A framework provided an outline toward the proper evaluation of potential screening strategies

J Clin Epidemiol. 2013 Jun;66(6):639-47. doi: 10.1016/j.jclinepi.2012.09.018. Epub 2013 Feb 6.


Objectives: Screening tests are often introduced into clinical practice without proper evaluation, despite the increasing awareness that screening is a double-edged sword that can lead to either net benefits or harms. Our objective was to develop a comprehensive framework for the evaluation of new screening strategies.

Study design and setting: Elaborating on the existing concepts proposed by experts, a stepwise framework is proposed to evaluate whether a potential screening test can be introduced as a screening strategy into clinical practice. The principle of screening strategy evaluation is illustrated for cervical cancer, which is a template for screening because of the existence of an easily detectable and treatable precursor lesion.

Results: The evaluation procedure consists of six consecutive steps. In steps 1-4, the technical accuracy, place of the test in the screening pathway, diagnostic accuracy, and longitudinal sensitivity and specificity of the screening test are assessed. In steps 5 and 6, the impact of the screening strategy on the patient and population levels, respectively, is evaluated. The framework incorporates a harm and benefit trade-off and cost-effectiveness analysis.

Conclusion: Our framework provides an outline toward the proper evaluation of potential screening strategies before considering implementation.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cost-Benefit Analysis
  • Early Detection of Cancer / methods
  • Evaluation Studies as Topic
  • Female
  • Guidelines as Topic*
  • Health Impact Assessment*
  • Humans
  • Mass Screening / adverse effects
  • Mass Screening / economics
  • Mass Screening / standards*
  • Research Design*
  • Sensitivity and Specificity
  • Uterine Cervical Neoplasms / prevention & control*