Your browser has 'Cookies' disabled, alert boxes will continue to appear without this feature.

Access myCPD through the new myRACGP Dashboard

Clinical guidelines

Guidelines for preventive activities in general practice 8th edition

15. Screening tests of unproven benefit

The following are not recommended as screening tests in low-risk general practice populations. These tests may have value as diagnostic tests or as tests to monitor disease progression.

Table 15.1 Screening tests not recommended in low-risk general practice populations
Screening testConditionReason not to useReferences for further reading
Genetic profiling Genetic disorders Limited evidence on the balance of benefits and harms, ethical issues and uncertain utility 632,633
Cardiac CT CHD No RCT evidence. RCTs of therapy show no effect on coronary artery progression. May be of benefit in those at intermediate risk of CHD 634-636
Serum homocysteine CHD Value as a risk factor for CHD is uncertain and published RCTs show no evidence of benefit by lowering levels 636-638
Exercise ECG CHD Low yield and high false positive rate given low prevalence in asymptomatic population 636,639
High sensitivity C-reactive protein (CRP) CVD Some evidence of benefit (i.e. reduction in CRP linked with reduction in major CVD events in one study, but not currently recommended as a screening test for CVD) 636,639-643
Ankle:brachial index (ABI) Peripheral vascular disease Longitudinal studies showing increased risk of clinical CVD if low ABI, but there is variable reliability and low sensitivity of assessment and no published RCT evidence showing benefit of screening 640,644,645
MRI Breast cancer Ongoing surveillance strategies for women at high risk of breast cancer may include imaging with MRI. A Medicare rebate is available for MRI scans for asymptomatic women under 50 years at high risk of breast cancer 506,507,646-648
CA125/transvaginal ultrasound Ovarian cancer There is no evidence to support the use of any test – including pelvic examination, CA125, or other biomarkers, ultrasound (including transvaginal ultrasound), or combination of tests – for routine population-based screening for ovarian cancer.
CA125 is limited by poor sensitivity in early-stage disease and low specificity. The specificity of transvaginal ultrasound is low. The low prevalence of ovarian cancer means that even screening tests that have very high sensitivity and specificity have a low positive predictive value for disease detection
Virtual colonoscopy/ CT colonography CRC Good sensitivity for lesions larger than 10 mm, but no evidence of reduction of CRC incidence or mortality. Not currently recommended 523,651-655
Whole body CT or MRI Cancer Whole body imaging has not been shown to improve quality of life and/or decrease mortality. It is associated with additional radiation exposure and a high number of false positive results. There are no RCTs of whole body imaging to detect cancer or CVD 656-661
Lung disease
Spirometry Chronic obstructive pulmonary disease (COPD) Assessment is unreliable and screening for COPD using spirometry has no net benefit. 662-665
Thyroid function tests Thyroid dysfunction Despite the relatively high incidence of subclinical hypothyroidism in older women (up to 17%), there is a lack of convincing data from controlled trials that early treatment reduces lipid levels, symptoms or the risk for CVD in patients with mild thyroid dysfunction detected by screening. 666-669
Chronic disease prevention
Vitamin D Vitamin D deficiency High prevalence, variability in assessment and lack of rigorous evidence of benefit of screening 670-674
MSU culture Asymptomatic bacteriuria (elderly) Identifying and treating non-pregnant adults with asymptomatic bacteriuria does not improve outcomes and may increase antibiotic resistance 675
Table 15.2 Screening tests of indeterminate value
Screening testConditionReason not to useReferences
Vitamin D Pregnancy Moderate prevalence and associated morbidity, but no RCT evidence of benefit. There is debate about what is an adequate level of vitamin D. High-risk groups for vitamin D deficiency may benefit from screening and supplementation. 676-679
Ultrasound Abdominal aneurysm USPSTF recommend screening, but low yield as declining incidence and ethical issues of screening only one subgroup (male smokers), and cost-effectiveness not clear 680-682
B-type natriuretic peptide (BNP) Congestive cardiac failure The evidence for screening for heart failure using BNP is mixed despite its sensitivity and prognostic significance. It may be useful in excluding the condition in suspected heart failure 683-686
Chest CT Lung cancer Good sensitivity but poor specificity; one RCT underway in smokers has preliminary results showing a 20% reduction in mortality in the CT arm. Low-dose CT screening may benefit individuals at an increased risk for lung cancer, but uncertainty exists about the potential harms of screening and the generalisability of results. Approximately 20% of individuals in each round of screening had positive results requiring some degree of follow-up, while approximately 1% had lung cancer. 687-689
Positron emission tomography – computed tomography (or PET CT scan) Lung cancer Good sensitivity and specificity, but no RCT results 688
Visual acuity Visual impairment No benefits of screening, even though impaired visual acuity is common and effective treatments are available 165,690


