(p. ix ) Foreword

It is just over 150 years since the concept of identifying the future health risks of individuals surfaced. Today, it would not seem remarkable to the public that individuals can be tested for the potential to develop disease. Whilst many have benefited from the multitude of screening programmes now on offer in the UK, developing these and ensuring that they reach the highest standard has not been without difficulty.

At the heart of this debate is the question best elucidated by Wilson and Junger in 1968 - what should the aims of a screening programme be? Their careful assessment and development of criteria has helped shape the evolution of screening, particularly in the UK. Initial programmes were ad hoc and often failed to fully meet these standards. The development of the National Screening Committee has brought academic rigour and authority to this complex area. The measured direction of this group has guided the introduction of important new initiatives, such as the colorectal cancer and neonatal sickle cell programmes.

The challenges of the past are not ended. The ever-increasing technological and biological wizardry of medicine raises expectations and further stretches clinicians. These challenges are as true for screening. The public health and research communities are responding, and doing so admirably; the UK Collaborative Trial of Ovarian Cancer (UKCTOCS) as cited in this book, is an example of how difficult questions may be researched, if collaboration is sought and rigorous research standards applied.

This book captures the challenges and lays down the gauntlet for the future. But more than this, the book gives the next generation of managers, public health doctors, clinicians and patients the understanding to meet these challenges. By marking the important contribution that screening can and has made, and charting the development of this new and exciting field of medicine, the book presents the power and the potential dangers of screening in a balanced and approachable manner.

(p. x ) Few developments have the potential to minimise suffering to the extent that quality screening can. This book is a timely and substantive reminder of why we screen, and the dangers of doing so. By examining the detailed processes that lead to successful screening programmes at a national and local level, elucidating the complexities of both initiating and perpetuating high quality programmes, the authors will help to ensure that the United Kingdom continues to provide only the best possible screening programmes.

This book manages to explain complex and challenging epidemiological and statistical concepts through thoughtful case examples, clear tutorials, and self-assessment. Whilst gently guiding the novice into this fascinating and difficult area, this unique book further manages to add to the knowledge base of more seasoned health professionals by the in-depth coverage of the subject matter and the detailed analysis of the failures and successes of the past, both within the UK and further afield.

I commend the authors for tackling this topic and by doing so with both breadth and clarity. I am sure that this book will become a valuable resource for the caretakers of screening programmes of the next 150 years.

SIR LIAM DONALDSON

CHIEF MEDICAL OFFICER

DEPARTMENT OF HEALTH