Guidelines for preventive activities in general practice

The Red Book
15. Screening tests of unproven benefit
☰ Table of contents

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. Screening tests not recommended in low-risk general practice populations

Screening test


Reason not to use

Genomic sequencing

Genetic risk

Limited evidence on the balance of benefits and harms, ethical issues and uncertain utility in an asymptomatic adult 1-5

Genetic testing – methylenetetrahydrofolate reductase (MTHFR)

Venous thrombo­embolism

The MTHFR test has minimum clinical utility and is not recommended in the evaluation of thrombophilia, recurrent pregnancy loss, or assessment of risk of coronary artery disease or any other condition 6

Genetic testing – apolipoprotein E (ApoE)

Alzheimer’s disease

ApoE testing is not recommended to assess risk of Alzheimer’s disease due to its poor predictive value and the lack of preventive options 6


Coronary computed tomography angiography* (CCTA)

Coronary artery disease (CAD)

No randomised controlled trial (RCT) evidence. RCTs of therapy show no effect on coronary artery progression 7–11 

May be of benefit in those at moderate risk of CAD – but not in:

  • asymptomatic persons
  • subjects with known significant CAD
  • subjects with a high pre-test probability of CAD

Computed tomography (CT) calcium scoring†

Coronary heart disease (CHD)

Usually not appropriate in a low-risk asymptomatic population, but may be of possible value in risk reclassification in those at moderate risk 8, 9, 11–13

Serum homocysteine


Value as a risk factor for CHD is uncertain and published RCTs show no evidence of benefit by lowering levels 14-18

Exercise electrocardiogram (ECG)


Low yield and high false-positive rate given low prevalence in asymptomatic population 14, 19–22

High sensitivity C-reactive protein (hsCRP)

Cardiovascular disease (CVD)

Insufficient evidence to support the role of hsCRP in preventive screening of asymptomatic patients 14, 22–29

Ankle:brachial index (ABI)

Peripheral vascular disease

Current evidence is insufficient to assess benefits and costs of using ABI to screen for peripheral vascular disease 28, 30–37

Carotid artery ultrasound38–43

Asymptomatic carotid artery stenosis

It is no longer justifiable to screen for the presence of asymptomatic carotid artery stenosis to select patients for carotid procedures. There is no current evidence of patient benefit. However, there is evidence of harms from screening, including significant procedural risk and cost 

Carotid stenting cannot be recommended because it causes about twice as many strokes or deaths as carotid endarterectomy (CEA), a risk that is not offset by the CEA risk of myocardial infarction 

Also, asymptomatic carotid artery stenosis patients with particularly high ipsilateral stroke risk who benefit from CEA, in addition to current optimal medical treatment alone, have not been identified. Evidence is insufficient to allow reliable risk stratification. For example, degree of stenosis within the 50–99% range, asymptomatic stenosis progression, plaque echolucency and transcranial Doppler embolus detection are not specific enough to identify patients likely to benefit from CEA 

A research priority is to find out if screening to detect asymptomatic carotid artery stenosis improves medical treatment and patient outcomes over screening for, and optimal treatment of, other established vascular risk factors


Magnetic resonance imaging (MRI)44–51

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 <50 years of age at high risk of breast cancer 

There is no evidence for MRI as a stand-alone screening test for women at average risk of breast cancer


Breast cancer

Thermography is associated with high false-positive and false-negative rates. There is insufficient evidence to support the use of thermography in breast cancer screening or as an adjunctive tool to mammography 52, 53

Single nucleotide polymorphism (SNP) testing46, 54–56

Breast cancer

Use of a SNP‐based breast cancer risk assessment test should only be undertaken after an in‐depth discussion led by a clinical professional familiar with the implications of genetic risk assessment and testing, including the potential insurance implications 

Genetic testing should be offered only with pre-test and post-test counselling to discuss the limitations, potential benefits, and possible consequences

