The Wilson-Jungner criteria for screening list nine conditions. Which criterion is most often cited to CONTRAINDICATE population-wide screening for a disease where treatment of screen-detected cases carries a 5% serious complication rate but the disease has an annual incidence of 1 per 100,000?
- A The natural history of the disease is not adequately understood
- B The disease should be an important health problem — low incidence fails this criterion ✓
- C There should be an accepted treatment for the disease
- D Case-finding should be a continuous process, not a once-and-for-all project
Correct answer: B. The disease should be an important health problem — low incidence fails this criterion
Explanation
Wilson and Jungner criterion 1 states the disease screened for must be 'an important health problem' — meaning it has sufficient frequency, severity or burden to justify a population-wide programme. A condition with incidence of 1 per 100,000 has negligible absolute burden; a 5% treatment complication rate would harm many more healthy screen-positive individuals than benefit true disease cases (absolute harm > absolute benefit), violating both criterion 1 and the principle of net benefit. This cost-benefit inversion is the most direct disqualifier here.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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