Screening without evidence of efficacy

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7438.521-a (Published 26 February 2004) Cite this as: BMJ 2004;328:521

Screening uncertainties concern evidence, efficacy, decisions

  1. Hazel Thornton, honorary visiting fellow (hazelcagct{at}aol.com)
  1. Department of Health Sciences, University of Leicester “Saionara,” Rowhedge, Colchester CO5 7EA

    EDITOR—Law argues that encouraging people to decide for themselves whether to attend for screening is ducking the issue.1 This is true only if a well founded public health programme for a specific disease has not been set up. Then, setting up a programme, as Law advocates, should be based on evidence, through rigorous scientific evaluation of efficacy through systematic review of high quality trials. Outcomes assessed should be both mortality and all associated adverse effects that affect an individual person's quality of life. Good quality evidence based information should also be made available to suit all citizens so that they have a better chance of arriving at an informed decision with their (equally well informed) health professional, if desired.

    Provision of such evidence takes time. But the screening industry and the public are not prepared to wait: mammographic screening for those aged 40-50 is widely practised, yet the findings from the AGE trial of breast screening by mammography in young women that began in 1991 and closed in November 2000 are not yet published. Is there not an ethical obligation to make these findings public without further delay?

    Encouraging people to decide for themselves through provision of better information is, however, crucial in well established screening programmes such as the NHS breast screening programme for 50-65 year olds.2 More than a decade of persuasive information has reinforced the intuitive appeal of screening early to save your life in a social and cultural climate that has blossomed on frequently reiterated beliefs.3 4 Evidence comes a poor second in decision making in a population not educated to see the need for fair tests of treatments, interventions, systems, and processes to underpin what and what is not offered in healthcare systems.5

    Embedded Image

    Breast self examination—an example of failure to apply scientific rigour to screening



    • Competing interests None declared.


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