Guidelines for preventive activities in general practice

Screening, case finding and prevention principles

Screening

      1. Screening

Screening

Screening is defined as ‘the examination of asymptomatic people in order to classify them as likely or unlikely to have a disease’.1 Screening is undertaken to detect early disease in apparently healthy individuals. The WHO has produced guidelines for the effectiveness of screening programs.2 These guidelines, and those of the National Health Service (NHS) in the UK,3 have been kept in mind in the development of recommendations about screening in the Red Book, as detailed below.
 
Condition

  • It should be an important health problem.
  • It should have a recognisable latent or early symptomatic stage.
  • The natural history of the condition, including development from latent to declared disease, should be adequately understood.
Test
  • It should be simple, safe, precise and validated.
  • It should be acceptable to the target population.
  • The distribution of test values in the target population should be known and a suitable cut-off level defined and agreed.
Treatment
  • There should be an effective treatment for patients identified, with evidence that early treatment leads to better outcomes.
  • There should be an agreed policy on who should be treated and how they should be treated.
Outcome
  • There should be evidence of improved mortality, morbidity or quality of life as a result of screening, and the benefits of screening should outweigh the harm.
  • The cost of case finding (including diagnosis and treatment of patients who are diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
Consumers
  • Consumers should be informed of the evidence so they can make an informed choice about participation in screening programs.
There are currently five population-based screening programs in Australia:4

 
A sixth program, the National Lung Cancer Screening Program, will commence in 2025.

  1. Morrison AS. Screening. In: Rothman KJ, Greenland S, Lash TL, editors. Modern epidemiology. 2nd edn. Lippincott-Raven, 1998.
  2. Principles and practice of screening for disease. J R Coll Gen Pract 1968;16(4):318.
  3. UK National Health Services. What is screening? UK National Screening Committee, 2021 [Accessed 16 October 2023].
  4. Department of Health and Aged Care. Population-based health screening. Australian Government, 2021 [Accessed 18 May 2023].
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