Box 1. Criteria for assessment of screening.
Wilson and Jungner | Crossroads 99a |
---|---|
Knowledge of disease | Knowledge of population and disease |
Condition must be an important problem. | Burden of target disease should be important. |
Target population or population at risk identifiable. | |
Recognizable latent or early symptomatic stage. | Considerable level of risk or latent or preclinical phase. |
Natural course of condition (including development from latent to declared disease) should be adequately understood. | Natural course (from susceptibility to precursor, early disease, and advanced disease) should be adequately understood. |
Knowledge of test | Feasibility of screening procedures |
Suitable test or examination. | Suitable test or examination. |
Test acceptable to the population. | Entire screening procedure acceptable to the population. |
Case finding should be a continuing process and not ‘once and for all' project. | Screening should be a continuing process and should encompass all elements of screening procedures. |
Treatment for disease | Interventions and follow-up |
Accepted treatment for patients with recognized disease. | Interventions that have physical, psychological, and social net benefit available. |
Facilities for diagnosis and treatment available. | Facilities for adequate surveillance, prevention, treatment, education, counselling, and social support available. |
Agreed on policy concerning whom to treat as patients. | Consensus on accepted management for those with positive test results. |
Cost considerations | Societal and health system issues |
Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as a whole. | Costs should be balanced in economic, psychological, social, and medical terms and with health-care expenditures as a whole. |
Appropriate screening services accessible to the entire population, without adverse consequences for non-participants. | |
Appropriate confidentiality procedures and antidiscrimination provisions for participants and non-participants. |
Ethical, legal, and sociobehavioral issues are considered across all domains. Screening should be considered within a framework that recognizes fundamental human rights.
Source: Reproduced from Goel.80 Copyright © 2001 with permission from BMJ Publishing Group Ltd.