Table 2.

Wilson and Jungner criteria applied to screening for renal cell carcinoma (RCC) [14]

Criteria for screening	Application to RCC screening
The condition sought should be an important health problem	Renal cancer is the 7th most common cancer in Europe [98]
There should be an accepted treatment for patients with recognised disease	Detection of smaller tumours may preferentially allow minimally invasive techniques reducing rates of open surgery, and therefore, associated morbidity and length of hospital stay
Facilities for diagnosis and treatment should be available	In a health service with a finite budget, important considerations must be made regarding the cost of investigations and management of patients found to have benign SRMs on screening
There should be a recognisable latent or early symptomatic stage	The sojourn time of RCC is between 3.7 and 5.8 years, suggesting that most RCCs have a detectable preclinical period [44]
There should be a suitable test of examination	Focused renal ultrasound thus far represents the only validated screening tool, with high sensitivity (82–83.3%) and specificity (98–99.3%) [56, 57]. Accurate and inexpensive, non-invasive methods of renal cancer detection, using blood or urine as the substrate, remain a research priority
The test should be acceptable to the population	Ultrasound is non-invasive and well tolerated by the general population. AAA screening is performed with ultrasound and attendance rates are 84–85%, with similar rates expected for RCC. [48, 49]
The natural history of the condition, including development from latent to declared disease, should be adequately understood	Reliable clinical predictors of a tumour’s growth rate and aggressiveness are not available Advances have been made in understanding the natural history of small renal masses and the European Active SurveillancE of Renal cancer (EASE study) aims to clarify this further [99]
There should be an agreed policy on whom to treat as patients.	Clear European Association of Urology guidelines have been published regarding the management of RCC [7]
The cost of case finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole	A cost-effectiveness analysis is warranted and constitutes a key research priority highlighted in this analysis
Case finding should be a continuing process and not a “once and for all” project	A cost-effectiveness analysis may elucidate the optimal screening frequency, be it one off screening such as AAA, or recurrent screening

AAA abdominal aortic aneurysm, RCC renal cell carcinoma, SRM small renal mass