Standard monitoring and evaluation procedures may be complemented by operational research aimed at improving the performance of screening in the local setting as well as research aimed at improving the global evidence base for screening. Topics that may be explored include:
- assessing the accuracy and performance of different algorithms for screening and diagnosis;
- identifying operational challenges and solutions;
- identifying the best ways to improve acceptability and minimize the harms of screening;
- establishing the effectiveness and cost–effectiveness of screening in different risk groups and in different epidemiological situations;
- establishing local calibration of CAD software for the specific case of a programme.
There is a need for more, larger and better randomized trials to assess the short-term and longterm effectiveness and cost–effectiveness of screening. Implementing such studies requires careful planning and considerable resources.