After experiments show that a new imaging technology can work, it's also important to confirm that its use in practice lives up to its promise. This effort is underway through the Division of Cancer Control and Population Sciences' Applied Research Program (ARP).
"We use physician surveys to understand attitudes about new technologies, but we also need to collect data in the course of delivering care to understand whether the new test is performing as it did in the efficacy studies…studies that are, after all, performed with staffing and coordination that may not be present in practice," Dr. Stephen Taplin, senior scientist in ARP, explains.
Dr. Taplin oversees the Breast Cancer Surveillance Consortium, a research network focused on understanding how current breast cancer screening methods operate in practice - how breast density, for example, affects cancer detection and whether new training software can improve radiologists' performance and make mammogram interpretation more accurate.
Mammography is a mature technology, notes Dr. Taplin. "We've had decades to evaluate its strengths and the consequences of its deficiencies." But as new technologies debut at a faster pace, the time to anticipate challenges and ask questions - and the resources available to address them - shrink. One solution for mammography evaluation was a resource-sharing partnership between federal and nonprofit agencies like the American Cancer Society.
Dr. Carrie Klabunde, an epidemiologist in ARP's Health Services and Economics Branch, manages a portfolio of research projects aimed at understanding the uptake of colorectal cancer screening in community practice. She is leading an effort to begin monitoring the use of virtual colonoscopy in the United States.
Virtual colonoscopy is a new technology to screen for colorectal cancer that uses external imaging devices to examine the lining of the colon. "There is still a need for high-quality data on ways of efficiently delivering virtual colonoscopy in practice, and on the procedure's outcomes," she notes.
One issue, for example, is suspicious findings that are inadvertently detected outside of the colon. "These findings could be anything from a tumor on a kidney to something that's completely benign, a lump of fat or normal variation on an organ," explained Dr. Klabunde. "There will be questions about who is responsible for finding out what that lump or bump may be, and who will pay for it. That will be one challenge ahead."
"There is a tremendous need for objective parties to look at issues such as these, because there are so many competing interests involved and because the analysis requires scientific rigor," said Dr. Taplin. "It's important for us to fund investigators who can look carefully and make sure that the technology is achieving the ends that we expect."
To build national capacity for monitoring the performance of colorectal cancer screening modalities, Dr. Klabunde and collaborators at the Agency for Healthcare Research and Quality have sponsored studies to develop and evaluate data systems for tracking colorectal cancer screening performance. A recent supplement to the journal Medical Care describes this research and can be ordered at http://healthservices.cancer.gov/publications/improv_deliv.html.