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ObjectiveNew screening tests for colorectal cancer (CRC) are rapidly emerging. Conducting trials with mortality reduction as the end point supporting their adoption is challenging. We re-examined the principles underlying evaluation of new non-invasive tests in view of technological developments and identification of new biomarkers.DesignA formal consensus approach involving a multidisciplinary expert panel revised eight previously established principles.ResultsTwelve newly stated principles emerged. Effectiveness of a new test can be evaluated by comparison with a proven comparator non-invasive test. The faecal immunochemical test is now considered the appropriate comparator, while colonoscopy remains the diagnostic standard. For a new test to be able to meet differing screening goals and regulatory requirements, flexibility to adjust its positivity threshold is desirable. A rigorous and efficient four-phased approach is proposed, commencing with small studies assessing the test’s ability to discriminate between CRC and non-cancer states (phase I), followed by prospective estimation of accuracy across the continuum of neoplastic lesions in neoplasia-enriched populations (phase II). If these show promise, a provisional test positivity threshold is set before evaluation in typical screening populations. Phase IIIprospective studies determine single round intention-to-screen programme outcomes and confirm the test positivity threshold. Phase IVstudies involve evaluation over repeated screening rounds with monitoring for missed lesions. Phases III and IV findings will provide the real-world data required to model test impact on CRC mortality and incidence.ConclusionNew non-invasive tests can be efficiently evaluated by a rigorous phased comparative approach, generating data from unbiased populations that inform predictions of their health impact.

A panel of experts reached consensus on recommendations on when to assess oncologic outcomes per patient, per session, and per tumor; definitions of starting and ending times; definitions of survival time; and time-to-event end points.

Colorectal cancer screening programmes worldwide have been disrupted during the COVID-19 pandemic. We aimed to estimate the impact of hypothetical disruptions to organised faecal immunochemical test-based colorectal cancer screening programmes on short-term and long-term colorectal cancer incidence and mortality in three countries using microsimulation modelling.

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Vaccination against human papillomavirus (HPV) types 16/18 is being implemented in many countries. There may be indirect benefit of HPV vaccination to nonvaccinated women, who may experience a reduced risk of infection with vaccine-preventable types (herd immunity). We attempt to disentangle the direct and indirect effects of HPV vaccination, while accounting for 14 oncogenic HPV types in a dynamic modeling framework.

When building a Bayesian belief network, usually a large number of probabilities have to be assessed by experts in the domain of application. Experience shows that experts are often reluctant to assess all probabilities required, feeling that they are unable to give assessments with a high level of accuracy. We argue that the elicitation of probabilities from experts can be supported to a large extent by iteratively performing sensitivity analyses of the belief network in the making, starting with rough, initial assessments. Since it gives insight into which probabilities require a high level of accuracy and which do not, performing a sensitivity analysis allows for focusing further elicitation efforts. We propose an elicitation procedure in which, alternately, sensitivity analyses are performed and probability assessments refined, until satisfactory behaviour of the belief network is obtained, until the costs of further elicitation outweigh the benefits of higher accuracy or until higher accuracy can no longer be attained due to lack of knowledge.