Cancer antigen (CA)125/transvaginal ultrasound46, 57–61

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 

The recently reported UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) trial of transvaginal ultrasound +/– CA125 found no significant difference in mortality over 0–14 years 

Secondary analyses suggest a possible benefit of screening using transvaginal ultrasound and CA125, but further follow-up is needed before firm conclusions can be reached on the long-term efficacy and cost-effectiveness of ovarian cancer screening

Optical colonoscopy or computed tomography (CT) colonography‡62–69

Colorectal cancer (CRC)

These have good sensitivity for cancer and advanced polyps, and are more acceptable than colonoscopy, but there is no current evidence of the reduction of CRC mortality. There are several trials under way to assess effectiveness and cost effectiveness of this as a screening strategy 

Neither optical colonoscopy nor CT colonography are recommended for primary screening because there is no current RCT evidence of effectiveness in relation to any harms

Whole-body CT or MRI


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 70–77

Lung disease


Chronic obstructive pulmonary disease (COPD)

Screening with spirometry in the absence of symptoms has no net benefit 

Opportunistic case-finding should be considered in high-risk individuals. These include those aged >40 years, plus either:

  • symptoms (chronic cough, increased sputum production, wheezing or dyspnoea)
  • history of exposure to relevant environmental factors such as cigarette smoke

Several questionnaires§ are useful and if positive, should be followed by spirometry by a trained professional (consensus statement)


Thyroid function tests84–89

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 

There is no evidence supporting an increased risk for stroke associated with subclinical thyroid dysfunction 

More research is needed to determine the clinical benefits associated with thyroid screening

Chronic disease prevention

Vitamin D

Vitamin D deficiency

Current evidence is insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults 90–97

Heel ultrasound


While there is some evidence that heel ultrasound in combination with femoral neck bone densitometry better predicts hip fracture, there are no RCTs showing any benefit of using heel ultrasound as the primary screening tool for osteoporosis, nor is its usefulness as a pre-screening tool in tandem with dual-energy X-ray absorptiometry (DXA) proven 98–103


Mid-stream urine (MSU) culture

Asymptomatic bacteriuria (elderly)

Identifying and treating non-pregnant adults with asymptomatic bacteriuria does not improve outcomes and may increase antibiotic resistance. The only two exceptions to this are pregnancy and a patient who is about to undergo a urological procedure 104, 105

Other tests

Enquiry about sleep106–109

Obstructive sleep apnoea (OSA)

The prevalence of undiagnosed OSA is high and it is associated with considerable morbidity. While there are some screening tools that are available, there are no large-scale RCTs showing the benefit or cost-benefit of routine screening for OSA in primary care 

Case-finding for OSA may be beneficial in commercial vehicle drivers and pilots, but it has not been mandated by any government authority

Bimanual pelvic exam

During a routine Papanicolaou (Pap) test in an asymptomatic woman

A bimanual examination performed as part of routine Pap smear examination is of no proven benefit, but studies are limited 110–113 

It has been shown to be not an effective screening method for ovarian cancer detection

* CCTA involves the use of multi-slice CT and intravenously administered contrast material to obtain detailed images of the blood vessels of the heart. It has been used as an alternative to conventional invasive coronary angiography for evaluating CAD and coronary artery anomalies. CCTA requires high doses of ionizing radiation, with an average dose of 8.1 milliSieverts for patients weighing 75 kg. This dose is approximately two to three times higher than the average radiation dose administered to patients during conventional coronary angiography 

† CT calcium scoring (also known as Coronary Calcium Scan and Coronary Artery Calcium Scoring). A good summary on CT calcium score [Accessed 26 May 2016] 

‡ There are no current Medicare Benefits Schedule (MBS) rebates for performing cardiac CT in asymptomatic individuals. 

