Discussion: Screening for Disease

In theory, disease screenings, at both an individual level and at the population level, have high appeal to the field of healthcare as potential low-risk, low-cost, high-benefit activities for primary prevention. The reality, however, is that screenings as widespread, indiscriminate practice are not universally beneficial if not bounded by evidence-based practice and the potential for alleviation of suffering. Screenings should also occur only in the context of potential to identify with some specificity the likelihood of disease as the outcome, as well as the possibility of preventing the disease by some action as a result of performing the screening. For example, Dr. LaPorte discussed the recommendation against screening for Type I diabetes on the basis of inability to prevent disease development simply as a result of screening positive (Laureate Education, 2012). Friis and Sellers (2021) described the differences between mass screening and selective screening, explaining that the former examines populations as a whole, while the latter refers to having already identified certain high-risk groups and screening only that subset of the larger population. Breast cancer screening by mammography is therefore an example of selective (high-risk) screening. The article by the U.S. Preventive Services Task Force (2009) sought to specify which portions of the United States adult female population require screening, based on relative risk reduction and decreased mortality.

The article recommends the following population health based guidance: breast cancer screening has the potential to significantly reduce advanced disease and is therefore recommended for women ages 50-74 years old, and has less validity for women ages 40 to 49, but should be considered in some individual cases (USPSTF, 2009). The meta-analysis resulted in recommendations for further research examining specifics regarding quality of life, the value of mammography alone versus mammography plus newer screening techniques, and nuances of disease incidence versus advanced disease development (USPSTF, 2009). However, researchers expressed concern that 1) the general public may not understand or appreciate the reticence to recommend screening for the 39 to 49 year old and 70 to 74 year old populations, and 2) that even among the recommended screening practice of 50 to 69 year old population, the “magnitudes of effect are small” (USPSTF, 2009, para. 37). In other words, the manhours spent and effort exerted into screening these populations may lack full social, scientific, and/or ethical validity as a screening tool, if outcomes are not statistically significant in their preventive efforts to the population as a whole (Friis & Sellers, 2021).

Ethical concerns include whether screening has the potential to preserve health, decrease mortality and morbidity, and save financial resources; as a population-based program, these measures may have different collective likelihoods than for particular individuals. In the case of a woman with significant family history of known genetic disease resulting in breast cancer, the age of screening may need to be much earlier than even 39. However, as a population-based policy, it might be unethical to recommend costly widespread screening when general population incidence is so low at that age. Another confounding factor is that increased awareness, funding for research, and larger data pools may render mammography technologies less and less costly over time, resulting in fewer cost-based arguments against offering the screenings to wider populations (Friis & Sellers, 2021). Further recommendations regarding a secondary screening process after mammography can help alleviate any concerns about low sensitivity of mammography; if genetic testing could follow any positive screens, which would reliably confirm or rule out genetic contributors, this could also render recommendations for wider screening populations more ethical, since it would not unduly contribute to psychological stress (Laureate Education, 2012).

References

Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett.

Laureate Education (Producer). (2012). Epidemiology and population health: Screening [Video file]. Baltimore, MD: Author.

U.S. Preventive Services Task Force. (2009). Screening for breast cancer. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary-screening-for-breast-cancer/breast-cancer-screening

Sample Answer 3 for Discussion: Screening for Disease

The selected article for discussion is Hugosson et al. (2010). The study shows that prostate cancer screening using the prostate-specific antigen (PSA) has the capability of reducing mortality rates. However, the scope of benefits and dangers of prostate cancer screening is controversial. It claims that screening for prostate cancer can result in over-diagnosis, which may lead to the discovery of other types of cancers that may have never been presented during the lifetime of a patient and lead to needless treatment that may compromise patients’ quality of life. The ethical considerations in this article include informed consent, voluntary participation by the subjects, and the relationship between benefits and risk to the participants (Biddle, 2020). On one side, patients have the right to full and precise information about their medical conditions. On the side, screening for prostate cancer is an attempt to look for disease in an individual without symptoms. In the present study, the recommendations that screening leads to over-diagnosis and possible detection of other cancers is not justified since screening for prostate cancer is mainly intended to reduce needless harm for the participants (Gandaglia et al., 2019).

Lopez et al. (2019) provide epidemiological evidence to support screening for cancer as one of the effective strategies for cancer prevention. The prostate screening program in the case at hand is population-based. Population-based screening program can influence the assessment by enabling screening setting that offers important opportunities to deliver credible, influential lifestyle advice, and reach out to a wide audience. On the other hand, the reported data can be used to move policy forward for enhancing population health around screening for prostate cancer by allowing policymakers to allocate resources and create responses that are focused on the issue of prostate cancer screening and tailored to realize the individual needs of patients (Althaus et al., 2020). Moreover, policymaking starts with priority setting; priorities can only be determined by the reported data.

References

Althaus, C., Bridgman, P., & Davis, G. (2020). The Australian policy handbook: A practical guide to the policy-making process. Routledge.

Biddle, J. B. (2020). Epistemic risks in cancer screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences, 79, 101200. https://doi.org/10.1016/j.shpsc.2019.101200

Gandaglia, G., Albers, P., Abrahamsson, P. A., Briganti, A., Catto, J. W., Chapple, C. R., … & van Poppel, H. (2019). Structured population-based prostate-specific antigen screening for prostate cancer: the European Association of Urology position in 2019. European urology, 76(2), 142-150. https://doi.org/10.1016/j.eururo.2019.04.033

Hugosson, J., Carlsson, S., Aus, G., Bergdahl, S., Khatami, A., Lodding, P., & … Lilja, H. (2010). Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Lancet Oncology, 11(8), 725–732. https://doi.org/10.1016/S1470-2045 (10)70146-7

Lopez, A. M., Hudson, L., Vanderford, N. L., Vanderpool, R., Griggs, J., & Schonberg, M. (2019). Epidemiology and implementation of cancer prevention in disparate populations and settings. American Society of Clinical Oncology Educational Book, 39, 50-60. DOI: 10.1200/EDBK_238965

Sample Answer 4 for Discussion: Screening for Disease