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Screening procedures that are definitely not worth doing routinely are barium enemas; barium meals; looking for cells in the sputum (spit); stress testing; lung-function tests; and biopsies of the lining of the uterus. All of these are, of course, useful diagnostic procedures in specific individuals.
Screening can be carried out in the community in general or it can be focused on specific sub-groups who are thought to be ‘at risk’. As we have seen, when screening for cervical cancer, money is best spent on screening women from lower down the socio-economic scale because it is much more common in this group.
Families are population sub-groups ripe for screening. The predisposition for many diseases (as well as truly hereditary disease, of course) runs in families. Common examples are breast cancer, diabetes, asthma and high blood pressure. Doctors have always considered screening families in the context of infectious diseases in the past but few do this kind î intra-family screening for chronic conditions.
Screening, especially the sort that involves paying a fixed sum for a batch of tests and examinations, is currently enjoying something of a revival. One of the attractions of screening programmes is that the; can often be inexpensive and can be implemented by relatively low grade personnel rather than doctors. But as the price has come down, fewer questions tend to be asked and screening is now-with the coming interactive computer systems-set become even more popular, after decade of apathy and serious questioning of its worth. Another reason for an increased interest in screening recently is that, with the setting-up of new health maintenance and prevention-orientated medical organizations, screening equipment and personnel can be used with the curative staff on hand. A major criticism of screening centers in the past has been that they left the patient high and dry with his or her findings from the screening. These new ways numbers of false positives that occur of working enable responsible follow- with certain screening procedures, up to be a part of the whole picture. This is essential in the light of the Much more research needs to be done before we can be absolutely sure just how valuable many screening procedures are. What looks like commonsense preventive medicine is often not so on deeper analysis. The danger with the coming of cheaper and easier screening methods is that society might ask fewer questions, not more.
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