Figure 2. A framework for ongoing improvement of cancer-screening programmes.

We present a modified version of the screening cascade proposed by the High‑Value Care Task Force of American College of Physicians¹⁰⁹. Our recommendations for cancer-screening programmes focus on incorporation of key clinical questions at each step of the cascade, as well as components of the ‘feedback loop’ (areas to refine) — aspects of screening decision‑making that can be actively improved using outcomes from the corresponding step on the cascade. IDLE, indolent lesions of epithelial origin.