New concepts in screening.

TLDR

Screening is a public‑health service that must be managed at the population level to monitor quality, and when introduced it must follow Wilson and Jungner criteria to minimize harm and maximize benefit, yet evidence is often limited by the rarity of conditions, necessitating systematic reviews. The National Screening Committee first uses research evidence to identify programmes that do more good than harm, then makes policy recommendations for those programmes that achieve more benefit at reasonable cost by considering opportunity cost. In the United Kingdom this is carried out by the National Screening Committee.

Abstract

ALTHOUGH screening is often delivered by clinicians, screening programmes are public health services that need to be managed at the level of a large population to monitor quality effectively. In the United Kingdom (UK) this is carried out by the National Screening Committee. The first task of the National Screening Committee is to use research evidence to identify programmes that do more good than harm. The second is to make policy recommendations about those programmes that will do more good than harm at reasonable cost, focusing on opportunity cost; that is, the professional time involved, as well as the financial cost. When it has been decided to introduce screening, using criteria based on the Wilson and Jungner WHO criteria, 1 care has to be taken to ensure that the programme is set up in a way that will minimise harm and maximise benefit. In policy making the evidence for screening is often limited because of the rarity of the conditions being screened for, which minimises the contribution that the randomised controlled trial can make, but emphasises the need for a systematic review of the evidence.