Screening 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.
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