§ Refer to the Lung Foundation 

ABI, ankle:brachial index; ApoE, apolopoprotein E; CA, cancer antigen; CAD, coronary artery disease; CCTA, coronary computed tomography angiography; CEA, carotid endarterectomy; CHD, coronary heart disease; CT, computed tomography; CVD, cardiovascular disease; DXA, dual-energy X-ray absorptiometry; hsCRP, high sensitivity C-reactive protein; MBS, Medicare Benefits Schedule; MRI, magnetic resonance imaging; MSU, mid-stream urine; MTHFR, methylenetetrahydrofolate; OSA, obstructive sleep apnoea; Pap, Papanicolaou; RCT, randomised controlled trial; SNP, single nucleotide polymorphism; UKCTOCS, UK Collaborative Trial of Ovarian Cancer Screening


Table 15.2. Screening tests of indeterminate value

Screening test


Reason not to use

Vitamin D92, 114–17


Pregnant women with one or more risk factors for low vitamin D levels should have their serum 25-hydroxy vitamin D levels measured at their first antenatal visit 

Risk factors for low vitamin D levels are lack of skin exposure to sunlight, dark skin, southerly latitude, conditions affecting vitamin D metabolism and storage (including obesity) and, for infants, being born to a mother with low vitamin D levels and exclusive breastfeeding combined with at least one other risk factor.



Abdominal aortic aneurysm (AAA)

National screening of men aged 65 years has been successfully introduced in the UK and parts of Scandinavia for AAA. However, it is unclear what the impact of the lower-than-expected prevalence (<2%) of AAAs will be on the long-term benefit 

The US Preventive Services Task Force (USPSTF) recommends screening of older male smokers. Limiting screening to this sub-group has raised some ethical issues and may influence cost-effectiveness 

Unpublished recent data from the Western Australian trial of screening for AAA suggests that the magnitude of the benefit from screening men aged ≥65 years does not warrant the introduction of a national AAA screening program in Australia at this stage

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. A recent, pragmatic, un-blinded randomised controlled trial (RCT) has shown some benefit for BNP screening in high-risk groups, but large scale trials are needed to confirm these findings and establish feasibility and cost effectiveness 25, 124–30


Low-dose chest computed tomography131–38

Lung cancer

A large trial in the US has shown that patients selected for high lung cancer risk have reduced lung cancer and total mortality within a carefully conducted LDCT screening program in the context of a structured program of selection, screening, evaluation, and management of the relatively high number of benign abnormalities 

Performing CT scans in high-risk individuals outside well-designed and conducted research programs may lack any benefit and may be harmful. Low-risk persons should not have screening CT as the reasonably foreseeable benefits are lower and may be substantially outweighed by harms. More accurate data on the identification of the appropriate target group including the threshold for absolute lung cancer risk, are required before any recommendation on LDCT

Positron emission tomography – computed tomography (or PET CT scan)

Lung cancer

There is no current evidence of benefit for PET screening for lung cancer 135, 139, 140


Visual acuity

Visual impairment

Current evidence is insufficient to assess the balance of benefits and harms of screening for impaired visual acuity in older adults 141–43

AAA, abdominal aortic aneurysm; BNP, B-type natriuretic peptide; LDCT, low-dose computed tomography; PET, positron emission tomography; RCT, randomised controlled trial ; USPSTF, US Preventive Services Task Force


