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The Screening Circus

In 2009, a recently retired professor of neurology with a long-standing interest in stroke prevention learnt that neighbours had received a leafleted invitation to be screened for stroke and other complications of cardiovascular disease. The leaflet, from a vascular screening company, invited them to go along to a local church (and pay £152, $230, €170) for a series of tests. Intrigued – not least because some of the information in the leaflet was factually misleading – he decided to go along himself.

‘First up was aortic aneurysm [enlargement of the main artery carrying blood from the heart] screening with ultrasonography done by a woman who did not want to be engaged in conversation about what the implications of finding an aneurysm might be. Next it was ankle and arm blood pressure measurements “for troubles with my circulation” . . . followed by a little non-vascular bonus: osteoporosis screening of my ankle. Then there was . . . electrocardiography to detect “trouble with the two upper chambers of my heart” . . . Then, finally, carotid [artery in the neck] ultrasonography to detect “plaque build up”. When I asked them what the implications of this might be they told me that blood clots could form and cause a stroke. Pressed on the sort of treatment I might be given, they offered a vague notion of blood thinning drugs but nothing about surgery until I asked directly if that might be an option, and indeed it was. “Might that be risky?” I enquired innocently. The answer was that any risks would depend on a full workup by my GP, with whom I should discuss abnormalities from any of the tests.

All of this was conducted without any privacy (except for the aortic aneurysm screening) . . . There seemed to be no doctor present, and the team showed no intention or will to engage in a discussion of the implications of false positive or false negative results, the prognostic implications of true abnormalities, or the risks and benefits of any treatments.

This was just screening, nothing more and nothing less, done for profit – with the results to be dumped in my lap within 21 working days and for my GP to sort out the emotional and physical consequences of any abnormality, true or false, even though she didn’t request the tests. . . . Inevitably this whole screening circus is liable to whip up anxiety in vulnerable people without discussing or taking the slightest responsibility for the consequences of any abnormalities found.’

Warlow C. The new religion: screening at your parish church. BMJ 2009;338:b1940