Evidence-based Recommendations on Health Screening Tests

I would like to go for health screening. How do I know which screening tests are suitable for me?

Health screening is important to everyone. It enables you to find out if you have a particular disease or medical condition even if you do not have any symptoms or show any signs of a disease or even if you feel perfectly well. It is important that you discuss with your doctor to understand your risk profile and ask about the potential benefits, limitations and harms associated with the different screening tests so that you can make an informed decision. Read on to find out more.

Health screening is conducted to facilitate early diagnosis of diseases, so that treatment and intervention can help prevent complications and to achieve better health outcomes.

There are screening tests that are suitable to be applied for the entire population because there is robust scientific evidence supporting their use and effectiveness in detecting diseases. However, there are many tests which are not backed by evidence, and when conducted, could lead to physical or psychological harms to those screened. Given the wide range of medical conditions for which screening is being offered, and the tests available for screening, a framework to categorise screening tests is necessary.

In Singapore, the Ministry of health has appointed the Screening Test Review Committee (STRC) to review scientific evidence of these screening tests for their effectiveness, potential benefits and harms and provide recommendations on the appropriateness of use in early detection. The STRC report classifies these recommendations by placing the screening tests in 3 categories:

• Category 1 - Suitable for population-level screening i.e. beneficial for everyone.
There is good and robust evidence that the screening test is both clinically effective and cost effective for use to screen the population. These tests are usually adopted into population-based screening programmes, for example, Screen for Life. These tests are listed in Table A.

• Category 2 - Suitable for individual-level decision i.e. beneficial for some but not others.
The net benefit does not outweigh the risk in general populations, but the screening may be useful for high-risk populations, or there is some evidence that the screening test is clinically effective but cost-effectiveness has not been evaluated or is not favourable. In these cases, decision will be made at an 'individual' level, based on an individual's risk factors, e.g. family history of hereditary or chronic diseases, exposure to factors that can lead to disease etc. For this category of tests, decision should be based on consultation with your family doctor, e.g. kidney function test is useful to screen for any impairment of kidney function in persons with diabetes, but this will not necessarily apply as a screening test in the general population.

• Category 3 - Not recommended.
There is insufficient evidence to make a decision regarding the usefulness of the test, or there is good evidence suggesting that the screening test is not effective, or that the net harm outweighs benefits of the tests, e.g. Ultrasound Breast.

Table A – General Screening Tests (Beneficial for everyone)

General Screening Tests for Adults