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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
Vascular
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
Cancer
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
649,650
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
Endocrine
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
Infection
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
Women
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
Vascular
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
Cancer
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
Elderly
Visual acuity Visual impairment No benefits of screening, even though impaired visual acuity is common and effective treatments are available 165,690

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