOBT-A), or 63% (PLCO-CRC). For potential MCD trial designs requiring 100 000 subjects per arm to achieve 90% power for multicancer mortality for the standard analysis, the IE analysis achieves 90% power for only 37 500-50 000 per arm, depending on assumptions concerning control-arm test-positives. Conclusions Testing stored specimens in the control arm of screening trials to conduct the IE analysis could substantially increase power to reduce sample size or accelerate trials and could provide particularly strong power gains for MCD tests. [ABSTRACT FROM AUTHOR]

Multicancer detection (MCD) tests use a single, easily obtainable biospecimen, such as blood, to screen for more than one cancer concurrently. MCD tests can potentially be used to improve early cancer detection, including cancers that currently lack effective screening methods. However, these tests have unknown and unquantified benefits and harms. MCD tests differ from conventional cancer screening tests in that the organ responsible for a positive test is unknown, and a broad diagnostic workup may be necessary to confirm the location and type of underlying cancer. Among two prospective studies involving greater than 16,000 individuals, MCD tests identified those who had some cancers without currently recommended screening tests, including pancreas, ovary, liver, uterus, small intestine, oropharyngeal, bone, thyroid, and hematologic malignancies, at early stages. Reported MCD test sensitivities range from 27% to 95% but differ by organ and are lower for early stage cancers, for which treatment toxicity would be lowest and the potential for cure might be highest. False reassurance from a negative MCD result may reduce screening adherence, risking a loss in proven public health benefits from standard‐of‐care screening. Prospective clinical trials are needed to address uncertainties about MCD accuracy to detect different cancers in asymptomatic individuals, whether these tests can detect cancer sufficiently early for effective treatment and mortality reduction, the degree to which these tests may contribute to cancer overdiagnosis and overtreatment, whether MCD tests work equally well across all populations, and the appropriate diagnostic evaluation and follow‐up for patients with a positive test. [ABSTRACT FROM AUTHOR]

Background: Management of indeterminate pulmonary nodules (IPNs) is associated with redistribution of lung cancer to earlier stages, but most subjects with IPNs do not have lung cancer. The burden of IPN management in Medicare recipients was assessed. Methods: Surveillance, Epidemiology, and End Results–Medicare data were analyzed for IPNs, diagnostic procedures, and lung cancer status. IPNs were defined as chest computed tomography (CT) scans with accompanying International Classification of Diseases (ICD) codes of 793.11 (ICD‐9) or R91.1 (ICD‐10). Two cohorts were defined: persons with IPNs during 2014–2017 comprised the IPN cohort, whereas those with chest CT scans without IPNs during 2014–2017 comprised the control cohort. Excess rates of various procedures due to reported IPNs over 2 years of follow‐up (chest CT, positron emission tomography [PET]/PET‐CT, bronchoscopy, needle biopsy, and surgical procedures) were estimated using multivariable Poisson regression models comparing the cohorts adjusted for covariates. Prior data on stage redistribution associated with IPN management were then used to define a metric of excess procedures per late‐stage case avoided. Results: Totals of 19,009 and 60,985 subjects were included in the IPN and control cohorts, respectively; 3.6% and 0.8% had lung cancer during follow‐up. Excess procedures per 100 persons with IPNs over a 2‐year follow‐up were 63, 8.2, 1.4, 1.9, and 0.9 for chest CT, PET/PET‐CT, bronchoscopy, needle biopsy, and surgery, respectively. Corresponding excess procedures per late‐stage case avoided were 48, 6.3, 1.1, 1.5, and 0.7 based on an estimated 1.3 late‐stage cases avoided per 100 IPN cohort subjects. Conclusions: The metric of excess procedures per late‐stage case avoided can be used to measure the benefits‐to‐harms tradeoff of IPN management. A metric was developed to assess the burden of diagnostic follow‐up of indeterminate pulmonary nodules (IPNs). The metric—excess procedures per late‐stage case avoided—can be used to measure the benefits‐to‐harms tradeoff of IPN management. [ABSTRACT FROM AUTHOR]

The article provides an answer to a question concerning undergoing screening for prostate cancer and options available with respect to further diagnostic testing and treatments.

The article discusses the use of magnetic resonance imaging (MRI) in reducing overdiagnosis of prostate cancer in men with elevated prostate-specific antigen (PSA) levels. Initially, there was hesitation in using active surveillance for low-grade disease due to concerns about missing high-grade disease. However, recent studies have shown that MRI can help detect high-grade disease with targeted biopsies, reducing the need for systematic biopsies. The article presents the findings of the Swedish GOTEBORG-2 trial, which showed a lower risk of detecting low-grade disease and a lower proportion of men with higher-grade disease in the MRI-targeted biopsy group compared to the systematic biopsy group. However, the MRI-targeted biopsy approach also led to a delay in diagnosing higher-grade disease in some men. The article concludes that performing MRI in everyone with an elevated PSA level is resource-intensive, but the experimental approach used in the trial minimized the number and extent of biopsies. Overall, the use of MRI in the context of PSA-based screening is evolving, and further research is needed to determine the most effective and cost-efficient strategies. [Extracted from the article]