BMJ  2008;336:480-483 (1 March), doi:10.1136/bmj.39470.643218.94

Analysis

Maximising benefit and minimising harm of screening

¹ National Knowledge Service, Oxford OX3 7LG, ² NHS Cancer Screening Programmes, Sheffield, ³ Institute of Cancer Research, Sutton, Surrey

Gordon Brown has pledged to increase screening services in the NHS. Muir Gray, Julietta Patnick, and Roger Blanks show how experience with the UK breast screening programme can help ensure that they are effective

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

All screening programmes do harm; some do good as well, and, of these, some do more good than harm at reasonable cost. The first task of any public health service is to identify beneficial programmes by appraising the evidence. However, evidence of a favourable balance of benefit to harm in a research setting does not guarantee that a similar balance will be reproduced in practice, so screening programmes need to be introduced in a way that allows their quality to be measured and continuously improved.

The policy decision

The decision to implement a breast cancer screening programme in the United Kingdom in 1987 was based on evidence of efficacy from other countries, especially Sweden. The Department of Health set up a committee to review the evidence, chaired by Pat Forrest, a leading researcher in treating and screening for breast cancer. His committee’s analysis of evidence and recommendations¹ has been criticised,² but the government . . . [Full text of this article]

Implementation

Standardising screening systems

Ensuring continuous improvement

Performance

Effects of screening

Secrets of successful screening
Summary points

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