Academic journal article The Hastings Center Report

"Don't Die of Ignorance"

Academic journal article The Hastings Center Report

"Don't Die of Ignorance"

Article excerpt

Such was the slogan devised for an AIDS awareness campaign twelve years ago. It has now surreptitiously become the slogan of many screening programs, in some of which the only purpose seems to be to help people to die knowingly.

Screening has become the shibboleth of preventive medicine. Just as the Ephraimites' inability correctly to say "Shibboleth" allowed them to be identified and slain by the Gileadites, so now those who question the value of screening programs may metaphorically be put to the sword.

A recent victim is Goran Sjonell, a Swedish general practitioner who doubts the value of breast screening. His team found that the number of deaths from breast cancer in Sweden over the last decade was only 0.8 percent less than would be expected without screening, while 100,000 false positives had led to 16,000 biopsies and 4,000 other breast operations.[1] When his findings were reported in the United Kingdom, he was roundly criticized, although the critics had to work hard. Their most common explanation was that it takes at least a decade for radiologists in clinical practice to learn to read mammograms as accurately as their colleagues in research. But what if routine breast screening can never reach the standard achieved in trials?

Ignoring the costs and risks of screening programs, however, seems standard practice. A recent paper examining the effect of the English cervical screening program on the incidence of, and mortality from, cervical cancer had not a single mention of any unwanted effects of screening.[2] Yet some critics have long argued that the anxiety and disruption of lives caused by the massively greater number of false than true positives may outweigh the benefit of some lives being saved.

Interestingly, the greatest threat to the cervical screening program, now reckoned to save 800 lives each year through the examination of 4.5 million smears, is from the law. There have been widely publicized cases each year of screening centers that have missed a few suspicious smears. In one case, three women sued the health authority for negligence and won: the High Court judge agreed that the women's smears warranted further investigation. In so doing, however, a standard of accuracy was applied that routine screening programs rarely achieve. If upheld on appeal, routine cervical screening in the United Kingdom would have to stop. Given that it costs about $280,000 per life saved, some would argue that the money could in any case be better spent elsewhere.

Screening for other cancers remains a hotly debated issue throughout Europe, with interest centering on ovarian and prostate cancers. …

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