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Public Health Screening Shared decisions

Screening Creep and the harm done

  I have been pretty vocal on ever creeping of proposals to screen for things a long way beyond National Screening Committee recommendation in the past. Lung cancer is the focus of this one. I wrote a lot on this a year or so ago in response to the planned rollout in G Mancs Carl […]

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Public Health Screening

Screening school. Lesson 1

Screening school. Lesson 1 I’ve written a lot on screening. Mainly for a technical audience. I often assume that’s there is a lot more background knowledge than people really have. I was asked by someone with little knowledge of screening to give a single key reference that summarises the field in a few sides. I […]

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Public Health Screening

Health Checks, an example of how we might cause harm by trying to do good

We have just written a chapter for the Sheffield JSNA on BP & hypertension. Conclusion = we appear to be bad at detecting HT but quite good at treating it once diagnosed (relative to average). We scratched our head about this odd trend in Sheffield QOF recorded prevalence. What happened here after 2012? We don’t […]

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Public Health Screening

Breast screening, age extension and IT errors. What next

The furore of the mistake in the breast cancer screening programme continues unabated in the press. Of course the mistake should be put right, of course there should be a review. It would be interesting if the terms of reference for the review were openly debated, especially given the controversy breast cancer screening generates. In […]

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Public Health Screening Shared decisions

Lung cancer screening

I’ve written a little on this already I know a thing or two about screening. It’s not like other healthcare, there’s an ethical issue of inviting people who think they are well……for a test that may have good and bad downstream consequences. It’s ethically not the same as offering someone with symptoms a test. I […]

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Screening

Gadgets and gizmos as a tool to screen for AF 5 reasons for caution

Smart watches, gadgets in the back of phones etc…… I’m not yet persuaded. Why? – Answer in 5 parts – Accept I’m hardline on this. 1). Optimise treatment in the current diagnosed population first. With robust patient centred care and shared decision making One of the reasons why the proposition to screen failed NSC test […]

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Screening

Screening 101 – lesson plans

“Screening saves lives” – trips off the tongue doesn’t it Try this – “Screening does harm, sometimes good, often huge opportunity cost” – trickier to land on a daily mail headline? And this -“screening rarely does more good than harm in the context of a programme that is both clinically and cost effective, and affordable.” […]

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Evidence Health Care Public Health Screening Value

Screening for cardiac risk in young adults – a poor way to save lives

This one has cropped up a lot over the years. See this thread from @CRY_UK inviting people between 14-35 to get free ECG heart screenings There’s a handy link to a website to get tested, with handy locations all over the uk. I mostly see the red mist at this point. I’ve also seen mass […]

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Diagnostics Health Care Public Health Screening Uncategorized

The case against early diagnosis of cancer

This blog may upset some. It’s quite uncompromising. It’s also a non referenced blog, not a PhD thesis. Early diagnosis of lung cancer is a good thing. Undoubtedly and indisputably. The problem is we don’t know how to do it reliably at population level. There are two main spins 1) Screening for lung cancer. Mostly […]

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Clinical Health Care Public Health Screening Shared decisions Value

A prostate cancer bumper edition

ICYMI here’s a suite of studies – principally the ProtecT and linked study. I’m told this is the most expensive trial ever. Which concluded that no difference in prostate specific cancer survival between three arms – active surveillance, radiotherapy, surgery. (Remember we know that robotic surgery is no better than standard surgery – study earlier […]