  1. Smeeth L, Iliffe S. Community screening for visual impairment in the elderly. Update of Cochrane Database Syst Rev 2000 (2). Cochrane Database Syst Rev 2006;3:CD001054
  2. National Breast and Ovarian Cancer Centre. Early detection of breast cancer – NBOCC Position statement. Sydney: NBOCC, 2009 [accessed 2012 May]. Available at position-statements/early-detection-of-breast-cancer
  3. National Breast and Ovarian Cancer Centre. Advice about familial aspects of breast and epithelial ovarian cancer: a guide for health professionals. Sydney: NBOCC, 2010 [accessed 2012 May]. Available at bog-advice-about-familial-aspects-of-breast-cancer-and-epithelial-ovarian-cancer
  4. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J. Evaluating test strategies for colorectal cancer screening – age to begin, age to stop, and timing of screening intervals: a decision analysis of colorectal cancer screening for the US Preventive Services Task Force from the Cancer Intervention and Surveillance Modeling Network (CISNET). Rockville, MD: Agency for Healthcare Research and Quality, 2009
  5. Udesky L. The ethics of direct-to-consumer genetic testing. Lancet 2010;376(9750):1377–8
  6. Evaluation of Genomic Applications in Practice and Prevention (EGAPP) Working Group. Recommendations from the EGAPP Working Group: genomic profiling to assess cardiovascular risk to improve cardiovascular health. Genet Med 2010;12(12):839–43
  7. Taylor AJ. CCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. J Am Coll Cardiol 2010;56(22):1864–94
  8. McEvoy JW, Blaha MJ, DeFilippis AP. Coronary artery calcium progression: an important clinical measurement? A review of published reports. J Am Coll Cardiol 2010;56(20):1613–22
  9. US Preventive Services Task Force. Using nontraditional risk factors in coronary heart disease risk assessment: US Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151(7):474–82
  10. Loland KH, Bleie Ø, Blix AJ, Strand E. Effect of homocysteine-lowering B vitamin treatment on angiographic progression of coronary artery disease: a Western Norway B Vitamin Intervention Trial (WENBIT) substudy. Am J Cardiol 2010;105(11):1577–84
  11. Potter K, Lenzo N, Eikelboom JW. Effect of long-term homocysteine reduction with B vitamins on arterial wall inflammation assessed by fluorodeoxyglucose positron emission tomography: a randomised double-blind, placebo-controlled trial. Cerebrovasc Dis 2009;27(3):259–65
  12. Lim LS, Haq N, Mahmood S. Atherosclerotic cardiovascular disease screening in adults: American College Of Preventive Medicine position statement on preventive practice. Am J Prev Med 2011;40(3):381.e1–10
  13. Helfand M, Buckley DI, Freeman M, Fu R. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the US Preventive Services Task Force. Ann Intern Med 2009;151(7):496–507
  14. Genest J, McPherson R, Frohlich J. Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and 2 prevention of cardiovascular disease in the adult – 2009 recommendations. Can J Cardiol 2009;25(10):567–79
  15. Buckley DI, Fu R, Freeman F, Rogers K. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the US Preventive Services Task Force. Ann Intern Med 2009;151(7):483–95
  16. Kones R. The Jupiter study, CRP screening, and aggressive statin therapy – implications for the primary prevention of cardiovascular disease. Ther Adv Cardiovasc Dis 2009;3(4):309–15
  17. Grondal N, Søgaard R, Henneberg EW. The Viborg Vascular (VIVA) screening trial of 65–74 year old men in the central region of Denmark: study protocol. Trials 2010;11:67