  1. Skirton H. Direct to consumer testing in reproductive contexts – Should health professionals be concerned? Life Sci Soc Policy 2015;11:4.
  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.
  5. Udesky L. The ethics of direct-to-consumer genetic testing. Lancet 2010;376(9750):1377–78.
  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.  [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.
  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.
  9. Rubin GD. Emerging and evolving roles for CT in screening for coronary heart disease. J Am Coll Radiol 2013;10(12):943–48.
  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.
  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.
  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 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.
  13. Cardiac Society of Australia and New Zealand. Position statement: Coronary artery calcium scoring. Sydney: Cardiac Society of Australia and New Zealand, 2016.
  14. 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.
  15. Loland KH, Bleie O, Blix AJ, et al. 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.
  16. Clarke R, Halsey J, Lewington S, et al. Effects of lowering homocysteine levels with B vitamins on cardiovascular disease, cancer, and cause-specific mortality: Meta-analysis of 8 randomized trials involving 37,485 individuals. Arch Intern Med 2010;170(18):1622–31.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. Desai CS, Blumenthal RS, Greenland P. Screening low-risk individuals for coronary artery disease. Curr Atheroscler Rep 2014;16(4):402.
  24. 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.
  25. Ledwidge MT, O’Connell E, Gallagher J, et al. Cost-effectiveness 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.
  26. 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.
  27. 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.
  28. 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.
  29. 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.
  30. 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.
  31. 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.
  32. 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.
  33. 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.
  34. 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. 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.
  36. Andras A, Ferket B. Screening for peripheral arterial disease. Cochrane Database Syst Rev 2014;4:CD010835.
  37. 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.
  38. 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.
  39. 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.
  40. 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.
  41. 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.
  42. Abbott A. Critical issues that need to be addressed to improve outcomes for patients with carotid stenosis. Angiology 2016;67(5):420–26.
  43. Abbott AL, Nicolaides AN. Improving outcomes in patients with carotid stenosis: Call for better research opportunities and standards. Stroke 2015;46(1):7–8.
  44. Lauby-Secretan B, Scoccianti C, Loomis D, et al. Breast-cancer screening – Viewpoint of the IARC Working Group. N Engl J Med 2015;372(24):2353–58.
  45. Cancer Australia. MRI for high risk women. Surry Hills, NSW: Cancer Australia, 2015. Available at [Accessed November 2015].
  46. Cancer Australia. Advice about familial aspects of breast and epithelial ovarian cancer: A guide for health professionals. Surry Hills, NSW: Cancer Australia, 2015. [Accessed November 2015].
  47. 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.
  48. Department of Health. MBS Online – Medicare Benefits Schedule. Canberra: DoH, 2015.  [Accesssed 1 December 2015].
  49. Cancer Australia. Early detection of breast cancer 2015. Surry Hills, NSW: Cancer Australia, 2015. [Accessed 1 December 2015].
  50. Department of Health. MBS Online – Medicare Benefits Schedule. Category 5 – Diagnostic imaging services. Item 63464. Canberra: DoH, 2016. [Accesssed 23 March 2016].
  51. Siu AL. Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement. Ann Intern Med 2016;164(4):279–96.
