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British Medical Bulletin 1998;54 (number 4) is an issue devoted to health screening and consists of 17 expert reviews on screening topics. The volume, entitledScreening is edited by Professor Catherine Peckham and Dr Carol Dezateux (Department of Epidemiology and Public Health, Institute of Child Health) who have compiled a series of excellent contributions.
The first contribution is by the editors and looks at the issues underlying screening programmes. Their thought provoking introduction raises many important but little recognised issues in screening and sets the scope and context for the rest of the book. They point out there has been an exponential rise in new screening programmes, reflecting rapid technological development and based on the assumption that early detection must be good. As the authors illustrate, this is not always true, and screening has the potential to do harm as well as good. For example, there is increasing recognition that people who receive false positive results may experience considerable anxiety, which may last even after follow up tests are negative. This introduction also highlights the need to base screening programmes on randomised trial evidence to avoid falsely concluding that screening is beneficial when, in fact, it is only detecting disease earlier, or detecting disease that would never have been clinically important. They also raise the thorny issues of adequate informed consent for screening and screening for genetic mutations.
Many of these difficult questions are discussed in detail in later contributions. For example, there is a paper on communication and interpretation of risk that concisely reviews key psychological research and discusses it in the context of individuals having to make difficult [screening] decisions under conditions of uncertainty. Other topical themes picked up in subsequent papers are: screening for prostate cancer, screening for colorectal cancer, economic perspectives in screening, and ethical and legal issues in screening.
It is an excellent guide through this difficult and complex subject and would be a valuable resource for anyone working in the area.
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