Red Book

Screening tests of unproven benefit

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

Table 15.1

Table 15.1

Screening tests not recommended in low-risk general practice populations

Table 15.2

Table 15.2

Screening tests of indeterminate value

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  2. Burton A. Are we ready for direct-to-consumer genetic testing? Lancet Neurol 2015;14(2):138–39.
  3. Botkin JR, Belmont JW, Berg JS, et al. Points to consider: Ethical, legal, and psychosocial implications of genetic testing in children and adolescents. Am J Hum Genet 2015;97(1):6–21.
  4. Scott J, Trotter T. Primary care and genetics and genomics. Pediatrics 2013;132(Suppl 3):S231–37.
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  6. Human Genetics Society of Australasia. The Human Genetics Society of Australasia top 5 low-value practices and interventions. Sydney: Royal Australasian College of Physicians, 2016 published-lists/human-genetics-society-of-australasia [Accessed 26 May 2016].
  7. Zeb I, Abbas N, Nasir K, Budoff MJ. Coronary computed tomography as a cost-effective test strategy for coronary artery disease assessment – A systematic review. Atherosclerosis 2014;234(2):426–35. [Accessed 26 May 2016].
  8. Earls JP, Woodard PK, Abbara S, et al. ACR appropriateness criteria asymptomatic patient at risk for coronary artery disease. J Am Coll Radiol 2014;11(1):12–19. [Accessed 26 May 2016].
  9. Rubin GD. Emerging and evolving roles for CT in screening for coronary heart disease. J Am Coll Radiol 2013;10(12):943–48. [Accessed 26 May 2016].
  10. Cho I, Chang HJ, O Hartaigh B, et al. Incremental prognostic utility of coronary CT angiography for asymptomatic patients based upon extent and severity of coronary artery calcium: Results from the COronary CT Angiography EvaluatioN For Clinical Outcomes InteRnational Multicenter (CONFIRM) study. Eur Heart J 2015;36(8):501–08. [Accessed 26 May 2016].
  11. Kianoush S, Rifai MA, Cainzos-Achirica M, et al. An update on the utility of coronary artery calcium scoring for coronary heart disease and cardiovascular disease risk prediction. Curr Atheroscler Rep 2016;18(3):13. [Accessed 26 May 2016].
  12. Wolk MJ, Bailey SR, Doherty JU, et al. ACCF/AHA/ ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease: A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of [Accessed 26 May 2016].
  13. Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014;63(4):380–406. [Accessed 26 May 2016].
  14. Cardiac Society of Australia and New Zealand. Position statement: Coronary artery calcium scoring. Sydney: Cardiac Society of Australia and New Zealand, 2016. [Accessed 26 May 2016].
  15. 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. [Accessed 26 May 2016].
  16. Loland KH, Bleie O, Blix AJ, et al. Effect of homocysteinelowering 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. [Accessed 26 May 2016].
  17. Clarke R, Halsey J, Lewington S, et al. Effects of lowering homocysteine levels with B vitamins on cardiovascular disease, cancer, and cause-specific mortality: Metaanalysis of 8 randomized trials involving 37,485 individuals. Arch Intern Med 2010;170(18):1622–31. [Accessed 26 May 2016].
  18. 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. [Accessed 26 May 2016].
  19. Ebbing M, Bleie O, Ueland PM, et al. Mortality and cardiovascular events in patients treated with homocysteine-lowering B vitamins after coronary angiography: A randomized controlled trial. JAMA 2008;300(7):795–804. [Accessed 26 May 2016].
  20. Chou R, High Value Care Task Force of the American College of Physicians. Cardiac screening with electrocardiography, stress echocardiography, or myocardial perfusion imaging: Advice for high-value care from the American College of Physicians. Ann Intern Med 2015;162(6):438–47. [Accessed 26 May 2016].
  21. Dowsley T, Al-Mallah M, Ananthasubramaniam K, Dwivedi G, McArdle B, Chow BJ. The role of noninvasive imaging in coronary artery disease detection, prognosis, and clinical decision making. Can J Cardiol 2013;29(3):285– 96. [Accessed 26 May 2016].
