Article

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

Centre of General Practice, Department of Public health and Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 33, Blok J, 3000 Leuven, Belgium. Electronic address: .
Journal of clinical epidemiology (Impact Factor: 5.48). 02/2013; 66(6). DOI: 10.1016/j.jclinepi.2012.09.018
Source: PubMed

ABSTRACT 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.

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May 30, 2014