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Asymptomatic COVID-19 testing pushes forward, with lessons from cancer

As broad COVID-19 screening gains momentum, early cancer detection provides a playbook

The growing demand for asymptomatic COVID-19 testing is shifting the conversation from one-time diagnosis to ongoing screening, and from single results to population outcomes. Companies moving the ball forward for early detection of cancer, some of which have jumped into COVID-19 testing, offer clues to what will be needed for broad uptake.

While diagnostic testing aims to classify disease in sick patients, screening seeks to uncover issues in seemingly healthy individuals. The same test could be used either way or tuned to serve one purpose over the other.

So far, SARS-CoV-2 detection has primarily followed the diagnostics playbook, particularly in the U.S.

But rising case numbers, pressure to open schools and workplaces and the imminent arrival of flu season are increasing calls for tests that can identify presymptomatic or asymptomatic individuals capable of infecting others.

In its July testing plan report, The Rockefeller Foundation argued for a paradigm shift that distinguishes screening tests from diagnostics, saying the former should prioritize testing speed, volume, cost efficiency and frequency over sensitivity, and called on FDA to “re-think” its sensitivity requirements for screening tests “to make sure the perfect is not the enemy of the good.”

Because their target populations are large and healthy, screening tests

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