Pre-participation screening of all competitive athletes is recommended in some countries and mandated in others to prevent sudden cardiac death in predisposed athletes. Whilst the prevalence of some conditions, which are screened for such as coronary artery anomalies and long QT syndromes, are stable across different populations, the prevalence of underlying conditions such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular dysplasia shows considerable geographic variability. Evidence exists that screening reduces sudden death, but the potential negative impact of exclusion from sport has not been quantified. Australia has a high rate of participation in sport and needs to consider whether screening is feasible, effective and affordable. It is difficult to make this decision currently as there is little information about the scope of the problem in Australia and whether the prevalence of underlying conditions which predispose to sudden cardiac death is similar or different to that in other countries. We review the evidence for and against screening and propose that systematic collection of Australian data is required before routine pre-participation screening can be introduced in Australia.