the USA, which stimulated interest in the concept of population screening. In Britain, the
inter-war years saw the development of the Pioneer Health Centre in Peckham, south
London, which provided both a social and health nucleus for the community and
enabled the health of the local community to be surveyed and monitored with ease
(Williamson and Pearse 1938; Pearse and Crocker 1943). The ethos of screening
received impetus from multiphasic screening, which became popular in the USA in the
late 1940s, and in 1951 the Kaiser Permanente organization incorporated screening
methods into its health examinations. Sweden mounted a large-scale multiphasic
screening programme that was completed in 1969 and similar programmes were set up
in the former West Germany and Japan in 1970. In London, in 1973, the Medical Centre
at King’s Cross organized a computerized automated unit that could screen 15,000
individuals a year. General practice also promoted the use of screening to evaluate
what Last (1963) called the ‘iceberg of disease’. In the 1960s and 1970s, primary care
developed screening programmes for disorders such as anaemia (Ashworth 1963),
diabetes (Redhead 1960), bronchitis (Gregg 1966), cervical cancer (Freeling 1965) and
breast cancer (Holleb et al. 1960).
Recent screening programmes
Enthusiasm for screening has continued into recent years. Forrest chaired a working
party in 1985 to consider the validity of a breast screening programme in the UK. The
report (Forrest 1986) concluded that the evidence of the efficacy of screening was
sufficient to establish a screening programme with three-year intervals. Furthermore,
in the late 1980s, Family Practitioner Committees began computer-assisted calls of
patients for cervical screening, and in 1993 a report from the Professional Advisory
Committee for the British Diabetic Association suggested implementing a national
screening programme for non-insulin-dependent diabetes for individuals aged 40– 75
years (Patterson 1993). In addition, the new contracts for GPs include mandatory tasks
such as assessments of patients over 75, and financial incentives for achieving set
levels of immunizations, cervical screening and health checks for pre-school children
(Department of Health and Welsh Office 1989). Likewise, practice nurses routinely
measure weight and blood pressure to screen for obesity and hypertension. Recent
screening programmes have also focused on self-screening in terms of breast and testicu-
lar self-examination and over-the-counter tests to measure blood sugar levels, blood
pressure and blood cholesterol. In addition, with the development of genetic testing,
genetic counselling is now offered for genetic disorders such as cystic fibrosis, Down’s
syndrome, Alzheimer’s disease, Huntington’s disease and forms of muscular dystrophy,
though many of these programmes are still in the early stages of development.
SCREENING AS A USEFUL TOOL
The proliferation of screening programmes was at first welcomed as an invaluable
and productive means of improving the health of a country’s population. It was seen
as a cost-effective method of preventing disease as well as providing statistics on the
SCREENING 213