  52. The Royal Australian and New Zealand College of Radiologists. Policy on the use of thermography to detect breast cancer. Sydney: RANZCR, 2014.
  53. Cancer Australia. Position statement: Statement on use of thermography to detect breast cancer. Surry Hills, NSW: Cancer Australia, 2010.  [Accessed 23 March 2016].
  54. Cancer Australia. Genetic testing for breast/ovarian cancer risk. Surry Hills, NSW: Cancer Australia, 2010. Available at [Accessed 14 December 2015].
  55. 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. [Accessed 1 December 2015].
  56. 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.  [Accessed 23 March 2016].
  57. Cancer Australia. Population screening and early detection of ovarian cancer in asymptomatic women. Surry Hills, NSW: Cancer Australia, 2009. [Accessed 15 December 2015].
  58. 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.
  59. Moyer VA. Screening for ovarian cancer: US Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2012;157(12):900–04.
  60. 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.
  61. 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. Available at [Accessed 23 March 2016].
  62. de Haan MC, Pickhardt PJ, Stoker J. CT colonography: Accuracy, acceptance, safety and position in organised population screening. Gut 2015;64(2):342–50.
  63. 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.
  64. Pickhardt PJ. CT colonography for population screening: Ready for prime time? Dig Dis Sci 2015;60(3):647–59.
  65. Philip AK, Lubner MG, Harms B. Computed tomographic colonography. Surg Clin North Am 2011;91(1):127–39.
  66. Weizman AV, Nguyen GC. Colon cancer screening in 2010: An up-date. Minerva Gastroenterol Dietol 2010;56(2):181–88.
  67. Pox CP, Schmiegel W. Role of CT colonography in colorectal cancer screening: Risks and benefits. Gut 2010;59(5):692–700.
  68. Laghi A, Iafrate F, Rengo M, Hassan C. Colorectal cancer screening: The role of CT colonography. World J Gastroenterol 2010;16(32):3987–94.
  69. Lieberman DA. Clinical practice. Screening for colorectal cancer. N Engl J Med 2009;361(12):1179–87.
  70. Albert JM. Radiation risk from CT: Implications for cancer screening. AJR Am J Roentgenol 2013;201(1):W81–87.
  71. 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.
  72. 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.
  73. Ladd SC. Whole-body MRI as a screening tool? Eur J Radiol 2009;70(3):452–62.
  74. 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.
  75. Fayngersh V, Passero M. Estimating radiation risk from computed tomography scanning. Lung 2009;187(3):143-48.
  76. Schoder H, Gonen M. Screening for cancer with PET and PET/CT: Potential and limitations. J Nucl Med 2007;48 (Suppl 1):4S–18S.
  77. Anderiesz C, Elwood JM, McAvoy BR. Whole-body computed tomography screening: Looking for trouble? Med J Aust 2004;181(6):295–96.
  78. O’Reilly J, Rudolf M. What’s nice about the new NICE guideline? Thorax 2011;66(2):93–96.
  79. US Preventive Services Task Force. Screening for chronic obstructive pulmonary disease using spirometry: Recommendation statement. Am Fam Physician 2009;80(8):853.
  80. 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.
  81. 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.
  82. Abramson M, Crockett AJ, Dabscheck E, et al. on behalf of Lung Foundation Australia and the Thoracic Society of Australia and New Zealand. The COPD-X Plan: Australian and New Zealand Guidelines for the management of chronic obstructive pulmonary disease V2.44. Milton, Qld: Lung Foundation Australia, 2015.
  83. Guirguis-Blake JM, Senger CA, Webber EM, Mularski RA, Whitlock EP. Screening for chronic obstructive pulmonary disease: Evidence report and systematic review for the US Preventive Services Task Force. JAMA 2016;315(13):1378–93.
  84. 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.
  85. Rugge JB, Bougatsos C, Chou R. Screening and treatment of thyroid dysfunction: An evidence review for the US Preventive Services Task Force. Ann Intern Med 2015;162(1):35–45.
  86. Empson M, Flood V, Ma G. Prevalence of thyroid disease in an older Australian population. Intern Med J 2007;37(7):448–55.
  87. Gopinath B, Wang JJ, Kifley A. Five-year incidence and progression of thyroid dysfunction in an older population. Intern Med J 2010;40(9):642–49.
