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

Department of Obstetrics and Gynaecology, Erasmus University Rotterdam, Rotterdam, South Holland, 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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    ABSTRACT: Since July 1998 all Dutch women (+/- 200,000/y) are screened for red cell antibodies, other than anti-RhesusD (RhD) in the first trimester of pregnancy, to facilitate timely treatment of pregnancies at risk for hemolytic disease of the fetus and newborn (HDFN). Evidence for benefits, consequences and costs of screening for non-RhD antibodies is still under discussion. The screening program was evaluated in a nation-wide study. As a part of this evaluation study we investigated, according to the sixth criterium of Wilson and Jüngner, the acceptance by pregnant women of the screening program for non-RhD antibodies. Controlled longitudinal survey, including a prenatal and a postnatal measurement by structured questionnaires. Main outcome measures: information satisfaction, anxiety during the screening process (a.o. STAI state inventory and specific questionnaire modules), overall attitude on the screening program. Univariate analysis was followed by standard multivariate analysis to identify significant predictors of the outcome measures. Participants: 233 pregnant women, distributed over five groups, according to the screening result. Satisfaction about the provided information was moderate in all groups. All screen- positive groups desired more supportive information. Anxiety increased in screen- positives during the screening process, but decreased to basic levels postnatally. All groups showed a strongly positive balance between perceived utility and burden of the screening program, independent on test results or background characteristics. Women highly accept the non-RhD antibody screening program. However, satisfaction about provided information is moderate. Oral and written information should be provided by obstetric care workers themselves, especially to screen-positive women.
    Full-text · Article · Dec 2008 · BMC Pregnancy and Childbirth
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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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    ABSTRACT: There is an increasing interest in designing decision tools [decision support technologies (DSTs)] that support patients when they have to decide about health matters. The purpose of this review was to describe and evaluate existing DSTs for amniocentesis testing. Ten medical and psychological databases were searched up to January 2008 and key authors and organizations contacted to identify DSTs for amniocentesis (published or otherwise). DSTs that described amniocentesis testing were included. Six DSTs met the inclusion criteria and were evaluated using the International Patient Decision Aids Standards Instrument. The evaluation suggested that most DSTs provided a satisfactory level of information on the index decision and, on the specific features of a diagnostic test; provided structured guidance in making a decision; were based on scientific evidence and disclosed the funding sources and authors' credentials. However, most DSTs failed to communicate probabilistic information, to clarify patient values and use plain language. The majority of DSTs did not use a systematic development process. Furthermore, the DSTs' evaluation often lacked scientific rigour. In most cases, neither the quality nor the effectiveness of the DST could be inferred from the evaluations. The review highlights variations in the development, evaluation and quality of existing DSTs for amniocentesis. We do not know what impact DSTs may have when implemented in clinical settings. Decisions in this context have high stakes and strong emotional impacts. It is important to ensure that DSTs achieve high standards.
    Full-text · Article · Oct 2008 · Human Reproduction Update
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    ABSTRACT: Down syndrome is a chromosomal disorder caused by triplicate material from chromosome 21. It has a variable phenotypic expression, with a characteristic constellation of physical findings including distinctive facial features and anomalies of multiple organ systems. Advances in genetics have increased our early detection of the condition, our understanding of its causes, and potential treatments for its complications. Provision of a comprehensive medical home and advocacy for appropriate educational programming can assure optimal outcomes for children with this condition.
    No preview · Article · Oct 2008 · Current problems in pediatric and adolescent health care
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