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Population based screening - the difficulty of how to do more good than harm and how to achieve it.
Swiss Medical Weekly
Print issue September
Screening people without symptoms of disease is an attractive idea. Screening allows early detection of disease or elevated risk of disease, and has the potential for improved treatment and reduction of mortality. The list of future screening opportunities is set to grow because of the refinement of screening techniques, the increasing frequency of degenerative and chronic diseases, and the steadily growing body of evidence on genetic predispositions for various diseases. But how should we decide on the diseases for which screening should be done and on recommendations for how it should be implemented? We use the examples of prostate cancer and genetic screening to show the importance of considering screening as an ongoing population-based intervention with beneficial and harmful effects, and not simply the use of a test. Assessing whether screening should be recommended and implemented for any named disease is therefore a multi-dimensional task in health technology assessment. There are several countries that already use established processes and criteria to assess the appropriateness of screening. We argue that the Swiss healthcare system needs a nationwide screening commission mandated to conduct appropriate evidence-based evaluation of the impact of proposed screening interventions, to issue evidence-based recommendations, and to monitor the performance of screening programmes introduced. Without explicit processes there is a danger that beneficial screening programmes could be neglected and that ineffective, and potentially harmful, screening procedures could be introduced.
Adult, Cost-Benefit Analysis/statistics & numerical data, Early Detection of Cancer/adverse effects, Early Detection of Cancer/economics, Early Detection of Cancer/standards, Early Detection of Cancer/statistics & numerical data, Early Diagnosis, Evidence-Based Medicine/standards, Evidence-Based Medicine/statistics & numerical data, Female, Genetic Testing/economics, Genetic Testing/standards, Health Plan Implementation/economics, Health Plan Implementation/standards, Health Plan Implementation/statistics & numerical data, Humans, Incidental Findings, Infant, Newborn, Mass Screening/adverse effects, Mass Screening/economics, Mass Screening/standards, Mass Screening/statistics & numerical data*, Neonatal Screening/standards, Neoplasms/diagnosis, Neoplasms/mortality, Neoplasms/prevention & control, Pregnancy, Prenatal Diagnosis, Switzerland, Technology Assessment, Biomedical, Unnecessary Procedures/economics, Unnecessary Procedures/statistics & numerical data
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