Reference framework for screening and medical surveillance in occupational health: Summary
By its very nature, screening is characterised by administering a test to presymptomatic or early symptomatic individuals who may benefit from a more effective intervention if it is performed before the usual time of diagnosis.
Far from being a trivial intervention, screening can lead to significant consequences to the people screened. Therefore, before offering screening to workers, its effectiveness and the predominance of benefits over disadvantages must be demonstrated at the population level. Furthermore, screening should have the recommended characteristics in order that the expected benefits can be observed in practice.
Approaches using algorithms or flowcharts are generally meant to be sequential. Our approach had to be flexible and allow for compromises. The proposed approach involves three key decision-making nodes, which must generally be addressed in a sequential manner. Generally speaking, a satisfactory response to one of them is required before moving on to the next. However, an evaluation of several key nodes can be performed simultaneously in an iterative way. The key decision-making nodes and underlying criteria should be viewed as a tool for analysis and reflection rather than as a rigid process.
Screening is performed in different contexts: it can be a "simple" screening activity, a screening program, medical surveillance, a pre-employment medical examination or a regulated medical examination. The use of screening should be evaluated from the perspective of the proposed approach and the specific aspects of each one, which are presented in the document.
Although the framework was designed to be applied specifically in the field of occupational health, the authors had a constant concern to make it as inclusive as possible and paid particular attention so that it could be applied to screening activities in the general population. However, in the case of medical examinations for non-occupational risks, the reader should consult the recommendations of experts committees or task forces and seek an understanding of the basis for their recommendations.