  22. Dolor R, Patel M, Melloni C, et al. Noninvasive technologies for the diagnosis of coronary artery disease in women. Rockville, MD: Agency for Healthcare Research and Quality, 2012. [Accessed 26 May 2016].
  23. Lim LS, Haq N, Mahmood S, Hoeksema L, Committee APP, American College of Preventive M. 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. [Accessed 26 May 2016].
  24. Desai CS, Blumenthal RS, Greenland P. Screening low-risk individuals for coronary artery disease. Curr Atheroscler Rep 2014;16(4):402. [Accessed 26 May 2016].
  25. Yousuf O, Mohanty BD, Martin SS, et al. High-sensitivity C-reactive protein and cardiovascular disease: A resolute belief or an elusive link? J Am Coll Cardiol 2013;62(5):397–408. [Accessed 26 May 2016].
  26. Ledwidge MT, O’Connell E, Gallagher J, et al. Costeffectiveness of natriuretic peptide-based screening and collaborative care: A report from the STOP-HF (St Vincent’s Screening TO Prevent Heart Failure) study. Eur J Heart Fail 2015;17(7):672–79. [Accessed 26 May 2016].
  27. 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. [Accessed 26 May 2016].
  28. 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. [Accessed 26 May 2016].
  29. 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. [Accessed 26 May 2016].
  30. 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. [Accessed 26 May 2016].
  31. Grondal N, Sogaard R, Henneberg EW, Lindholt JS. The Viborg Vascular (VIVA) screening trial of 65–74 year old men in the central region of Denmark: Study protocol. Trials 2010;11:67. [Accessed 26 May 2016].
  32. 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. [Accessed 26 May 2016].
  33. Alahdab F, Wang AT, Elraiyah TA, et al. A systematic review for the screening for peripheral arterial disease in asymptomatic patients. J Vasc Surg 2015;61(3 Suppl):42S–53S. [Accessed 26 May 2016].
  34. Lin JS, Olson CM, Johnson ES, Whitlock EP. The ankle-brachial index for peripheral artery disease screening and cardiovascular disease prediction among asymptomatic adults: A systematic evidence review for the US Preventive Services Task Force. Ann Intern Med 2013;159(5):333–41. [Accessed 26 May 2016].
  35. Perk J, De Backer G, Gohlke H, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J 2012;33(13):1635–701. 35. [Accessed 26 May 2016].
  36. Ferket BS, Spronk S, Colkesen EB, Hunink MG. Systematic review of guidelines on peripheral artery disease screening. Am J Med 2012;125(2):198–208, e3. [Accessed 26 May 2016].
  37. Andras A, Ferket B. Screening for peripheral arterial disease. Cochrane Database Syst Rev 2014;4:CD010835. [Accessed 26 May 2016].
  38. Moyer VA, USPST. Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med 2013;159(5):342–48. [Accessed 26 May 2016].
  39. Jonas DE, Feltner C, Amick HR, et al. Screening for asymptomatic carotid artery stenosis: A systematic review and meta-analysis for the US Preventive Services Task Force. Ann Intern Med 2014;161(5):336–46. [Accessed 26 May 2016].
  40. Abbott AL. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: Results of a systematic review and analysis. Stroke 2009;40(10):e573–83. [Accessed 26 May 2016].
  41. Abbott AL, Paraskevas KI, Kakkos SK, et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke 2015;46(11):3288–301. [Accessed 26 May 2016].
  42. Abbott AL, Adelman MA, Alexandrov AV, et al. Why calls for more routine carotid stenting are currently inappropriate: An international, multispecialty, expert review and position statement. Stroke 2013;44(4):1186–90. [Accessed 26 May 2016].
  43. Abbott A. Critical issues that need to be addressed to improve outcomes for patients with carotid stenosis. Angiology 2016;67(5):420–26. [Accessed 26 May 2016].
  44. Abbott AL, Nicolaides AN. Improving outcomes in patients with carotid stenosis: Call for better research opportunities and standards. Stroke 2015;46(1):7–8. [Accessed 26 May 2016].
  45. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breastcancer screening – Viewpoint of the IARC Working Group. N Engl J Med 2015;372(24):2353–58. [Accessed 26 May 2016].
