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Innsbruck, 27. February 2010
Club Dialog 1 – SCREENING - local, regional, (inter-)national
Univ.- Prof. Dr. Buchberger, MSc, TILAK and University-Hospital Innsbruck, Prim. Dr. Hans Concin, LKH Bregenz, department of gynaecology, and Dr. Wilhelm Oberaigner, Tumorregister Tirol, were discussing the advances, chances but also the riscs of medical screening.

Screening is about investigation in healthy patients with the aim of reduction in mortality. Therefore there are a few approaches towards screening.

First it has to be distinguished between opportunistic and organised screening. Organised screening means to invite healthy patients in order to screen but not examin these in certain diseases.

Here, organised screening is definetly the prefered one. It is simply the more effective way of screening although it produces higher costs and a certain infrastructure is required.

To fullfill the needs of sufficient screening there are a few requirements: First, standards of quality have to be met (a certain number of examinations per year, training of the medical experts, technical standards, independent evaluation and controlling).

Secondly, methods have to be reproducible whoever wherever is examining with a high sensitivity and high specifity*.
Then, the method should be widely accepted by the patients as well: e.g. not too invasive, so the patient follows the invitation to the examination, e.g.: the PAP–screening in order to reduce mortality in cervical cancer- it is simply a smear in a routine gynaegolocical examination.

Hence, in Finland there is nearly no mortality in cervical cancer anymore due to sufficient screening! That is what screening is about!

On the other hand screening badly is a risc as well. As mentioned, healthy patients are examined. In the screening of prostate cancer highly invasive methods are common (biopsy when PSA ist too high). The effectiveness is still to be debated, the follow-up for the patients momentous. Also the psychological burden during the process of screening in patients with “positive” test results should not be unmentioned. To refer to Prim. Concin: bad screening is a crime!
To establish a screening program or not is a political question at last and often related to EU-wide health policy. The costs of a screening program have to be justified by a significant reduction in mortality. Today, in the European Union screening in breast cancer, cervical cancer and cancer of the colon are widely accepted and highly recommended screening programs in certain ages.

To conclude, sufficient screening can reduce mortality in certain diseases to a minimum, but riscs and costs have to be kept in mind.

Dr. Thomas Laschitz, MBA, Mentee 2009/10