10. National program for screening every 2 years, aged 50-70

*There is a national program for a screening test that is recommended every two years for persons aged 50–70 who have a family history of the disease. Comment on the following statements:*

**I wanna play it save – if it is good after the age of 50 I rather be extra careful and have a screening earlier**

In order for screening to be successful it needs to be applied to a population which is at risk and for which treatment is promising. As a young person you are not at high risk and screening might result in many false positives, unnecessary treatment and harm, and waste of resources.

*There is a national program for a screening test that is recommended every two years for persons aged 50–70 who have a family history of the disease. Comment on the following statements:*

**The national program discriminates against the old, because you need to be younger that 70 in order to be eligible for screening. I think as a 78 years old I am even at higher risk, thus screening becomes even more important. The state only wants to save money and see the old people die.**

It is correct that older people are a high risk group and less false positives are to be expected. Still, older people are in danger of over-treatment for diseases that would never have bothered them. This is especially true for disease with long duration from early detection to symptoms. Also older people do less likely tolerate massive treatment and are more in danger of harmful side effects.

*There is a national program for a screening test that is recommended every two years for persons aged 50–70 who have a family history of the disease. Comment on the following statements:*

**I do not understand the age limitation? There are old people who are fitter than younger ones and vice versa.**

The statement is correct. The screening program should rather rely on a person’s health or the remaining life expectancy. Since these measures are difficult to derive and highly subjective, age has been found to be a well accepted, politically correct proxy. Think about a person that migrates between regions of low and high life expectancy, where also age recommendations for screening programs are adjusted accordingly. All of a sudden the very same person is or is no longer eligible to participate in a screening program.

*There is a national program for a screening test that is recommended every two years for persons aged 50–70 who have a family history of the disease. Comment on the following statements:*

**I have a family history as my grandfather was diagnosed with the disease**

Not necessarily – did he die of the disease or might it have been a pseudodisease? What age was he when diagnosed and what form of the disease? What stage did the disease take? For instance thyroid or prostate cancers in old people are often pseudodiseases and most people develop it if they live long enough although it never bothers them (“most men die with but not many die of prostate cancer”).

*There is a national program for a screening test that is recommended every two years for persons aged 50–70 who have a family history of the disease. Comment on the following statements:*

**I wanna play it save – instead of waiting two years for the screening I have it performed every 6 months**

With the suggested procedure the chances of false positive results increases drasti- cally. The person is prone to over-diagnosis and unnecessary scare. The fact that the national screening program recommends an interval of two years probably has also to do with the fact that the disease is progressing slowly and there is no benefit in a detection that appears a couple of months earlier.

*There is a national program for a screening test that is recommended every two years for persons aged 50–70 who have a family history of the disease. Comment on the following statements:*

**I am 68 and a half years old. If I get my screening now I am no longer in the age range in two years. Is it including 70 years old or not, anyway? Wouldn’t it be better to postpone the screening slightly to have it late at 69, if it is may last screening anyhow?**

Don’t drive yourself crazy. It really does not matter that much. Do whatever suits you. It is simply up to you to decide. Talk to your doctor about your needs and values, and come to an informed consent together. In the very worst case you pay for the screening out of your own pocket, that’s all (more likely your doctor states a justification and the screening is reimbursed). See also answer to C).

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C) The screening program should rather rely on a person’s health or the remaining life expectancy. Since these measures are difficult to derive and highly subjective, age has been found to be a well accepted, politically correct proxy. Think about a person that migrates between regions of low and high life expectancy, where also age recommendations for screening programs are adjusted accordingly. All of a sudden the very same person is or is no longer eligible to participate in a screening program.

*There is a national program for a screening test that is recommended every two years for persons aged 50–70 who have a family history of the disease. Comment on the following statements:*

**I just turned 50 years old and my family doctor told me that at the next visit he will perform the screening. I am a bit scared.**

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there is a screening recommendation (maybe together with a reimbursement offer); no obligation. The screening decision should be a personal decision, assisted by your doctor and based on current evidence. The doctor should inform you about all the facts and help you find out what is best for you. If your doctor can not assist you in this process and puts pressure on you, you should replace your doctor.