  46. Cancer Australia. MRI for high risk women. Surry Hills, NSW: Cancer Australia, 2015. Available at https:// [Accessed November 2015].
  47. Cancer Australia. Advice about familial aspects of breast and epithelial ovarian cancer: A guide for health professionals. Surry Hills, NSW: Cancer Australia, 2015 files/publications/advice-about-familial-aspects-breastcancer-and-epithelial-ovarian-cancer/pdf/2015_bog_ familial_aspects_int.pdf [Accessed November 2015].
  48. 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. [Accessed November 2015].
  49. Department of Health. MBS Online – Medicare Benefits Schedule. Canberra: DoH, 2015. Available at www9. [Accesssed 1 December 2015].
  50. Cancer Australia. Early detection of breast cancer 2015. Surry Hills, NSW: Cancer Australia, 2015 position-statements/early-detection-breast-cancer [Accessed 1 December 2015].
  51. Department of Health. MBS Online – Medicare Benefits Schedule. Category 5 – Diagnostic imaging services. Item 63464. Canberra: DoH, 2016. Available at www9.health. &criteria=63464 [Accesssed 23 March 2016].
  52. Siu AL. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med 2016;164(4):279–96. [Accesssed 23 March 2016].
  53. The Royal Australian and New Zealand College of Radiologists. Policy on the use of thermography to detect breast cancer. Sydney: RANZCR, 2014. [Accesssed 23 March 2016].
  54. Cancer Australia. Position statement: Statement on use of thermography to detect breast cancer. Surry Hills, NSW: Cancer Australia, 2010. Available at https:// position-statements/statement-use-thermography-detectbreast-cancer [Accessed 23 March 2016].
  55. Cancer Australia. Genetic testing for breast/ovarian cancer risk. Surry Hills, NSW: Cancer Australia, 2010 [Accessed 14 December 2015].
  56. Human Genetics Society of Australasia, Clinical Oncology Society of Australia, The Royal College of Pathologists of Australasia. Joint position statement. The role of single nucleotide polymorphisms (SNP) testing for personalised breast cancer risk prediction. Camperdown, NSW: COSA, 2013 cosa-hgsa-rcpa-joint-position-statement-on-snp-testing_ final_11november2013.pdf [Accessed 1 December 2015].
  57. Cancer Australia. Recommendations for the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of a gene mutation. Surry Hills, NSW: Cancer Australia, 2014 guidelines/gene_mutation/index.php [Accessed 23 March 2016].
  58. Cancer Australia. Population screening and early detection of ovarian cancer in asymptomatic women. Surry Hills, NSW: Cancer Australia, 2009 position-statements/population-screening-and-earlydetection-ovarian-cancer-asymptomatic-women [Accessed 15 December 2015].
  59. Schorge JO, Modesitt SC, Coleman RL, et al. SGO White Paper on ovarian cancer: Etiology, screening and surveillance. Gynecol Oncol 2010;119(1):7–17. [Accessed 15 December 2015].
  60. Moyer VA. Screening for ovarian cancer: US Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2012;157(12):900–04. [Accessed 15 December 2015].
  61. Jacobs IJ, Menon U, Ryan A, et al. Ovarian cancer screening and mortality in the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS): A randomised controlled trial. Lancet 2016;387(10022):945–56. [Accessed 15 December 2015].
  62. Society of Gynecologic Oncology of Canada. GOC Opinion Statement regarding the UK Collaborative Trial Of Ovarian Cancer Screening (UKCTOCS) results. Ottawa: Society of Gynecologic Oncology of Canada, 2016 [Accessed 23 March 2016].
  63. de Haan MC, Pickhardt PJ, Stoker J. CT colonography: Accuracy, acceptance, safety and position in organised population screening. Gut 2015;64(2):342–50. [Accessed 23 March 2016].
  64. 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. [Accessed 23 March 2016].
  65. Pickhardt PJ. CT colonography for population screening: Ready for prime time? Dig Dis Sci 2015;60(3):647–59. [Accessed 23 March 2016].
  66. Philip AK, Lubner MG, Harms B. Computed tomographic colonography. Surg Clin North Am 2011;91(1):127–39. [Accessed 23 March 2016].
