Report from the Evaluation Indicators Working Group: Guidelines for Monitoring Breast Screening Program Performance

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Appendix A: Conceptual Framework

The Conceptual Framework is an updated modification of the classic Wilson and Jungner²⁷ criteria:

• The target cancer should be appropriate for screening.
• The objectives of the screening must be clearly identified.
• There should be an appropriate screening test.
• There should be agreement on the appropriate management of people with positive results on the screening test.
• There must be sound evidence that screening has a favourable impact on its intended objectives.
• Screening should do more good than harm.
• The health care system should be capable of supporting all necessary elements of screening, including diagnosis and treatment.
• Screening should be endorsed only if it is provided in a continuous manner in conjunction with the necessary quality assurance and programmatic elements.

Cancer screening should incorporate all of the essential programmatic elements of the clinical trials that form its evidentiary base. These Key Elements include the following:

• Screening must be comprehensive, including recruitment, recall, follow-up and timely assessment of people with positive screening tests.
• Screening must be supported by public education, including education about primary prevention when applicable.
• Screening must be supported by the education of health care workers.
• All eligible people should have reasonable access to screening, diagnostic assessment and treatment.
• The groups targeted for participation in a screening program should be selected on the basis of a realistic understanding of the harms and benefits of screening and the manner in which health information will be managed.
• All aspects of the screening program must be subject to continuous monitoring and evaluation.
• Screening programs must adopt a culture of continually striving to increase the benefits and minimize the harms of screening.
• Screening programs must have the capacity to modify screening standards, guidelines and best practices on the basis of new scientific evidence.
• The program must have an effective and efficient computerized information system.
• There must be adequate resources (financial, physical, human and informational) to support all aspects of screening.

Screening programs must include a consumer perspective in all aspects of planning and operations.

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