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Human Reproduction Update Advance Access originally published online on June 28, 2006
Human Reproduction Update 2006 12(5):499-512; doi:10.1093/humupd/dml027
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Screening in women’s health, with emphasis on fetal Down’s syndrome, breast cancer and osteoporosis

Hajo I.J. Wildschut1,4, T.J. Peters2 and Carl P. Weiner3

1 Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands, 2 Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Clifton, Bristol, UK and 3 Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, KS, USA

4 To whom correspondence should be addressed at: Department of Obstetrics and Gynecology, Erasmus University Medical Center, PO box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: h.wildschut{at}erasmusmc.nl

Screening tests have become increasingly popular in women’s health care over the last two decades. The initiative for screening is typically generated by either an agency or the health care professional being consulted for some reason. In many instances, however, the demand for screening tests is patient driven with the health care provider being poorly prepared to determine the usefulness of screening. This review illustrates the complexity of screening using three disorders where early detection and treatment have the potential to improve the quality and longevity of life. Prenatal diagnosis of Down’s syndrome does not offer the parents the opportunity for cure but does offer the opportunity for education and rational choice as the impact of the diagnosis on the family is weighed. The evidence for breast cancer screening is more persuasive for older than younger women, but even in older women, there is a balance of risks and benefits. Treatment options for osteoporosis have improved in terms of reductions in fracture risk as well as beneficial effects on bone density, but evidence of the effectiveness of a screening programme for this condition in an unselected population is lacking. Ultimately, it is crucial that women be provided with clear and comprehensive information about the screening programme, in terms of possible gains but also costs of various kinds: physical, economic and psychological.

Key words: breast cancer / Down’s syndrome / informed choice / osteoporosis / screening


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