  18. Fowkes FG, Jamrozik K. Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA 2008;300(2):197–208
  19. National Breast Cancer Centre. Magnetic resonance imaging for the early detection of breast cancer in women at high risk: a systematic review of the evidence. Sydney: NBCC, 2006 [accessed 2012 May]. Available at
  20. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2009;151(10):716–26, W–236
  21. Australian Department of Health and Ageing MBS Online – Medicare Benefits Schedule.  [accessed 2012 June]. Available at
  22. Schorge JO, Modesitt SC, Coleman RL, Cohn DE, Kauff ND, Duska LR, et al. SGO White Paper on ovarian cancer: etiology, screening and surveillance. Gynecol Oncol 2010;119(1):7–17
  23. National Breast and Ovarian Cancer Centre. Population screening and early detection of ovarian cancer in asymptomatic women – NBOCC Position statement. NBOCC, 2009 Available at [accessed 2012 May].
  24. Philip AK, Lubner MG, Harms B. Computed tomographic colonography. Surg Clin North Am 2011;91(1):127–39
  25. Weizman AV, Nguyen GC. Colon cancer screening in 2010: an up-date. Minerva Gastroenterol Dietol 2010;56(2):181–8
  26. Pox CP, Schmiegel W. Role of CT colonography in colorectal cancer screening: risks and benefits. Gut 2010;59(5):692–700
  27. Laghi A, Lafrate F, Rengo M. Colorectal cancer screening: the role of CT colonography. World J Gastroenterol 2010;16(32):3987–94
  28. Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med 2009;361(12):1179–87
  29. Weltermann B, Hermann M, Gesenhues S. Diagnostic screening for cancer and coronary heart disease with radiological and nuclear imaging techniques: early diagnosis at any price? Dtsch Med Wochenschr 2010;135(16):813–8
  30. Canadian Health Services Research Foundation. Myth: whole-body screening is an effective way to detect hidden cancers. J Health Serv Res Policy 2010;15(2):118–9
  31. Ladd SC. Whole-body MRI as a screening tool? Eur J Radiol 2009;70(3):452–62
  32. Fayngersh V, Passero M. Estimating radiation risk from computed tomography scanning. Lung 2009;187(3):143–48
  33. Schoder H, Gonen M. Screening for cancer with PET and PET/CT: potential and limitations. J Nucl Med 2007;48 (Suppl 1):S4–18
  34. Anderiesz C, Elwood JM, McAvoy BR. Whole-body computed tomography screening: looking for trouble? Med J Aust 2004;181(6):295–6
  35. O’Reilly J, Rudolf M. What’s nice about the new NICE guideline? Thorax 2011;66(2):93–6
  36. COPD guidelines committee. The COPD-X Plan: Australian and New Zealand Guidelines for the management of chronic obstructive pulmonary disease. Canberra: Australian Lung Foundation and the Thoracic Society of Australia and New Zealand, 2011
  37. US Preventive Services Task Force. Screening for chronic obstructive pulmonary disease using spirometry: recommendation statement. Am Fam Physician 2009;80(8):853
  38. O’Donnell DE, Hernandez P, Kaplan A. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2008 update – highlights for primary care. Can Respir J 2008;15(Suppl A):A1–8
  39. Gopinath B, Wang JJ, Kifley A. Five-year incidence and progression of thyroid dysfunction in an older population. Intern Med J 2010;40(9):642–9
  40. Ochs N, Auer R, Bauer DC. Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med 2008;148(11):832–45
  41. Empson M, Flood V, Ma G. Prevalence of thyroid disease in an older Australian population. Intern Med J 2007;37(7):448–55
  42. Helfand M. Screening for subclinical thyroid dysfunction in nonpregnant adults: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2004;140(2):128–41
