Other Population Health Screening Issues
This page contains information relating to other population health screening issues.
- Population Based Screening Framework
- What is Population Screening?
- Screening and early detection of skin cancer statement
- Prostate Cancer Screening in Australia: Position Statement
Population Based Screening Framework
The Screening Subcommittee of the Australian Population Health Development Principal Committee (APHDPC) has developed a Population Based Screening Framework (PDF 144 KB) to provide guidance to decision makers when assessing potential screening programs in Australia.What is Population Screening?
Population screening is where a test is offered to all individuals in a target group, usually defined by age, as part of an organised program.Screening can help protect your health through early detection, even if you don’t have any symptoms of the disease.
Screening involves simple tests to look for particular changes, or early signs of a disease, before a disease has developed or in its early stages before any symptoms develop.
There must be evidence that early diagnosis and treatment increases your chances of successfully treating or managing the disease.
However, having a screening test will not necessarily prevent the disease happening in the future. If the disease has already developed, having a screening test cannot guarantee that it can be cured.
No screening test is 100% accurate which is why it is important to be screened at regular intervals. If you are worried that you might have a symptom or sign of the disease you should see your doctor, even if you have recently had a screening test.
Some screening tests are done on a large scale - usually through a national program, such as BreastScreen Australia.
This is called ‘population screening’ and tests large groups of apparently healthy people for early signs of a disease.
Screening is offered to a selected group of the population called the ‘target population’. This group is targeted because there is strong scientific evidence that they are most at risk of getting the disease and will get the most health benefit from screening.
An example of a target population is women aged between 50 and 69 years, who are encouraged to attend for free breast cancer screening through BreastScreen Australia. These women are at higher risk for developing breast cancer and will benefit most from screening.
When women reach the target age group they are invited for their first screening mammogram at a BreastScreen Australia service. Reminder letters are sent out when they are next due for their screening visit.
Anyone found to have signs of the disease through population screening is encouraged to return for further tests.
The Australian Government has developed a Population Based Screening Framework (PDF 144 KB), based on the World Health Organization (WHO) principles of screening. The aim of the Screening Framework is to provide guidance for decision makers when considering potential population based screening programs in Australia.
Population screening is planned and coordinated with the aim of bringing maximum health benefits for the community. The programs involved are assessed regularly to make sure they are safe and effective.
There are three national population-based screening programs in Australia: BreastScreen Australia, the National Cervical Screening Program, and the National Bowel Cancer Screening Program.
Why screen for cancer?
Treatment is most likely to be effective when screening finds cancer in its early stages.Some screening programs can also help to prevent cancer developing if changes can be found before they become a cancer.
The cervical and bowel cancer screening programs can find changes in the body before they become cancer. Treating these changes can help stop cancer developing.
Screening tests are different to diagnostic tests
Diagnostic tests are done if you already have symptoms of a disease. They prove that a disease is present.If you already have signs of a disease, or are at a higher risk of getting a disease, it is important that you see your own doctor for individual care. You should not wait until you are eligible to be involved in a population screening program.
Other types of screening
Other kinds of tests offered to the general population may be called ‘screening tests’ - but they are not part of population screening programs.Your doctor or health worker may offer screening tests to you at one of your routine appointments - depending on your history, age or circumstances.
Blood tests to check cholesterol or iron levels are examples of these types of tests.
What are the requirements for a population screening program?
The Population Based Screening Framework (PDF 144 KB) (October 2008), which is used to decide whether our population should be screened for a disease, advises:- The screening program will provide more benefit than harm to the people being screened.
- The condition should:
- be an important health problem.
- have a recognisable latent or early symptomatic stage.
- The test should:
- be able to find the early stages of the disease (be highly sensitive).
- be very accurate in finding the early stages of disease (be highly specific).
- be able to provide consistent results from the test (be validated).
- be safe.
- find most disease present at the time of the screening test (have a relatively high positive predictive value).
- be normal when there is no disease present (have a relatively high negative predictive value).
- be acceptable to the target population including important sub groups such as target participants who are from culturally and linguistically diverse backgrounds, Aboriginal and Torres Strait Islander people, people from disadvantaged groups, and people with a disability.
- Systems should be in place for evidence based follow up assessment of all people with a positive screening test regardless of rurality, ethnicity, socio economic status or disadvantage status.
- Treatment should be effective, available, easily accessible and acceptable to all patients with the recognised disease or condition.
Further information
If you require additional information on cancer screening please contact us at cancerscreening@health.gov.auScreening and early detection of skin cancer statement
The Screening Subcommittee of the Australian Population Health Development Principal Committee has endorsed The Cancer Council Australia’s position statement on Screening and early detection of skin cancer developed in consultation with the Australasian College of Dermatologists. A copy of the position statement is attached.The Screening Subcommittee identified there is no population based screening program in Australia for the early detection of skin cancer. In determining whether there is sufficient evidence to establish an organised population-based screening program the Australian Government currently adheres to the Population Based Screening Framework, based on the World Health Organization (WHO) population screening principles, which recommend that screening programs are based on clear evidence of better health outcomes for the screened population. The WHO principles are:
- The condition should be an important health problem.
- There should be a recognisable latent or early symptomatic stage.
- The natural history of the condition, including development from latent to declared disease should be adequately understood.
- There should be a suitable test or examination.
- The test should be acceptable to the population.
- There should be an accepted treatment for patients with recognised disease.
- There should be an agreed policy on whom to treat as patients.
- Facilities for diagnosis and treatment should be available.
- The cost of case-findings (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
- Case-findings should be a continuing process and not a ‘once and for all’ project.
- Do not recommend mass or population-based screening for:
- non-melanocytic skin cancer, as the disease in the vast majority of cases is not life-threatening or serious enough to cause long term illness; or
- melanoma, as research indicates that current diagnostic practices for melanoma are not optimal in terms of accuracy or cost-effectiveness and there is insufficient evidence that screening the general population offers reduced morbidity and mortality.
- Recommend that general practitioners:
- develop surveillance programs for patients at high risk;
- assess patients who are concerned and develop appropriate management programs depending on their level or risk; and
- who identify risk factors for skin cancer in patients presenting for other reasons to inform patients about sun protection measures and offer them an opportunity for a full body examination and an appropriate management plan (i.e. case finding with follow-up).
Endorsed by the Australian Health Ministers’ Advisory Council - March 2008
Prostate Cancer Screening in Australia: Position Statement
Page currency, Latest update: 29 June, 2010