To screen or not to screen
From a patient perspective, screening for a specific disease sounds like a good idea. Many doctors will also go along with that statement, but we are in the privileged position of knowing that screening has both pros and cons and that, in some circumstances, there is no clear cut answer as to whether we should screen for a condition or not.
One obvious example is prostate cancer, for which, as explained on the NHS Cancer Screening Programmes website, "there is no organised screening programme... but an informed choice programme" (click here). In a perfect world we would have a clearer approach, but in medicine you cannot always get clarity until solid evidence arrives.
Maybe now we have clearer evidence regarding breast cancer screening at least, as recently featured in the Univadis news (click here). According to the report, an independent review concluded that "screening reduces breast cancer mortality but leads around 4,000 women per year in the UK to receive unnecessary treatment". This statistic will still be hard for many members of the public to understand. Fortunately, the article also provides a more patient-friendly explanation: "This translates to three women being overdiagnosed for every woman whose life is saved due to screening."
Given this kind of information, it does make it easier for people to understand the limitations and effectiveness of screening. Not only should we be aware of these facts and figures but we should also explain to patients that screening is not hazard free. It takes time to counsel patients and provide them with the information they need in order to consent to a screening procedure. Even then, patients can still become confused about the nature of the actual screening test. They may make a decision based on incomplete information or simply (not unreasonably) ask you what you would do in their situation.
Meanwhile we as healthcare professionals should have a deep understanding of the various issues in this complex area. We should be able to communicate this to our patients, while at the same time being aware that much more research into current and potential future screening programmes is needed.
Dr Harry Brown, editor-in-chief Univadis
By Dr Harry Brown