A clean bill of health is something we all value and many of us take positive steps to stay as healthy as we can – perhaps by eating a balanced diet, regularly exercising or stopping smoking.
It is no surprise then that private screening tests are becoming increasingly popular. After all, it is a commonly held conception that the early detection and treatment of a condition will lead to life lengthening or even lifesaving results.
But, health screening has the potential to cause harm, from over diagnosis and overtreatment, to undue anxiety and an unnecessary financial burden if you have paid for private health screening. You could be wrongly identified as having a condition due to an inaccurate test or you could be treated for a condition that you do have, but would never have caused you any harm in your lifetime.
This is the reason we only screen for certain conditions in England, where the benefits of screening outweigh the harms for the individual, such as for cervical cancer in women over the age of 25 or for abdominal aortic aneurysms in men aged 65 and over. Even with NHS screening programmes there are risks involved and this is why it is so important people are given the full information about the benefits and risks before making a decision on whether to have the proposed screening test.
A number of private health screening organisations offer ‘screening’ for abdominal aortic aneurysms (AAA) to women or men under the age of 65. An AAA is when the wall of the main blood vessel to your kidneys and legs becomes enlarged. The tearing of this or ‘rupturing’ can lead to death. However, major scientific studies have shown that surgical treatment of an AAA that is under 5.5cm in size (which is most often the case for aneurysms in men under the age of 65 and for women of any age) actually carries a higher risk of death than the condition itself. This is an example of the potential harms from screening outweighing the benefits.
Glasgow-based GP, Dr Margaret McCartney, comments on private screening: You'd hardly know from the effusive advertising from many private, commercial screening clinics that the vast majority of the (expensive) tests they recommend aren't shown to benefit people. It's crucial that people get high quality information about screening because the science is often counterintuitive - what seems logical ('finding things early') often turns out to be much more complicated - especially the problems leading from false positive tests. The advertising from these private clinics should make clear that evidence based screening is already available on the NHS - where people should be able to access information allowing them to make a fully informed choice about the pros and cons.
The UK National Screening Committee (UK NSC) provides the expert advice underpinning screening in England. Not only does the NHS provide ‘whole’ screening programmes from invitation to test and treatment, the whole pathway is scrutinised to ensure we only offer screening where we can prove it does more good than harm. Private screening services do not apply these same standards and may offer tests where there is little or no evidence that they will benefit the individual.
Although the UK NSC supports the right of individuals to buy any private health screening services they want, there are concerns that these services may not be accompanied by the full information. This leaves people vulnerable, having to make important decisions without really knowing whether the screening they are being offered will be the right choice for them.
There are some specific concerns about private health screening:
- Private companies are not subject to the same detailed scrutiny that the NHS screening programmes are and so the information these companies give is often insufficient to allow people to make an informed choice.
- Private screening often finds something wrong with an apparently healthy person: cysts, narrowing of vessels, enlarged vessels, odd looking bumps or lumps in internal organs. But which ones will cause problems? Which will never cause you any bother? And if treatment is offered, will this be more likely to do you harm than leaving it alone?
- Private tests simply tell people who are ‘healthy’ when they walk in there is something wrong. Some companies do offer treatment and diagnosis but at an extra cost and others refer back to the NHS where the GP or hospital has to advise on what, if any, help or treatment is needed.
Given the potentially significant implications for someone’s health, clear information about the benefits and the harms of the offered screening service need to be provided and explained. We want private health providers to explain fully the screening tests they offer and why these are not available on the NHS.
The UK NSC has produced information for individuals who are considering having private screening and for GPs who may have been approached by private screening providers who wish to offer screening to their NHS patients.
It is important to remember that health screening is not for people with symptoms as it aims to identify ‘healthy’ people who are at risk of a condition before they start showing symptoms. If you have any health concerns you should speak to your GP in the first instance.