title: A framework provided an outline toward the proper evaluation of potential screening strategies.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Our framework provides an outline toward the proper evaluation of potential screening strategies before considering implementation.
authors: Centre of General Practice, Department of Public health and Primary Care, Katholieke Universiteit Leuven, Kapucijnenvoer 33, Blok J, 3000 Leuven, Belgium. wim.adriaensen@med.kuleuven.be
authors: Wim J
authors: WJ
authors: Adriaensen
authors: Cathy
authors: C
authors: Matheï
authors: Frank J
authors: FJ
authors: Buntinx
authors: Marc
authors: M
authors: Arbyn
mesh_terms: D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000379:methods; D005069:Evaluation Studies as Topic; D005260:Female; D017408:Guidelines as Topic; D062489:Health Impact Assessment; D006801:Humans; D008403:Mass Screening / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D012107:Research Design; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control*