title: Prospects for developing an accurate diagnostic biomarker panel for low prevalence cancers.
abstract: BACKGROUND
  Early detection screening of asymptomatic populations for low prevalence cancers requires a highly specific test in order to limit the cost and anxiety produced by falsely positive identifications. Most solid cancers are a heterogeneous collection of diseases as they develop from various combinations of genetic lesions and epigenetic modifications. Therefore, it is unlikely that a single test will discriminate all cases of any particular cancer type. We propose a novel, intuitive biomarker panel design that accommodates disease heterogeneity by allowing for diverse biomarker selection that increases diagnostic accuracy.
  
  
  METHODS
  Using characteristics of nine pancreatic ductal adenocarcinoma (PDAC) biomarkers measured in human sera, we modeled the behavior of biomarker panels consisting of a sum of indicator variables representing a subset of biomarkers within a larger biomarker data set. We then chose a cutoff for the sum to force specificity to be high and delineated the number of biomarkers required for adequate sensitivity of PDAC in our panel design.
  
  
  RESULTS
  The model shows that a panel consisting of 40 non-correlated biomarkers characterized individually by 32% sensitivity at 95% specificity would require any 7 biomarkers to be above their respective thresholds and would result in a panel specificity and sensitivity of 99% each.
  
  
  CONCLUSIONS
  A highly accurate blood-based diagnostic panel can be developed from a reasonable number of individual serum biomarkers that are relatively weak classifiers when used singly. A panel constructed as described is advantageous in that a high level of specificity can be forced, accomplishing a prerequisite for screening asymptomatic populations for low-prevalence cancers.
authors.affiliation: Department of Surgery, University of Utah School of Medicine and the Huntsman Cancer Institute, Salt Lake City, UT, USA. matt.firpo@hsc.utah.edu.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Firpo
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Boucher
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Mulvihill
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000097:blood / Q000378:metabolism*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D016022:Case-Control Studies; D006801:Humans; D008954:Models, Biological; D010190:Pancreatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor
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