Quality metrics for cancer screening tests vary considerably across cancer types, according to research published in the Journal of the National Cancer Institute.

Researchers identified multiple guideline-recommended quality metrics for breast cancer and colorectal cancer screening tests but few for cervical cancer and lung cancer screening tests. 

They also found that less than 20% of the recommended metrics are supported by evidence other than expert opinion. 

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In a systematic review, the researchers identified guidelines from screening programs or professional organizations that contained quality metrics for tests used to screen for breast, cervical, colorectal, or lung cancer. 

The team identified 39 guideline articles from 33 organizations, and those articles contained 54 individual test performance quality metrics. Ten of the quality metrics (19%) were supported by evidence other than expert opinion. 

For breast cancer screening, there were 11 guidelines that recommended 20 test performance quality metrics — 15 for accuracy, 3 for safety, and 2 for adequacy. A total of 5 quality metrics were supported by evidence beyond expert opinion in at least 1 guideline.

For cervical cancer screening, none of the guidelines provided evidence to support the recommended quality metrics. There were a total of 5 guidelines recommending 9 test quality metrics — 7 for accuracy and 2 for adequacy. 

For colorectal cancer screening, there were 14 guidelines recommending 18 test quality metrics — 8 for accuracy, 5 for safety, 3 for completeness, and 2 for adequacy. Overall, 5 of the metrics were supported by studies.

For lung cancer screening, none of the guidelines provided evidence to support the recommended test quality metrics. There were 3 guidelines recommending 7 metrics — 3 for adequacy and 4 for safety. 

“Considerably more guideline-recommended test performance metrics exist for breast and colorectal cancer screening than cervical or lung cancer,” the researchers concluded. “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.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Selby K, Sedki M, Levine E, et al. Test performance metrics for breast, cervical, colon and lung cancer screening: A systematic review.J Natl Cancer Inst. Published online February 8, 2023. doi:10.1093/jnci/djad028