Questioning screening

Abstract

Death rates from cancer are falling in almost all countries. It is tempting to attribute these encouraging trends equally to, screening, early detection and better treatments. There is a great deal of scientific research being invested in these endeavours and all are rigorously scrutinised. Screening has an intuitive attraction and is often emotionally championed to be “the responsible thing to do”. Recent work has questioned the scope and role of screening in three major fields of Women’s Health namely cervical cytology, mammography and ovarian cancer detection. If gynaecologists are to be advocates for women’s health then they must be sure that correct, evidence-based information is distributed. What was true about screening 7 years ago is not necessarily true today and the present “facts” may not be true in the future. Vested interests in the promotion of screening do exist and the well-woman visit needs to be able to prove that all its steps are in the woman’s interests. This article raises new evidence about screening and argues for the evaluation in all screening on a benefits/harms ratio and then the choice being agreed by the care-giver and patient. As the evidence changes, so do our prejudices come under scrutiny. Are we prepared to objectively review our position in the light of new data?

Keywords: Cervical cytology; Mammography; Ovarian cancer screening