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Screening

Screening is a public health service in which members of a defined population, who do not necessarily perceive they are at risk of, or are already affected by a disease or its complications, are asked a question or offered a test, to identify those individuals who are more likely to be helped than harmed by further tests or treatment to reduce the risk of a disease or its complications.

Screening can:

  • save lives;
  • reduce the risk of developing a disease;
  • reduce the risk of complications;
  • enable more effective and timely treatment; and
  • improve quality of life.

But Screening is not simply about talking the latest available diagnostic tool and subjecting the whole population to it, even if that were affordable.  For one thing, it is not a fool-proof process and  cannot offer any guarantees of success. Every screening programme has its share of “false positive” results (wrongly reported as having the disease when there is none) and “false negative” results (wrongly reported as not having the disease when it is there).

Screening also raises some profound questions, from the scientific (does the test really work?) and the legal (whose responsibility is it?) to the ethical (will anyone be harmed by it?).  

Ethical dimension

Screening has important ethical differences from everyday clinical practice. Screening populations for disease is fundamentally, philosophically and functionally different from detecting disease in a patient who is consulting (for example, examining a woman complaining of a breast lump), as the Screening Programme is targeting apparently healthy people, who believe they are healthy at that time.
The following table shows key differences
  Clinical practice Population screening
Who Initiates? Patient Health service
Role of the subject Sick person Normal person
Role of the service Passive, Responding Active, Searching
Ideal goal To restore health to a sick person To detect disease in a “healthy” person
Minimum goal Not to make sick person worse Not to make healthy person sick



The ethical justification for Screening is that it is preferable that a small amount of discomfort is endured by the many in order that a few may be saved from serious consequences like death. However, for the ethical argument to work, it is paramount that the “discomfort” should be at the lowest possible level, while detection rates should be at the highest possible level.

Choosing Screening Programmes

At the very least, a Screening Programme should confer a clear benefit to the individual while doing him or her no harm.  People are often surprised by the fact that when this apparently simple principle is applied rigorously, very few programmes actually meet the standard. For example, although some genetic testing products are available, many are unsuitable for screening programmes because treatments do not currently exist and screening could result in more harm than good to the individual.  Each potential programme has to be judged and chosen on how well it meets the standards.

For more details on the framework used to judge whether a Screening Programme is desirable and safe, see below.
Criteria for determining a Screening Programme
Screening Programmes in Gibraltar
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