Appraising organised screening programmes for testing for genetic susceptibility to cancer

Public health officials rely on criteria developed by Wilson and Jungner for assessing whether or not to implement population screening programmes. These criteria were developed over 30 years ago, when screening primarily focused on detecting early stages or precursors of chronic disease. With the introduction of testing for genetic susceptibility, particularly for cancer, it is important to assess whether these criteria can continue to be applied in the decision making process. We report on a workshop that assessed criteria for population screening in the context of testing for genetic susceptibility to cancer.

Many criteria for the evaluation of screening programmes have been proposed, 1 2 and most are similar to those proposed by Wilson and Jungner in a 1968 World Health Organization report.3 The criteria are based on a simple linear model of disease progression (figure) in which screening tests primarily detect a preclinical asymptomatic phase.

The continuum of screening has expanded to include a range of other states. The figure illustrates another model for screening—screening for risk factors or susceptibility, the detection of risk factors for disease4 (such as blood pressure or cholesterol concentration), or the identification, through the detection of genetic markers, of individuals who have increased susceptibility to disease.5 Separate consideration of these forms of screening is important as the type of interventions …