Screening needs a fresh approach

doi:10.1136/bmj.39395.370278.80

BMJ 2007;335:1007-1008 (17 November), doi:10.1136/bmj.39395.370278.80

Letters

Familial hypercholesterolaemia

Screening needs a fresh approach

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

Hadfield and Humphries favour cascade testing for familial hypercholesterolaemia(identifying relatives of affected individuals)¹ over the child-parentscreening approach² but accept that cascade testing may onlyidentify 50% of affected cases in the population. Cascade testingmay have been "tried and tested" and found to be useful in identifyingcases of familial hypercholesterolaemia within families, butit is not tried and tested as a general screening policy.³ Identifyingall, or most, families first is a prerequisite for cascade testing,and this has not been achieved in any such programme.⁴

Expert groups have not recommended a general screening approachbecause cholesterol measurement is a poor screening test atbirth and in adults. Our screening meta-analysis showed thatbetween 1 and 9 years it is a good screening test—detectingabout nine out of 10 affected individuals with a low false positiverate (about one in 1000). This finding provides the basis for. . . [Full text of this article]

David S Wald, senior lecturer, Jonathan P Bestwick, statistician, Nicholas J Wald, professor

Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, London EC1M 6BQ

d.s.wald@qmul.ac.uk