  88. 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.
  89. 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.
  90. 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.
  91. LeFevre ML, USPST. Screening for vitamin D deficiency in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med 2015;162(2):133–40.
  92. Paxton GA, Teale GR, Nowson CA, et al. Vitamin D and health in pregnancy, infants, children and adolescents in Australia and New Zealand: A position statement. Med J Aust 2013;198(3):142–43.
  93. Bjelakovic G, Gluud LL, Nikolova D, et al. Vitamin D supplementation for prevention of mortality in adults. Cochrane Database Syst Rev 2011;7:CD007470.
  94. Chung M, Balk EM, Ip S, et al. Systematic review to support the development of nutrient reference intake values: Challenges and solutions. Am J Clin Nutr 2010;92(2):273–76.
  95. Hanley DA, Cranney A, Jones G, Whiting SJ, Leslie WD, Guidelines Committee of the Scientific Advisory Council of Osteoporosis Canada. Vitamin D in adult health and disease: A review and guideline statement from Osteoporosis Canada (summary). CMAJ 2010;182(12):1315–19.
  96. Holick MF, Binkley NC, Bischoff-Ferrari HA, 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.
  97. 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.
  98. US Preventive Services Task Force. Screening for osteoporosis: Clinical summary of US Preventive Services Task Force recommendation. Rockville, MD: USPSTF, 2011.
  99. Nayak S, Edwards DL, Saleh AA, Greenspan SL. Systematic review and meta-analysis of the performance of clinical risk assessment instruments for screening for osteoporosis or low bone density. Osteoporos Int 2015;26(5):1543–54.
  100. McCloskey EV, Kanis JA, Oden A, et al. Predictive ability of heel quantitative ultrasound for incident fractures: An individual-level meta-analysis. Osteoporos Int 2015;26(7):1979–87.
  101. Pisani P, Renna MD, Conversano F, et al. Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World J Radiol 2013;5(11):398–410.
  102. Thomsen K, Jepsen DB, Matzen L, Hermann AP, Masud T, Ryg J. Is calcaneal quantitative ultrasound useful as a prescreen stratification tool for osteoporosis? Osteoporos Int 2015;26(5):1459–75.
  103. Minniti D, Davini O, Gualano MR, Gianino MM. Techniques for diagnosing osteoporosis:A systematic review of cost-effectiveness studies. Int J Technol Assess Health Care 2014;30(3):273–81.
  104. 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.
  105. Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40(5):643–54.
  106. Strohl KP, Brown DB, Collop N, et al. An official American Thoracic Society clinical practice guideline: Sleep apnea, sleepiness, and driving risk in noncommercial drivers. An update of a 1994 Statement. Am J Respir Crit Care Med 2013;187(11):1259–66.
  107. 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.
  108. Burns N. An integrative review of screening for obstructive sleep apnea in commercial vehicle drivers. Workplace Health Saf 2014;62(3):114–20.
  109. Chai-Coetzer CL, Antic NA, Rowland LS, et al. A simplified model of screening questionnaire and home monitoring for obstructive sleep apnoea in primary care. Thorax 2011;66(3):213–19.
  110. Qaseem A, Humphrey LL, Harris R, Starkey M, Denberg TD, Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2014;161(1):67–72.
  111. MacLaughlin KL, Faubion SS, Long ME, Pruthi S, Casey PM. Should the annual pelvic examination go the way of annual cervical cytology? Womens Health (Lond Engl) 2014;10(4):373–84.
  112. Bloomfield HE, Olson A, Greer N, et al. Screening pelvic examinations in asymptomatic, average-risk adult women: An evidence report for a clinical practice guideline from the American College of Physicians. Ann Intern Med 2014;161(1):46–53.
  113. Stewart RA, Thistlethwaite J. Routine pelvic examination for asymptomatic women-–Exploring the evidence. Aust Fam Physician 2006;35(11):873–77.
  114. Dror DK, Allen LH. Vitamin D inadequacy in pregnancy: Biology, outcomes, and interventions. Nutr Rev 2010;68(8):465–77.
  115. Ebeling PR. Routine screening for vitamin D deficiency in early pregnancy: Past its due date? Med J Aust 2011;194(7):332–33.