  67. Weizman AV, Nguyen GC. Colon cancer screening in 2010: An up-date. Minerva Gastroenterol Dietol 2010;56(2):181–88. [Accessed 23 March 2016].
  68. Pox CP, Schmiegel W. Role of CT colonography in colorectal cancer screening: Risks and benefits. Gut 2010;59(5):692–700. [Accessed 23 March 2016].
  69. Laghi A, Iafrate F, Rengo M, Hassan C. Colorectal cancer screening: The role of CT colonography. World J Gastroenterol 2010;16(32):3987–94. [Accessed 23 March 2016].
  70. Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med 2009;361(12):1179–87. [Accessed 23 March 2016].
  71. Albert JM. Radiation risk from CT: Implications for cancer screening. AJR Am J Roentgenol 2013;201(1):W81–87. [Accessed 23 March 2016].
  72. Schmidt G, Dinter D, Reiser MF, Schoenberg SO. The uses and limitations of whole-body magnetic resonance imaging. Dtsch Arztebl Int 2010;107(22):383–89. [Accessed 23 March 2016].
  73. 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):118–19. [Accessed 23 March 2016].
  74. Ladd SC. Whole-body MRI as a screening tool? Eur J Radiol 2009;70(3):452–62. [Accessed 23 March 2016].
  75. 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):813–18. [Accessed 23 March 2016].
  76. Fayngersh V, Passero M. Estimating radiation risk from computed tomography scanning. Lung 2009;187(3):14348. [Accessed 23 March 2016].
  77. Schoder H, Gonen M. Screening for cancer with PET and PET/CT: Potential and limitations. J Nucl Med 2007;48 (Suppl 1):4S–18S. [Accessed 23 March 2016].
  78. Anderiesz C, Elwood JM, McAvoy BR. Whole-body computed tomography screening: Looking for trouble? Med J Aust 2004;181(6):295–96. [Accessed 23 March 2016].
  79. O’Reilly J, Rudolf M. What’s nice about the new NICE guideline? Thorax 2011;66(2):93–96. [Accessed 23 March 2016].
  80. US Preventive Services Task Force. Screening for chronic obstructive pulmonary disease using spirometry: Recommendation statement. Am Fam Physician 2009;80(8):853. [Accessed 23 March 2016].
  81. Celli BR, Decramer M, Wedzicha JA, et al. An official American Thoracic Society/European Respiratory Society statement: Research questions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2015;191(7):e4–e27. [Accessed 23 March 2016].
  82. Luize AP, Menezes AM, Perez-Padilla R, et al. Assessment of five different guideline indication criteria for spirometry, including modified GOLD criteria, in order to detect COPD: Data from 5315 subjects in the PLATINO study. NPJ Prim Care Respir Med 2014;24:14075. [Accessed 23 March 2016].
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  85. Chaker L, Baumgartner C, Ikram MA, et al. Subclinical thyroid dysfunction and the risk of stroke: A systematic review and meta-analysis. Eur J Epidemiol 2014;29(11):791–800. [Accessed 23 March 2016].
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  91. Nowson CA, McGrath JJ, Ebeling PR, et al. Vitamin D and health in adults in Australia and New Zealand: A position statement. Med J Aust 2012;196(11):686–87. [Accessed 23 March 2016].
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  105. Lin K, Fajardo K. Screening for asymptomatic bacteriuria in adults: Evidence for the US Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2008;149(1):W20–24. [Accessed 23 March 2016].
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  108. Bonnet MH, Burton GG, Arand DL. Physiological and medical findings in insomnia: Implications for diagnosis and care. Sleep Med Rev 2014;18(2):111–22. [Accessed 23 March 2016].
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  119. Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: A comprehensive review. Exp Clin Cardiol 2011;16(1):11–15. [Accessed 23 March 2016].
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  123. Davis M, Harris M, Earnshaw JJ. Implementation of the National Health Service Abdominal Aortic Aneurysm Screening Program in England. J Vasc Surg 2013;57(5):1440–45. [Accessed 23 March 2016].
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  125. 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. [Accessed 23 March 2016].
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