Wilson’s criteria for an ideal screening test, applied to cardiac surveillance for chemotherapy
| Criteria24 | Surveillance echocardiography for chemotherapy |
|---|---|
| The condition should be an important health problem | Cardiotoxicity is an important health problem but is detectable by screening only in a minority of patients |
| The natural history of the condition should be understood | The natural history of cardiotoxicity has been reasonably well studied for established chemotherapy agents such as anti-HER2 |
| There should be a recognizable latent or early symptomatic stage | Left ventricular dysfunction typically relates to acute toxicity and becomes manifest within the first year of exposure. Early recognition is important, because cumulative doses typically compound toxicity |
| A test should exist that is easy to perform and interpret, and is acceptable, accurate, reliable, sensitive, and specific | Imaging with echocardiography has these qualities but also involves considerable challenges and limitations |
| An accepted treatment for the disease should exist | Current guideline-directed heart failure management is recognized as treatment for chemotherapy-related cardiomyopathy. Evidence is limited for specific treatments beyond these guidelines, although the subject is under active investigation |
| Treatment should be more effective if started early | If started early, current guideline-directed heart failure management is considered to be more effective. Early recognition of chemotherapy-related cardiomyopathy is important for preventing additional dose exposures, which typically compound toxicity |
| There should be a policy on who should be treated | Current guideline-directed heart failure management covers who should be treated |
| Diagnosis and treatment should be cost-effective | Limited data suggest favorable cost-effectiveness for screening and early treatment, although a more targeted approach can likely significantly improve it |
| Case-finding should be a continuous process | Case-finding can be a continuous process |