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.
Original language | English |
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Pages (from-to) | 639-647 |
Journal | Journal of Clinical Epidemiology |
Volume | 66 |
Issue number | 6 |
DOIs | |
Publication status | Published - Jun 2013 |
Keywords
- Cancer screening
- Screening evaluation
- Cervical cancer
- Screening strategy
- Harm benefit
- Framework