Quantifying Overdiagnosis for Multicancer Detection Tests: A Novel Method

Multicancer detection (MCD) tests use blood specimens to detect preclinical cancers. A major concern is overdiagnosis, the detection of preclinical cancer on screening that would not have developed into symptomatic cancer in the absence of screening. Because overdiagnosis can lead to unnecessary and harmful treatments, its quantification is important. A key metric is the screen overdiagnosis fraction (SOF), the probability of overdiagnosis at screen detection. Estimating SOF is notoriously difficult because overdiagnosis is not observed. This estimation is more challenging with MCD tests because short-term results are needed as the technology is rapidly changing. To estimate average SOF for a program of yearly MCD tests, I introduce a novel method that requires at least two yearly MCD tests given to persons having a wide range of ages and applies only to cancers for which there is no conventional screening. The method assumes an exponential distribution for the sojourn time in an operational screen-detectable preclinical cancer (OPC) state, defined as once screen-detectable (positive screen and work-up), always screen-detectable. Because this assumption appears in only one term in the SOF formula, the results are robust to violations of the assumption. An SOF plot graphs average SOF versus mean sojourn time. With lung cancer screening data and synthetic data, SOF plots distinguished small from moderate levels of SOF. With its unique set of assumptions, the SOF plot would complement other modeling approaches for estimating SOF once sufficient short-term observational data on MCD tests become available.