Today, there are no widely adopted clinical protocols for managing presymptomatic detection in higher-risk communities. Current screening guidelines do not recognize environmental contamination as a risk factor warranting different approaches. Reimbursement frameworks often misclassify presymptomatic cancer detection as "prevention" rather than what it is: diagnostic evaluation of existing disease.

The central research question: If general population presymptomatic cancer prevalence is 1-2%, what is the prevalence in communities near Superfund sites and cancer clusters? Is it 5%? 8%? 12%? This question determines appropriate screening protocols, informs clinical guideline development, and establishes whether payers should recognize testing as diagnostic evaluation rather than preventive screening.

Diagnostic companies deploying technologies and generating real-world prevalence data.

Clinical researchers developing screening protocols informed by documented prevalence in at-risk populations.

Professional societies with the authority to translate evidence into guideline recommendations that recognize environmental risk.

Payers establishing reimbursement frameworks that appropriately classify presymptomatic detection.

Policymakers creating the regulatory infrastructure this emerging healthcare ecosystem requires.

NMQF does not build clinical protocols, guidelines, or reimbursement frameworks directly. We convene the experts who can, provide them with the evidentiary foundation through CSSI, and ensure the needs of environmentally compromised communities drive the collaborative agenda.

CSSI enrolls 4,000 participants across 20 sites nationwide in environmentally compromised communities, generating:

Population-level prevalence data comparing baseline rates to at-risk communities.

Stage distribution analysis documenting disease burden.

Validation studies for emerging detection technologies.

Coverage-policy evidence supporting reimbursement decisions.

The CSSI biobank becomes the shared resource around which Working Group members collaborate. Diagnostic companies deploy technologies. Clinical researchers analyze outcomes. Professional societies evaluate evidence for guideline development. Payers assess data for coverage decisions. Policymakers understand the populations that current frameworks fail to serve.

CSSI's flagship national cancer study is currently enrolling participants, with initial enrollment underway in Houston Fifth Ward, Texas and Flint, Michigan.