I read with interest the response by Dr Richard Smith to the news that routine NHS screening for prostate cancer has been rejected by the UK National Screening Committee [1]. Whilst the politicisation of health issues is inevitable due to the current funding structure of the NHS, the scenario painted by Dr Smith is particularly alarming, with the potential to cause significant harm to both those men overtreated and, through opportunity cost, those men affected by life-threatening disease.
I have been retired from the NHS for several years now. In my career I took an interest in ethics and, given my role as a Consultant in psychiatry for older adults, I inevitably encountered issues related to cognitive screening. With the intention of diagnosing as early as possible, ‘case-finding’ for dementia was advocated at a UK level. Indeed in Scotland a national target, with financial incentivisation for NHS boards which met the target, was implemented. It is not clear, even now, how clinicians can distinguish non-progressive cognitive impairments (not uncommon as we age) from the very early stages of dementia, and this governmental approach had practical consequences. The threshold for diagnosing ‘very early Alzheimer’s disease’ was, in practice, lowered. Mistaken diagnoses resulted, along with all the consequences for patients and families that result from a diagnosis of dementia. Services for the assessment of dementia became increasingly stretched. It was this backdrop, with ‘dementia screening’ still being promoted, that led me to take time to read as much as I could about screening. I kept returning to a Public Health Paper, No 34, published by the WHO in 1968. This paper by Wilson and Jungner was titled The Principles and Practice of Screening For Disease and outlined ten principles to be followed in deciding whether a screening programme would do more good than harm. Being aware of these principles means that I am not surprised by the UK National Screening Committee’s recommendations regarding screening for prostate cancer.
I am about the same age as this WHO paper. It seems to me that sometimes in the endless profit-driven pursuit of ‘progress’ we dismiss the fundamental scientific principles that, despite the passage of time, have not changed. Wilson and Jungner’s criteria are every bit as relevant, indeed vital, as they were when written. Someone should tell Wes Streeting that.