Screening for scoliosis - New recommendations, old dilemmas, no straight solutions

Table 6 Fifty years after Wilson and Jungner, Consolidated principles for screening, 2018[9]

“Consolidated principles for screening” Dobrow et al[9], 20181
“Disease/condition principles:
1 Epidemiology of the disease or condition (..) should be adequately understood, and the disease or condition should be an important health problem
2 Natural history of disease or condition (…) should be adequately understood, the disease or condition is well-defined, and there should be a detectable preclinical phase
3 Target population for screening (…) should be clearly defined (e.g., with an appropriate target age range), identifiable and able to be reached
Test/ intervention principles:
4 Screening test performance characteristics (…) should be appropriate for the purpose, with all key components specific to the test (…) being accurate (…) and reliable or reproducible. The test should be acceptable to the target population and it should be possible to perform or administer it safely, affordably and efficiently
5 Interpretation of screening test results. Screening test results should be clearly interpretable and determinate (e.g., with known distribution of test values and well-defined and agreed cut-off points) to allow identification of the screening participants who should (and should not) be offered diagnostic testing and other postscreening care
6 Postscreening test options. There should be an agreed (…) course of action for screening participants with positive screening test results that involves diagnostic testing, treatment or intervention, and follow-up care that will modify the natural history and clinical pathway for the disease or condition; that is available, accessible and acceptable to those affected; and that results in improved outcomes (…). The burden of testing on all participants should be understood and acceptable, and the effect of false-positive and false-negative tests should be minimal
Program/ system principles:
7 Screening program infrastructure (…)
8 Screening program coordination and integration (…)
9 Screening program acceptability and ethics. All components of the screening program2 should be clinically, socially and ethically acceptable to screening participants, health professionals and society, and there should be effective methods for providing screening participants with informed choice, promoting their autonomy and protecting their rights
10 Screening program benefits and harms. The expected range and magnitude of benefits (…) and harms (…) for screening participants and society should be clearly defined and acceptable, and supported by existing high-quality scientific evidence (or addressed by ongoing studies) that indicates that the overall benefit of the screening program outweighs its potential harms
11 Economic evaluation of screening program (…) (e.g., cost-effectiveness analysis, cost–benefit analysis and cost–utility analysis) (…), using a health system or societal perspective, (…) to assess the full costs and effects of implementing, operating and sustaining the screening program while clearly considering the opportunity costs and effect of allocating resources to other potential nonscreening alternatives (…)
12 Screening program quality and performance management (…)

¹based on a systematic review and a modified Delphi consensus process, using 41 sets and 367 screening principles[9]; elaborations abridged;

²i.e. “recruitment, testing, information access, diagnosis, referral, treatment, follow-up, patient education and support, staff training and program management and evaluation”[9].