The balance between benefits and harms of screening interventions may change over time. This can be caused by changes in disease prevalence; development of new more effective and safer treatments; recognition of previously overlooked harms; and emergence of new data that contradict previous conclusions. While there are established principles for the introduction of screening, there is a need for a framework for standardised, periodic, and independent re-assessment of screening interventions in current use. Evidence integrated into this framework may lead to a recommendation for de-intensification or de-implementation, for which practical guidance is also needed. Our project will address each of these important steps in the process. Re-assessment may also lead to recommendations to expand or intensify screening, although that process, while acknowledged, is not the focus of this project.
The conceptual basis will be GRADE and USPSTF principles for assessing benefits and harms of interventions. We will emphasise the importance of pre-specification of acceptable levels of benefits and harms, having independent panel members with diverse skill sets, and including citizen representatives. Our vision is that re-assessment and its conclusions have three components. Component 1 is reassessment, based on a standardisation process that includes setting up outcomes tables, and monitoring procedures for established screening practices. Component 2 is establishment of critical warning signs, and triggers indicating the need for a change in recommendations and policy. Component 3 is implementation and monitoring the impact on patient-relevant benefits and harms.