Organising a Screening Service (e.g Breast cancer)
- Identifying women to be screened
- Non- invited - fail safe mechanism so positive results leads to action
- Basic screening - taking mammograms, reading, notifying
- Localised screening units
- Assessment and biopsy
- Screening records systems
- Identification, invitation, recall
- Attendance, test/recall
- Monitoring process/ effectiveness
- Quality of mammography between and within centres
- Radiation protection/ monitoring
Criteria for appraising screening
|Use mnemonic: 'PRAT WILSON'
P - Protocols
R - Resources for screening and treatment
A - Activity continuous
T - treatable condition
W - Worthwhile - evidence of effectiveness
I - Importance - incidence / death rate
L - Latent phase - early detectable phase
S - Suitable and acceptable test
O - Outcome improved by early detection - benefits >harm
N - National History known
Then add: 1990's criteria for appraising screening to PRAT WILSON.
Is there evidence from RCT that proposed screening reduces death rate
If yes - what is NNT
If yes - how many people adversely affected by screening: / 1000 screened or / life saved.
If yes - how broad are Confidence intervals
If yes - what are financial cost of screening program.