Screening in women's health, with emphasis on fetal Down's syndrome, breast cancer and osteoporosis

Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Human Reproduction Update (Impact Factor: 10.17). 09/2006; 12(5):499-512. DOI: 10.1093/humupd/dml027
Source: PubMed


Screening tests have become increasingly popular in women's health care over the last two decades. The initiative for screening is typically generated by either an agency or the health care professional being consulted for some reason. In many instances, however, the demand for screening tests is patient driven with the health care provider being poorly prepared to determine the usefulness of screening. This review illustrates the complexity of screening using three disorders where early detection and treatment have the potential to improve the quality and longevity of life. Prenatal diagnosis of Down's syndrome does not offer the parents the opportunity for cure but does offer the opportunity for education and rational choice as the impact of the diagnosis on the family is weighed. The evidence for breast cancer screening is more persuasive for older than younger women, but even in older women, there is a balance of risks and benefits. Treatment options for osteoporosis have improved in terms of reductions in fracture risk as well as beneficial effects on bone density, but evidence of the effectiveness of a screening programme for this condition in an unselected population is lacking. Ultimately, it is crucial that women be provided with clear and comprehensive information about the screening programme, in terms of possible gains but also costs of various kinds: physical, economic and psychological.

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    • "(Figure 1). The model was based on similar models that are used in the evaluation of (pregnancy) screening [11-14]. "
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    BMC Pregnancy and Childbirth 12/2008; 8(1):49. DOI:10.1186/1471-2393-8-49 · 2.19 Impact Factor
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    • "Research shows that pregnant women commonly undertake screening tests for Down's syndrome without realizing they could be offered an amniocentesis, receive a diagnostic of chromosomal abnormality and/or be offered a termination of pregnancy (Jaques et al., 2004; Dormandy et al., 2006). The decision to undertake prenatal screening tests along with the anxiety subsequent to an indication of high risk have been extensively documented in the literature (Santalahti et al., 1998; Michie et al., 1999; Wildschut et al., 2006). However, the amniocentesis decision has been commonly confounded with the decision to undertake prenatal screening tests. "
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