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Screening for disease prior to the development of overt manifestation of illness , also referred to as secondary prevention, has been a mainstay of public health practice. Few would question the value of screening for cervical dysplasia/cancer, hypertension, newborn hypothyroidism and enzyme deficiencies, or hypercholesterolemia. Disease that once showing overt symptoms are often already past points of symptomatic intervention.
Screening for disease prior to the development of overt manifestation of illness , also referred to as secondary prevention, has been a mainstay of public health practice. Few would question the value of screening for cervical dysplasia/cancer, hypertension, newborn hypothyroidism and enzyme deficiencies, or hypercholesterolemia. Disease that once showing overt symptoms are often already past points of symptomatic intervention.
Of course once diagnosed, there is an intervention that is
required. For cervical dysplasia that
has been reduced to essentially a one-time cure. The other illnesses noted above often
require lifelong intervention and incur significant costs.
Screening programs only work if they reach a high proportion
of the population at risk for developing the disease – hence the cost can be
significant. Compound this where there
are individuals or groups of individuals who stand to benefit from the
screening program who are separate from where the cost benefits of early
intervention are accrued and a fertile ground for abuse develops. That ground can extend to biased research and poorly founded recommendations.
So in come the two major gender specific debates, screening
for breast and prostate cancers. Both are still the leading cancer type for
each of the sexes. The outcomes of both illnesses are dreaded and
frequently result in death, adding dramatization to the debate. The cost of a mammogram is about $100, that
of a prostate specific antigen (PSA) around is about half that. Spread over millions of folks, that begins to
look like a lot of money. Add to the
cost of screening is both have fairly high false positive rates that mean
intervention in the absence of disease that would likely have progressed.
So it is notable that within a short space of time there are
finally some review articles and lay literature beginning to push back based on
the negative consequences of overscreening. Health Evidence has recently published two reviews,
international
mammography comparison and meta-analysis of prostate
screening raising concerns about current programs. The former questioning the value of population
based screening and not even delving into the debates of age-specific
recommendations, the later further fuelling the evidence that PSA screening is
not recommended.
Notable in the 2012 Cancer statistics just released, there is multiple references to the value of screening for cervical, breast, prostate, and colorectal cancers without mention of the potential negative consequences. Screening and secondary prevention have a very clear role in public health,but also in public health objectivity remains a core value, even in passionate debates over life and death. Worse still is the confusion caused by supposed 'expert' advice that is conflicting. Groups like the Canadian Task Force on Preventive Health Care were and are designed to wade through this myriad and develop defensable recommendations that all health care workers should follow http://www.canadiantaskforce.ca/
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