Screening: Evidence and PracticeScreening is the routine testing of populations to identify individuals who may have a particular medical condition or disease. It is carried out by both government and private organisations with the aims of: better prognosis/outcome for individuals; to protect society from contagious disease; to allow rational allocation of resources; to allow selection of healthy individuals; and for research purposes. About £500 million is spent on screening each year in Britain alone, and it is an issue that has relevance in health systems and for the general public and media. For many years, screening was practised without debate, but in the 1960s serious challenges were raised about standard screening procedures. Benefits of screening must be judged against negative side-effects, and concern was raised about potential and actual harm arising when people without a health problem received dangerous and unnecessary investigations and treatments as a result of 'routine' screening tests. Controversy raged and only now 50 years later, is there widespread recognition that quality assured service delivery and proper consumer information are essential. In addition to debate over health risks, the cost-effectiveness of such results also has to be considered, making this a highly contested issue. This book serves as a non-technical, introductory guide to all aspects of screening. The first section deals with concepts, methodology and evidence, explaining what screening is and how to evaluate it. The second section describes practical management, for example how to make policy and how to deliver it to a high quality. It includes many examples and case histories, a glossary to make medical terms accessible to the non-medic, and each chapter concludes with a summary and self-test questions. Although reference is made to the UK NHS, a world leader in screening, the book remains internationally relevant as the principles, knowledge and skills of screening are applicable in any setting. The controversies, paradoxes, uncertainties and ethical dilemmas of screening are explained in a balanced way. Muir Gray and Angela Raffle have been at the forefront of achieving improvements in screening over recent years, and they bring their wealth of experience to this essential text. |
Contents
1 How screening started | 1 |
2 What screening is and is not | 33 |
3 What screening does | 59 |
4 Measuring what screening does | 85 |
5 Implementing screening | 127 |
6 Quality assuring screening programmes | 155 |
7 Day to day management of screening for public health practitioners and programme managers | 179 |
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Common terms and phrases
abnormal achieve aneurysm babies benefit and harm bowel cancer breast cancer breast screening breast self-examination cancer screening cells cent cervical cancer cervical screening programme Chapter clinical clinicians colonoscopy condition cont control group cost cytology decisions definition delivered detection develop diagnostic eligible ensure evidence examination example factors family doctor genetic health service healthcare heart disease high quality implementation important improve individual infants intervention group involved length time bias mammography means measure National Screening Committee negative neuroblastoma numbers offered screening outcome ovarian cancer overdiagnosis participants patient pilot population positive potential practice present problems prostate cancer public health practitioners quality assurance quality standards Question randomized controlled trials receiver operator characteristic reduce risk routine screen-detected screener screening policy screening programme screening service screening test sieve specific staff symptomless symptoms test result thalassaemia tion treatment women