  116. Holmes VA, Barnes MS. Vitamin D deficiency and insufficiency in pregnant women: A longitudinal study. Br J Nutr 2009;102(6):876–81.
  117. Lichtenstein AH. Nutrient supplements and cardiovascular disease: A heartbreaking story. J Lipid Res 2009;50 (Suppl):S429–33.
  118. Aggarwal S, Qamar A, Sharma V, Sharma A. Abdominal aortic aneurysm: A comprehensive review. Exp Clin Cardiol 2011;16(1):11–15.
  119. Ferket BS, Grootenboer N, Colkesen EB, et al. Systematic review of guidelines on abdominal aortic aneurysm screening. J Vasc Surg 2012;55(5):1296–304.
  120. Svensjo S, Bjorck M, Wanhainen A. Update on screening for abdominal aortic aneurysm: A topical review. Eur J Vasc Endovasc Surg 2014;48(6):659–67.
  121. LeFevre ML, US Preventive Services Task Force. Screening for abdominal aortic aneurysm: US Preventive Services Task Force recommendation statement. Ann Intern Med 2014;161(4):281–90.
  122. 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.
  123. Nair N, Sarfati D, Shaw C. Population screening for abdominal aortic aneurysm: Evaluating the evidence against screening criteria. N Z Med Jl 2012;125(1350):72–83.
  124. 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.
  125. 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):405–09.
  126. National Institute for Clinical Excellence. Chronic heart failure: National clinical guideline for diagnosis and management in primary and secondary care. London: NICE, 2010.
  127. 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.
  128. Taylor CJ, Roalfe AK, Iles R, Hobbs FD. The potential role of NT-proBNP in screening for and predicting prognosis in heart failure: A survival analysis. BMJ Open 2014;4(4):e004675.
  129. Ledwidge M, Gallagher J, Conlon C, et al. Natriuretic peptide-based screening and collaborative care for heart failure: The STOP-HF randomized trial. JAMA 2013;310(1):66–74.
  130. Balion C, Don-Wauchope AC, Hill S, Santaguida PL, Booth RA, Brown JA. Use of natriuretic peptide measurement in the management of heart failure. Comparative Effectiveness Review No. 126. Rockville, MD: Agency for Healthcare Research and Quality, 2015.
  131. Wiener RS, Ouellette DR, Diamond E, et al. An official American Thoracic Society/American College of Chest Physicians policy statement: The Choosing Wisely top five list in adult pulmonary medicine. Chest 2014;145(6):1383–91.
  132. Wender R, Fontham ET, Barrera E, Jr., et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin 2013;63(2):107–17.
  133. Jaklitsch MT, Jacobson FL, Austin JH, et al. The American Association for Thoracic Surgery guidelines for lung cancer screening using low-dose computed tomography scans for lung cancer survivors and other high-risk groups. J Thorac Cardiovasc Surg 2012;144(1):33–38.
  134. Mulshine JL, van Klaveren RJ. Lung cancer screening: What is the benefit and what do we do about it? Lung Cancer 2011;71(3):247–48.
  135. Baldwin DR. Imaging in lung cancer: Recent advances in PET-CT and screening. Thorax 2011;66(4):275–77.
  136. Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer: A systematic review. JAMA 2012;307(22):2418–29.
  137. Brims F, McWilliams A, Fong K. Lung cancer screening in Australia: Progress or procrastination? Med J Aust 2016;204(1):4–5.
  138. Humphrey LL, Deffebach M, Pappas M, et al. Screening for lung cancer with low-dose computed tomography: A systematic review to update the US Preventive Services Task Force recommendation. Ann Intern Med 2013;159(6):411–20.
  139. Chien CR, Liang JA, Chen JH, et al. [(18)F]Fluorodeoxyglucose-positron emission tomography screening for lung cancer: A systematic review and meta-analysis. Cancer Imaging 2013;13(4):458–65.
  140. Sogaard R, Fischer BM, Mortensen J, Hojgaard L, Lassen U. Preoperative staging of lung cancer with PET/CT: Cost-effectiveness evaluation alongside a randomized controlled trial. Eur J Nucl Med Mol Imaging 2011;38(5):802–09.
  141. 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.
  142. 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.
  143. Chou R DT, Bougatsos C, Grusing S, Blazina I. Screening for impaired visual acuity in older adults: A systematic review to update the 2009 US Preventive Services Task Force recommendation. Rockville, MD: Agency for Healthcare Research and Quality, 2015.