Appendix X

Factors to be Considered when Recommending Starting and Stopping Times for Screening

1. Evidence regarding the following factors should be considered when recommending initiation of screening:
   1. Whether the attributable risk and potential burden of the targeted condition is limited to or increased significantly in subgroups of people who are easily identified by one or more of the following factors: age, gender, ethnicity, particular behaviors (e.g., sexually active), and/or comorbid or biological risk factors.
   2. Whether the potential to avert risk and burden is decreased by competing risks such as short life expectancy.
   3. Whether the accuracy of available screening tests differs or is uncertain in particular subgroups of people.
   4. Whether the feasibility, efficacy, and/or harms of treatment for the risk factor or target condition differ in particular subgroups of people.
   5. Whether available research about 1-4 is limited to particular subgroups of people, particularly if there is biological or epidemiological knowledge that suggests the risk of disease, the accuracy of the screening test, and/or the efficacy of the treatment may vary significantly across a particular subgroup.
2. Evidence regarding the following factors should be considered when recommending termination of screening:
   1. Whether risk and potential burden of the targeted condition is absent or decreased significantly in subgroups of people who are easily identified by one or more of the following factors: age, gender, ethnicity, particular behaviors (e.g., sexually inactive), and/or biologic or physical factors (e.g., surgical removal of target organ).
   2. Whether the potential to avert risk and burden is decreased by competing risks such as short life expectancy.
   3. Whether the accuracy of screening tests differs or is uncertain in particular subgroups of people.
   4. Whether the feasibility, efficacy, and/or harms of treatment for the risk factor or target condition differ in particular subgroups of people.
   5. Whether available research about 1-4 is limited to particular subgroups of people, particularly if there is biological or epidemiological knowledge that suggests the risk of disease, the accuracy of the screening test, and/or the efficacy of the treatment may vary significantly across a particular subgroup.
   6. Whether the natural history of the target condition suggests a long development or precursor period and prior screening tests have been negative.

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