Decisions to screen must take account of the social and psychological costs

The costs and benefits of screening programmes are generating more than their usual share of interest. Last week the NHS Executive's new national screening committee held a press conference at the Royal College of Surgeons and declared that the costs of prostate cancer screening-in terms of impotence, incontinence, postoperative mortality, and psychological disturbance-outweighed any possible benefits. This statement was made possible because of two systematic reviews commissioned by the Health Technology Assessment programme.1 2 Many more systematic reviews of screening programmes are due to be reported soon, so the debate on screening will continue to run.

The decision about prostate cancer screening was relatively easy because there is no reliable evidence that early treatment improves outcome and the operative morbidity is unacceptable. But for some programmes due to be reported on soon the decisions may be more difficult; …