Screening programmes: a short guide

1 Increase effectiveness, maximize benefits and minimize harmScreening programmes: a short guideScreening programmes: a short guideIncrease effectiveness, maximize benefits and minimize harmAbstractThe purpose of Screening is to identify people in an apparently healthy population who are at higher risk of a health problem or a condition, so that an early treatment or inter-vention can be offered and thereby reduce the incidence and/or mortality of the health problem or condition within the population. There appears to be a growing trend in the WHO European Region towards more Screening for noncommunicable diseases and health checks.

2 However, in too many cases, a clear evidence base for effectiveness is missing. Policy-makers, health professionals and the public often seem unaware of the potential harm of Screening , its cost and burden on the health system and the need for strong quality assurance. This guide is designed for policy-makers and public health leads involved in planning, designing and implementing Screening programmes in the WHO European Region. It describes various aspects policy-makers should consider before starting, continuing or stopping a Screening programme and the operational, monitoring and evaluation aspects of implementation.

3 This guide forms part of WHO s efforts to increase the effectiveness of Screening programmes within the Region, maxi-mizing benefits and minimizing harm. World Health Organization 2020 ISBN 978 92 890 5478 2 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike IGO licence (CC BY-NC-SA IGO; ). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below.

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9 Iii ContentsList of boxes ivList of figures ivAcknowledgements viForeword viiPreface viiiIntroduction 1 What is Screening ? 3 Aims of Screening programmes 5 Wilson & Jungner s principles of Screening 7 Screening programmes as pathways 8 Measuring test performance 9 Understanding how Screening tests work in practice 9 Measuring outcomes from Screening programmes 12 Benefits and harm of Screening 14 Benefits 14 Maximizing the benefits of Screening programmes 14 Harm 14 Understanding harm 15 Balancing benefits and harm 18 How are benefits and harm compared?

10 18 Who benefits? 19 Does the context affect the balance between harm and benefits? 19 Ethics of Screening 19 Deciding whether to start or stop a Screening programme 22 Leading the process 22 Recognizing different interests 22Is Screening the answer? 22 What does the evidence say? 22 Modelling numbers and costs 25 Using criteria to guide decision-making 25 Pilot testing 27 Designing effective Screening programmes 28 Types of Screening 28 Multiple Screening tests carried out at the same time 28 Operational readiness 33 Leadership.