Screening in Disease Prevention: What Works?

179 Pages·2005·11.365 MB·English

by  Walter W Holland, Susie Stewart

The attack on disease must not be meddlesome; the desire to do
something must be guided by sure argument that good will come of it.
Gibson AG (1933) The Physician's Art. Clarendon Press, Oxford.

Screening in
Disease Prevention
What works?
Walter W Holland
Emeritus Professor
London School of Economics and Political Science
Health and Social Care
London
and
Susie Stewart
Honorary Research Fellow
University of Glasgow
Glasgow
This book is a co-publication between The Nuffield Trust
and the European Observatory on Health Systems and Policies
The |
FOR R E S K A R C II A N D POLICY "*
STUDIES IX HEALTH SERVICES Ort and
CRC Press
Taylor &. Francis Croup
Boca Raton London New York
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Radcliffe Publishing Ltd
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© 2005 The Nuffield Trust
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise without the prior permission
of the copyright owner.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN 1 85775 770 X
Typeset by Anne Joshua & Associates, Oxford
Printed and bound by TJ International Ltd, Padstow, Cornwall
Contents
About the authors vi
The Nuffield Trust vii
List of Trustees viii
Acknowledgements ix
1 Historical background, current definitions and criteria 1
2 Key issues in screening: genetics, information and economics 17
3 Key issues in screening: ethics and audit 33
4 Antenatal and neonatal screening 43
5 Screening and surveillance in childhood and adolescence 67
6 Screening in adults 85
7 Screening in the elderly 123
8 Screening practices in Europe 139
9 Overview and recommendations 143
Appendix: Recommendations for screening by life-cycle stage 157
Index 160
V
About the authors
Walter Holland CBE, FRCP, FFPH qualified from St Thomas's Hospital Medical
School in 1954. His entire career has been in medical research. His interests in
epidemiology were aroused by his involvement in investigations of the 1957
influenza pandemic while doing his national service in the RAF. After gaining
experience at the London School of Hygiene and John Hopkins University School
of Hygiene, he returned in 1962 to St Thomas's, where he remained until 1994.
His major research interests have been in the epidemiology of chronic respiratory
disease, blood pressure and the application of epidemiological principles to health
services research. He has published widely, including acting as editor of the Oxford
Textbook of Public Health. He was President of the International Epidemiological
Association and of the Faculty of Public Health Medicine (now the Faculty of
Public Health). He has served on many national and international committees
concerned with public health, and has spent periods of time in Australia, France,
Germany and various parts of the USA. He has had experience of life at the 'sharp
end' as a member of a District Management Team, member and vice-chairman of
a health authority and non-executive director of a health authority. Susie Stewart
and Walter Holland have produced joint publications on several occasions,
including Screening in Health Care (1990) and Public Health: the Vision and the
Challenge (1998), both published by the Trust.
Susie Stewart DL, MA, FFPH graduated from St Andrews University in 1962 and
obtained a postgraduate diploma in Social Studies from Edinburgh University in
1963. She became an Honorary Member of the Faculty of Public Health Medicine
in 1992 and a Fellow in 2001, when she was also appointed an Honorary
Research Fellow in the Faculty of Medicine, University of Glasgow. Her career
began with a research assistantship in mental handicap and genetic counselling.
In 1971 she took up a research and editorial position with Professor Holland in the
Department of Community Medicine at St Thomas's Hospital. Following a move
back to her home city of Glasgow in 1977, she was for 10 years technical editor of
two of the British Medical Association's specialist journals and technical editor for
the Panel of Social Medicine and Epidemiology of the Commission of the
European Communities. In 1990 she was appointed Executive Secretary of the
Scottish Forum for Public Health Medicine and the subsequently established
