Regulations, Guidelines and Circulars

11 Feb 2020

06 Mar 2019

MH 53:34/13

1.   The Screening Test Review Committee (STRC), under the Academy of Medicine Singapore (AMS), reviews and makes recommendations on the appropriate use of specific screening tests based on prevailing scientific evidence. The STRC Guidelines 2019, updated from the previous version in 2011, has been published on the AMS website.

2.   Under the guidelines, screening tests have been classified into three categories to guide medical professionals who provide screening for their patients.

   (i)   Category 1 - Suitable for population-level screening (i.e. Good and robust evidence that the test is both clinically effective and cost effective for screening of the general population).

   (ii)   Category 2 - Suitable for individual-level decision (i.e. Screening may be useful for high-risk populations, or there is evidence that the test is clinically effective but cost-effective has not been evaluated or that is not favourable).

   (iii)   Category 3 - Not recommended (i.e. There is insufficient evidence to make a decision regarding the usefulness of the test, or there is good evidence that the test is not cost-effective, or that the net harms outweighs the benefits).

The list of recommended Category 1 and 2 tests can be found in Annex A and B.

3.   The Ministry of Health (MOH) has also introduced changes to population-level screening recommendations in Singapore based on a review of local and international evidence, and the endorsement of relevant professional bodies, including the STRC. The changes are as follows:

   (i)   Use of HbA1c as an alternative screening test for diabetes mellitus (in addition to Fasting Plasma Glucose, which remains one of the recommended tests) (See Annex C for details).

   (ii)   Use of non-fasting lipid profile as an alternative initial screening test for lipid disorders (in addition to fasting lipid profile, which remains one of the recommended tests) (See Annex D for details).

   (iii)   Use of Human Papillomavirus (HPV) test as the new primary screening test (instead of Pap smear) for cervical cancer, for women aged 30 years and above (See Annex E for details).

The alternate screening tests for diabetes mellitus and lipid disorders could facilitate opportunistic screening. The new HPV test for cervical cancer screening has better sensitivity and reduces frequency of screening for women aged 30 years and above.

4.   Recommendations reflected in this circular are effective immediately. However, under the Screen for Life (SFL) Programme, subsidies for the above mentioned tests will only be available from 7 May 2019 onwards. For Community Health Assist Scheme (CHAS) General Practitioners (GP), you will also receive a separate circular which will provide more details on the corresponding operational changes to the SFL programme, in view of the revised population-level screening recommendations as detailed in para 2.

5.   Please email MOH_INFO@moh.gov.sg should you require further clarifications.

Thank you.


A/PROF BENJAMIN ONG
DIRECTOR OF MEDICAL SERVICES
MINISTRY OF HEALTH

Annex A: LIST OF CATEGORY 1 SCREENING TESTS
Annex B: LIST OF CATEGORY 2 SCREENING TESTS
Annex C: USE OF HBA1C AS AN ALTERNATIVE INITIAL SCREENING TEST FOR DIABETES MELLITUS
Annex D: USE OF NON-FASTING LIPID PROFILE AS AN ALTERNATIVE INITIAL SCREENING TEST FOR LIPID DISORDERS
Annex E: USE OF HUMAN PAPILLOMAVIRUS (HPV) TEST AS THE PRIMARY SCREENING TEST INSTEAD OF PAP SMEAR FOR WOMEN AGED 30 YEARS AND ABOVE




The full document (together with Annex A,B,C,D,E) can be downloaded below:
Download [.PDF, 211KB]