appeared to increase the rate of cerebral palsy measured at 18 months of age (Shy et al.
1990). In a recent review of the effects of antenatal blood pressure screening on the
incidence of pre-eclampsia (high blood pressure in pregnancy, which threatens the
mother’s life), the authors concluded that the introduction of antenatal screening has
had no significant effect on pre-eclampsia, suggesting that this screening process
does not benefit the individual. Recent papers have also questioned the efficacy of
screening for congenital dislocation of the hip in neonates (Leck 1986), hypertension,
breast cancer and cervical cancer in terms of the relative effectiveness of early (rather
than later) medical interventions and the effects of simply increasing the lead time (the
period of time between detection and symptoms).Non-maleficence – screening must do no harm
Skrabanek (1988) suggested that screening should be subjected to the same rigours
as any experimental procedure, that the possible risks should be evaluated and that
the precept of ‘first do no harm’ should be remembered. Therefore, for screening
to be ethical, it must not only benefit the patient, but it must also have no negative
consequences either to the individual or to society as a whole. The psychological
and financial consequences of screening will be dealt with under later headings.
However, screening may cause personal harm in terms of biological consequences
and false-negative (receiving a negative result when the problem is actually present)
or false-positive (receiving a positive result when the problem is actually absent)
results; it may also cause social harm in terms of the medicalization of popula-
tions and the exacerbation of the existing stigmatization of certain groups of
individuals.Personal harm Some of the techniques used to monitor an individual’s health may
have a detrimental effect on their biological state. This is of particular concern for
the frequent use of mammography for the detection of breast cancer. Evidence for the
harmful effects of the irradiation of breast tissue and the links to cancer can be found in
reports of breast cancer in women who have been treated for benign conditions using
radiation therapy (Metler et al. 1969; Simon 1977), in survivors of the bombings
of Hiroshima and Nagasaki (Wanebo et al. 1968) and in women who have been
given fluoroscopy for tuberculosis (MacKenzie 1965). It has been argued that there is a
threshold, below which radiation could be considered totally safe, and that the above
examples of an association between irradiation and breast cancer are due to the
unusually high levels of radiation (Perquin et al. 1976). However, there is some dis-
agreement with this view. In particular, Upton et al. (1977) suggested that exposure to
1 rad would increase the risk of breast cancer by 1 per cent. Furthermore, Strax (1978)
suggested that if 40 million women were screened for 20 years, 120 would die from
radiation-induced breast cancer. However, since these concerns were raised, the dose
of radiation used in mammography has been reduced, although some concerns still
remain.
All tests are fallible and none can promise 100 per cent accuracy. Therefore, there is
always the chance of false positives and false negatives. A false-positive result may lead222 HEALTH PSYCHOLOGY