and further assessed the additional impact of treatment (Palmer et al. 1993). The
results showed that following the diagnosis, the women experienced high levels of
intrusive thoughts, avoidance and high levels of anger. In addition, the diagnosis
influenced their body image and sexuality. However, the authors reported that there
was no additional impact of treatment on their psychological state. Perhaps, the
diagnosis following screening is the factor that creates distress and the subsequent
treatment is regarded as a constructive and useful intervention. Further research is
needed to assess this aspect of screening.5 The existence of a screening programme. Marteau (1993) suggested that the
existence of screening programmes may influence social beliefs about what is healthy
and may change society’s attitude towards a screened condition. In a study by
Marteau and Riordan (1992), health professionals were asked to rate their attitudes
towards two hypothetical patients, one of whom had attended a screening pro-
gramme and one who had not. Both patients were described as having developed
cervical cancer. The results showed that the health professionals held more negative
attitudes towards the patient who had not attended. In a further study, community
nurses were given descriptions of either a heart attack patient who had changed their
health-related behaviour following a routine health check (healthy behaviour condi-
tion) or a patient who had not (unhealthy behaviour condition) (Ogden and Knight
1995). The results indicated that the nurses rated the patient in the unhealthy
behaviour condition as less likely to follow advice, more responsible for their condition
and rated the heart attack as more preventable. In terms of the wider effects of screen-
ing programmes, it is possible that the existence of such programmes encourages
society to see illnesses as preventable and the responsibility of the individual, which
may lead to victim blaming of those individuals who still develop these illnesses. This
may be relevant to illnesses such as coronary heart disease, cervical cancer and breast
cancer, which have established screening programmes. In the future, it may also be
relevant to genetic disorders, which could have been eradicated by terminations.
Why has this backlash happened?
Screening in the form of secondary prevention involves the professional in both detection
and intervention and places the responsibility for change with the doctor. The backlash
against screening could, therefore, be analysed as a protest against professional power
and paternalistic intervention. Recent emphasis on the psychological consequences of
screening could be seen as ammunition for this movement, and the negative con-
sequences of population surveillance as a useful tool to burst the ‘screening bubble’.
Within this framework, the backlash is a statement of individualism and personal power.
The backlash may reflect, however, a shift in medical perspective – a shift from ‘doctor
help’ to ‘self-help’. In 1991, the British Government published the Health of the Nation
document, which set targets for the reduction of preventable causes of mortality and
morbidity (DoH 1991). This document no longer emphasized the process of secondary
prevention – and therefore implicitly that of professional intervention – but illustrated a
shift towards primary prevention, health promotion and ‘self-help’. General practitioners
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