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Testing and cancer diagnosis in general practice
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  • Published on: 20 January 2025
    Evidence-based and causal framework to inform cancer testing
    • Arnaud Chiolero, Epidemilogist and Professor of Population Health Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland

    Apparently, the more tests a patient get before the diagnosis of a cancer, the better are the outcomes (1). However, this does not imply that increased testing is the cause of these improved outcomes. More importantly, these findings should not be interpreted as a call for general practitioners to ask for more tests indiscriminately.

    Prediction does not imply causation, and the availability of large observational datasets on tests performed prior to cancer diagnosis is insufficient to confidently determine the effect of the former on the latter. A causal approach is essential (2, 3), both in study design and analysis, to avoid being misled, particularly by confounding factors. The people who are doing more tests differ from the people who are doing less tests, and these differences could be the causes of the better outcomes, acting as confounders. For example, it is reasonable to assume that individuals with higher socioeconomic status are more likely to undergo frequent testing and tend to experience better outcomes in the event of a cancer diagnosis (4). The observed association between increased testing and improved outcomes may, therefore, be explained by the shared influence of socioeconomic status on both testing frequency and cancer outcomes.

    Within an evidence-based and causal framework (3), randomized controlled trials are the standard method for determining whether a test is effective in improving cancer outcomes. An analogy can be drawn with the ev...

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    Conflict of Interest:
    None declared.