Premarital screening: lessons from Thalassaemia in Cyprus.
Premarital screening in China(1) readdresses issues that have long
attracted attention in the socio-medico-political arena. Antenatal
screening and counselling for haemoglobin disorders, for instance, are
standard practice in the UK but have been recognised to be delivered
inadequately and inequitably(2). A model of success may be the
Thalassaemia prospective carrier screening and genetic control programme
in Mediterranean at-risk populations(3).
The Cyprus programme has been operating since 1973 and comprises
public education, premarital population screening, genetic counselling and
antenatal diagnosis. The actual number of homozygotes born has been
diverging from those expected since 1976(4) and is currently considered as
one of the most successful programmes worldwide.
The effectiveness of this programme owes much to its social
acceptance which in itself was the result of support by the governmental
and other influential social factors in a largely homogeneous community,
namely the Church. This proves that the social dimensions of medicine are
never to be underestimated and suggests that in a country so much bigger
as China more factors will need to be considered, especially taking into
account its population heterogeneity.
The debate as regards the "geneticisation" of disease by a "web of
social control"(5) and the doubt as to whether free and voluntary choice
does indeed remain available to individuals have not however been resolved
1. Hesketh T. Getting married in China: pass the medical first. BMJ
2003; 326: 277-279.
2. Modell B, Harris R, Lane B, Khan M, Darlison M, Petrou M, Old J,
Layton M, Varnavides L. Informed choice in genetic screening for
thalassaemia during pregnancy: audit from a national confidential inquiry.
3. Cao A, Rosatelli MC, Monni G, Galanello R. Screening for
thalassemia: a model of success. Obstet Gynecol Clin North Am
4. Angastiniotis MA, Hadjiminas MG.Prevention of thalassaemia in
Cyprus. Lancet 1981;1(8216):369-71.
5. Hoedemaekers R, ten Have H. Geneticization: the Cyprus paradigm.
Med Philos 1998 Jun;23(3):274-87.
Competing interests: No competing interests