IntroductionDr Hannah Farrimond considers the issues surrounding government plans to screen the over-40s.
Health Secretary Alan Johnson has been outlining in greater detail the government’s plans to offer health screening for the over-40s, first announced by the prime minister in January. Pilots will be carried out this autumn, and a full roll-out will begin next year. Egenis Research Fellow Dr Hannah Farrimond is concerned that the roll-out has been announced before the pilot study has been carried out.
“The whole point of the pilot study is to test the screening,” says Dr Farrimond. “It’s slightly strange to pre-empt the results as general screening may turn out to be not cost-effective, or not effective in terms of behaviour change.
“The majority of people screened, particularly the younger ones, won’t have elevated risk. For those who do, it isn’t yet clear how they will respond to intervention, which is why the pilot is so important. Some people will make lifestyle changes, though whether it will be enough to justify the very considerable resources this screening will require is the fundamental question. Research has already been carried out into assessing cardio-vascular risk and behaviour change programmes. Although intensive interventions can result in modest behaviour change, it is expensive and we don’t know if that lasts over the long term. There needs to be an economic analysis following the pilot – the fact is that if you put money into this, you are diverting it away from some other part of the health budget.
“Resources may be better spent on targeting groups we already know are at higher risk, like those with high blood pressure, or high cholesterol. One way to target those at risk is to focus on those who have a family history of cardiovascular disease or diabetes – research shows, for example, that if the family members of heart attack victims were contacted and invited for screening and treatment, four out of 10 premature heart attacks could be preventable.”
Dr Farrimond agrees that there are sound reasons for screening a whole population: “The good thing about this proposal is that it will be offered to everyone over 40 rather than just relying on people to initiate the health checks themselves. This means that groups who may not realise that they are at elevated risk of disease or may not be as prone to initiating treatment (e.g. those in lower socio-economic groups, certain ethnic minorities) will still benefit. It will also mean women are invited for screening, which is important because research shows that neither GPs nor women themselves perceive women to be at risk of heart disease and it goes unnoticed and untreated.
“On the other hand, just because everyone is invited doesn’t mean everyone will attend. The pilot should tell us who comes forward, how they react to the intervention and how cost-effective it is.”
Dr Farrimond also questions the benefits of screening all older people and offering medication such as statins to them. “The risk of these diseases is strongly related to age. Almost every man over 60, for example, will end up being classified as ‘high risk’ of heart disease and so will be offered statins, which would massively increase the statins bill. We are at risk of medicalising old age. We should look to focus on preventing premature heart disease in those who are particularly likely to die early (under 60) as they have the most to gain by such preventive measures.”
Dr Farrimond's work at Egenis has focused on two common and complex diseases: coronary heart disease and diabetes. She has focused on exploring how patients/lay individuals make sense of their risk of these diseases, particularly in relation to their genetic and family histories. The current project she is leading, in conjunction with the Peninsula Medical School, is a qualitative exploration of the notion of pre-diabetes (elevated blood sugar), considering how family histories of diabetes may impact on motivation to avoid full-blown diabetes in this particular group.