Table 1

The Wilson and Jungner criteria from 1968 that must be satisfied for screening to be justified

PrincipleFurther explanation by Wilson and Jungner
The condition sought should be an important health problem.Not only regarding prevalence, conditions with serious consequences for either individuals or the community may both justify screening.
There should be an accepted treatment for patients with recognised disease.If not, actual harm may be done.
(1) Does treatment at the presymptomatic stage or at an earlier disease stage than normal affect its course and prognosis?
Facilities for diagnosis and treatment should be available.Resources must be available for further diagnostic evaluation and treatment.
There should be a recognisable latent or early symptomatic stage.Must be a relevant asymptomatic period in the course of the CVD.
There should be a suitable test or examination.Acceptable to be less sensitive and specific than diagnostic tests. Higher false-positive rate may be acceptable, but high false-negative rate is not.
The test should be acceptable to the population.Acceptability is related to the nature and risk of the test, and whether the target population finds it relevant. The latter may need public education. Acceptability is not solely dependent on overall acceptance rate but also on adequate actable rate among those in higher risk.
The natural history of the condition, including development from latent to declared disease should be adequately understood.It is necessary to know what changes are pathological and what are physiological variations, and are early pathological changes progressive?
There should be an agreed policy on whom to treat as patients.There is a ‘borderline’ problem whereby people are found by screening who are neither clearly normal nor abnormal. It is important to have a clear policy for either treatment or follow-up of these people.
The cost of case findings should be economically balanced in relation to possible expenditure on medical care as a whole.The aims of screening are to improve health and/or to reduce costs. If benefit is gained for increased costs, it is important to know the costs per gained benefit outcome. RCTs are almost mandatory to clarify this.
Case finding should be a continuing process and not a ‘once and for all project’.The benefit of ‘single-occasion’ screening is mostly limited.
  • CVD, cardiovascular disease; RCTs, randomised, controlled trials.