  43. Bjelakovic G, Gluud LL, Nikolova D, Whitfield K, Wetterslev J, Simonetti RG, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2011;7:CD007470
  44. Chung M, Balk EM, Ip S, Lee J, Terasawa T, Raman G, et al. Systematic review to support the development of nutrient reference intake values: challenges and solutions. Am J Clin Nutr 2010;92(2):273–6
  45. Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada (summary). CMAJ 2010;182(12):1315–9
  46. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(7):1911–30
  47. Wang L, Manson JE, Song Y, Sesso HD. Systematic review: Vitamin D and calcium supplementation in prevention of cardiovascular events. Ann Intern Med 2010;152(5):315–23
  48. Lin K, Fajardo K. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2008;149(1):W20–4
  49. Ebeling PR. Routine screening for vitamin D deficiency in early pregnancy: past its due date? Med J Aust 2011;194(7):332–3
  50. Dror DK, Allen LH. Vitamin D inadequacy in pregnancy: biology, outcomes, and interventions. Nutr Rev 2010;68(8):465–77
  51. Lichtenstein AH. Nutrient supplements and cardiovascular disease: a heartbreaking story. J Lipid Res 2009;50 (Suppl):S429–33
  52. Holmes VA, Barnes MS. Vitamin D deficiency and insufficiency in pregnant women: a longitudinal study. Br J Nutr 2009;102(6):876–81
  53. Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: a comprehensive review. Exp Clin Cardiol 2011;16(1):11–15
  54. Ferket BS, Grootenboer N, Colkesen EB, Visser JJ, van Sambeek MR, Spronk S, et al. Systematic review of guidelines on abdominal aortic aneurysm screening. J Vasc Surg 2012;55(5)1296–304
  55. US Preventive Services Task Force. Screening for abdominal aortic aneurysm: recommendation statement. Ann Intern Med 2005;142(3):198–202
  56. Felker GM, Hasselblad V, Hernandez AF, O’Connor CM. Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials. Am Heart J 2009;158(3):422–30
  57. Krum H, Jelinek MV, Stewart S, Sindone A, Atherton JJ. 2011 update to National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006. Med J Aust 2011;194(8):405–9
  58. National Institute for Clinical Excellence. Chronic heart failure. National clinical guideline for diagnosis and management in primary and secondary care. London: NICE, 2010
  59. Porapakkham P, Zimmet H, Billah B, Krum H. B-type natriuretic peptide-guided heart failure therapy: a meta-analysis. Arch Intern Med 2010;170(6):507–14
  60. Mulshine JL, van Klaveren RJ. Lung cancer screening: what is the benefit and what do we do about it? Lung Cancer 2011;71(3):247–8
  61. Baldwin DR. Imaging in lung cancer: recent advances in PET-CT and screening. Thorax 2011;66(4):275–7
  62. Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012:307(22):2418-29
  63. Chou R, Dana T, Bougatsos C. Screening older adults for impaired visual acuity: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2009;151(1):44–58
Advertisement loading...


The Royal Australian College of General Practitioners

General enquiries

Opening hours 8:00 am-8:00 pm AEST

1800 4RACGP

1800 472 247 | +61 (3) 8699 0300 (international)

Follow us on

Follow RACGP on Twitter Follow RACGP on Facebook Follow RACGP on LinkedIn

Healthy Profession. Healthy Australia Logo

The Royal Australian College of General Practitioners (RACGP) ABN 34 000 223 807
RACGP House, 100 Wellington Parade, East Melbourne, Victoria 3002 Australia

Terms and conditions | Privacy statement
Sponsor conditions | Delegate conditions