Screening for cancer with computed tomography: Screening in private  sector has knock on effects in public sector in two tier health  systems

doi:10.1136/bmj.326.7404.1457-c

BMJ 2003;326:1457-1458 (28 June), doi:10.1136/bmj.326.7404.1457-c

Letter

Screening for cancer with computed tomography

Screening in private sector has knock on effects in public sector in two tier health systems

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

EDITOR—Swensen in his editorial discusses the effect of false positive diagnoses and excessive costs of screening.¹He describes 700 ancillary findings in a screening study ofcomputed tomography of the body, in which most of these ancillaryfindings were falsely positive and whose investigation adverselyaffected quality of life and resulted in unnecessary diagnosticand interventional procedures.

In two tier healthcare systems where public and private facilitiesrun side by side the unnecessary diagnostic and interventionalprocedures referred to by Swenson will tend to be devolvedto the public sector. In my (public) hospital we regularlyreceive requests for follow up computed tomography scanningon the basis of findings detected at local private screening facilities. The patient, having paid several hundred dollarsto find out he or she has a 4 mm lung nodule, rightly or wronglyexpects that the healthcare system will now take him or her. . . [Full text of this article]