What screening does
This chapter gives a deeper understanding of screening, and of the diverse consequences it brings. It illustrates the over-detection problem with reference to mammography breast screening, and explains the ‘popularity paradox’ that this leads to. In the early days, the simplistic notion that screening must automatically be beneficial meant that people only asked ‘why are we not doing it?’ Later scientific challenges brought a new question: ‘how do we tell if screening succeeds in reducing risk?’ This served well as a driving force for better evaluation, but it ignored the need to assess harmful consequences. Growing experience has revealed the need to ask: ‘what are all the consequences?’ Different observers see some consequences more starkly than others depending on their viewpoint. This chapter explains why it is important that everyone recognizes the complete overview.
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