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In future months Bandolier will feature a number of pieces on screening. The Chief Medical Officer made a major speech on screening in January 1994 where he outlined the way in which screening policy and practice should be organised in future.

The approach is based on the principle that because screening is offered to healthy populations, the burden of proof of its effectiveness, the balance between beneficial and adverse effects, and the need to deliver a high quality service are all even more important in screening than in conventional clinical practice.

During 1995 it is probable that the National Screening Network will be set up as part of the Public Health Network, and it will be charged with the responsibility of ensuring that screening is better managed in future than it has been in the past. In the meantime Bandolier will carry a series of articles on screening as a regular feature.

All or none screening

The decision to screen or not to screen is an all or none decision. Either the evidence is good and the screening should be perfectly done, or it should be kept out of purchasing and clinical practice. Below is a list of screening tests that are offered in some parts of the country but for which there is insufficient evidence to support their introduction or continuation except as part of high quality research, carried out to a defined protocol with subjects informed about the experimental nature of the procedure being offered:
  • screening for prostate cancer
  • screening for ovarian cancer
  • screening for colorectal cancer
  • chlamydia screening in pregnancy
  • human papilloma virus screening as part of cervical screening
  • screening of neonates for congenital biliary atresia
  • whole population cholesterol screening
J A Muir Gray Director of Research and Development

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