General introduction 13 1 Table 1. Criteria of Wilson and Jungner (1968) 1 The disease to be detected must be a major health problem. 2 There must be a generally accepted method of treatment for the disease. 3 There must be adequate facilities for diagnosis and treatment. 4 There must be a recognizable latent or early symptomatic stage of the disease. 5 A reliable detection method must exist. 6 The detection method must be acceptable to the public. 7 The natural course of the disease to be detected must be known. 8 There must be agreement as to who should be treated. 9 The cost of detection, diagnosis and treatment must be in an acceptable proportion to the cost of health care as a whole. 10 The process of detection must be a continuous process and not a one-time project. In 2008, a list of additional criteria was drawn up by the World Health Organization (WHO). Although the abovementioned criteria are intended for large-scale screenings, such as national population studies, they can also be used as guidance for small-scale screenings. Think of local initiatives or specific patient groups. It becomes less clear when screening is used on an individual basis for complaints that would otherwise be overlooked. Or when it concerns using the screener as a severity scale. It is doubtful whether this is still a screening in itself, or whether it is more about using a screener to follow the course of a disease for an individual situation. Other ethical criteria, which are usually enshrined in health laws, will come into effect. However, what if the “on indication” is applied to all (referred) patients? Therefore, we will consider the WHO criteria as a starting point, but not as a rule. Several criteria enumerated by the WHO are touched upon in this dissertation, whereas many are not answered for various reasons. The most important reason is that the criteria themselves are not the subject of our study, but we use them as guidelines. As the above personal clinical experience illustrates, it is easy to overlook (or ignore) other matters that are at hand, such as social isolation or cognitive impairment (the underlying cause of a problem?), when your attention is focused on something else (the main complaint). In particular, when efficiency is expected due to time constraints and costs, to minimise waiting lists. Screening can never be a substitute for a thorough diagnostic workup. However, can screening not be a helping hand? If so, when should one consider screening? In addition to the above criteria, when a screening is justified, there are also costs. These costs should not be limited to the financial sphere (Table 1, criteria 9). There are many
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