Scottish Needs Assessment Programme. From 1998 to 2000 she acted as Executive
Secretary to a Working Group of the Scottish Royal Colleges on Inequalities in
Health, and was a member of the Healthy Public Policy Network of the Scottish
Council Foundation and editor of the report The Possible Scot. She is currently
based in the Public Health and Health Policy Section of the Division of Com-
munity-Based Sciences at Glasgow University.
VI
The Nuffield Trust
F OK K K S K A R C II A N D P O L I C Y
S T U m K S IN II E A L T I i S E R V I C E S
The Nuffield Trust is one of the leading independent health policy charitable
trusts in the UK. It was established as the Nuffield Provincial Hospitals Trust in
1940 by Viscount Nuffield (William Morris), the founder of Morris Motors. In
1998 the Trustees agreed that the official name of the trust should more fully
reflect the Trust's purposes and, in consultation with the Charity Commission,
adopted the name The Nuffield Trust for Research and Policy Studies in Health
Services, retaining 'The Nuffield Trust' as its working name.
The Nuffield Trust's mission is to promote independent analysis and informed
debate on UK healthcare policy. The Nuffield Trust's purpose is to communicate
evidence and encourage an exchange around developed or developing know-
ledge in order to illuminate recognised and emerging issues.
It achieves this through its principal activities:
• bringing together a wide national and international network of people
involved in UK healthcare through a series of meetings, workshops and
seminars
• commissioning research through its publications and grants programme to
inform policy debate
• encouraging inter-disciplinary exchange between clinicians, legislators, aca-
demics, healthcare professionals and management, policy makers, industrial-
ists and consumer groups
• supporting evidence-based health policy and practice
• sharing its knowledge in the home countries and internationally through
partnerships and alliances.
To find out more, please refer to our website or contact:
The Nuffield Trust
59 New Cavendish St
London
WIG 7LP
Website: www.nuffieldtrust.org.uk
Email: [email protected]
Tel: [phone]
Fax: [phone]
Charity number: 209201
VII
List of Trustees
Patron
Her Royal Highness The Princess Royal
Governing trustees
Professor Sir Denis Pereira Gray QBE FRCP FRCGP
Chairman, The Nuffield Trust
Emeritus Professor of General Practice, University of Exeter
Professor Sir Leszek Borysiewicz FRCP
Deputy Rector, Imperial College of Medicine
Professor Sir Keith Peters FRCP FRS
Regius Professor of Physic, University of Cambridge
Dame Fiona Caldicott DBE, FRCP, FRCPsych
Principal, Somerville College Oxford
Sir Christopher France GCB
Formerly Permanent Secretary, Department of Health
and Permanent Secretary, Ministry of Defence
Lord Carlile of Berriew QC
Recorder and formerly Member of Parliament for Montgomery
Baroness Cox of Queensbury
Chancellor, University of Bournemouth
Vice-President, Royal College of Nursing
Professor Don Detmer MD FACS FACMI FAHSR
President & Chief Executive Officer, American Medical Informatics Association
viii
Acknowledgements
We are extremely grateful to the following friends and colleagues who have given
us their views on screening and commented on various sections and drafts of the
manuscript: Professor M Adler, Professor E Alberman, Ms S Allin, Dr J Austoker,
Mr CJ Black, Professor M Bobrow, Dr M Brodin, Dr G Comstock, Dr J Cooper,
Dr D Delnoy, Professor C Dezateux, Sir Liam Donaldson, Ms K Dunnell, Dr R
Elliott, Dr M Fitzpatrick, Dr P Fox, Dr M Gill, Professor L Gordis, Dr J Muir Gray,
Professor M Harrington, Ms C Heidbrink, Dr RC Holland, Dr S Iliffe, Ms N Jemiai,
Professor N Kass, Dr N Klazinga, Mr R Klein, Mr J Lawrence, Mr M Lehman, Dr E
Lynge, Dr M McCartney, Professor M McKee, Professor T Marteau, Dr J Melia,
Professor D Morrell, Dr E Mossialos, Ms D Nicolaou, Mrs J Patnick, Dr A Raffle, Dr
LM Reay, Professor M Reid, Dr F Rose, Dr M Rosen, Dr L Salas, Dr F Sassi,
Professor F Schelp, Dr N Segnan, Dr D Snashall, Dr H Stoate MP, Professor D
Stone, Dr A Streetly, Professor N Wald, Dr JMG Wilson and Dr WN Wykes.
The opinions we express in this book are, of course, entirely our own and we
take full responsibility for them.
Walter Holland
Susie Stewart
June 2005
IX