Evidence based screening for Down's syndrome

doi:10.1136/bmj.320.7235.592

BMJ 2000;320:592-593 ( 4 March )

Editorials

Evidence based screening for Down's syndrome

We should be prepared to re-examine entrenched practices

Papers p 606

The first 150 words of the full text of this article appear below.

An important lesson in all medicine, but particularly illustrated in screening programmes, is the continued need to reviewand audit. Serum screening for Down's syndrome, introduced bymany health authorities in the past decade,^1-3 is a good example.The original demonstration projects compared the detection ratewhen Down's syndrome was identified after serum screening withearlier data derived from screening targeted towards pregnanciesin older women.² Howe et al from Southampton now challengesome of the assumptions (see p 606).⁴ They found that the Down'ssyndrome detection rate in one Southampton maternity hospitalaveraged 68% (and at least 41% in the pregnancies of women agedless than 35), without using serum screening. The higher detectionrate without serum studies undermines the cost benefit argumentsfor such screening and raises questions about what to donext.