Screening tests - weighing up the benefits and harms

Screening tests can be very important and useful in preventing disease or detecting it at an early stage where treatment is more likely to succeed.

Examples of successful screening programs include newborn screening for inherited metabolic diseases and cervical screening for cancer of the cervix in women. Some screening programs are less successful such as serum PSA screening for prostate cancer in men.

In order for a screening program to be successful a number of criteria must be met:

  • the disease should be an important health problem
  • there should be a recognisable  early stage of the disease
  • there should be an effective treatment for patients with recognised disease
  • there should be a suitable test or examination that has a high level of accuracy
  • the test should be acceptable to the population
  • facilities for diagnosis and treatment should be available
  • there should be an agreed policy on who should be treated
  • the cost of the screening program (including diagnosis and treatment of patients diagnosed) should be an effective use of resources that could otherwise be used for something else

On the Lab Tests Online Australasia website a number of screening programs are discussed in our Health Check drop-down list.

There are a variety of harms that can come out of screening programs and people being screened should be aware of these. The most important are false-positive diagnosis and false-negative diagnosis. False-positive results cause unnecessary harm by worrying the affected person and causing them to be subjected to unnecessary and potentially harmful investigations and expense. False-negative results cause the person to be falsely reassured that they are disease-free.

Sense about Science is a UK-based charity that aims to provide information to the public about science and its uses. They have recently published a very useful booklet and web resources called Making Sense of Screening.

The slide show on the web can be found here and is highly recommended to anyone interested in health screening.

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