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Organized and opportunistic screening
- Alain Braillon (3 July 2009)
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Alain Braillon, Public Health Amiens 80000. France
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Organized and opportunistic screening Bulliard et al. address an important question but their conclusion for effectiveness of opportunistic screening is premature. This observational study has several weakness: a) a non significant difference does not mean equivalence or noninferiority; b) the 5 years period of time is short, a programme covers a period of 20 years; c) screening has several harms, including false positives and overdiagnosis, which were not investigated; c) confounding risk and prognosis factors where not tested. In France, where both type of screening coexist and participation rate is far from the 80% objective, the participation to opportunistic screening depends on socio-economic factors including higher education level.[2] Guidelines recommend that women make an informed decision after learning about the benefits and harms. Public campaign for organized screening too often failed to address this issue which may be more debated when opportunistic screening is proposed by a physician. Coexistence of both organized and opportunistic screening is a paradox which only means that organisation is poor. References 1. Bulliard JL, Ducros C, Jemelin C, Arzel B, Fioretta G, Levi F. Effectiveness of organised versus opportunistic mammography screening. Ann Oncol 2009;20:1199-1202 2. Gueguen J, Cadot E, Spira A. Pratiques du dépistage du cancer du sein à Paris : résultats de l’enquête Osapiens 2006 [Breast screening practices in Paris: results of the OSAPIENS study, 2006]. BEH. 2008:Oct7:332-5 (available at http://www.invs.sante.fr/BEh/2008/37/beh_37_2008.pdf. accessed July 1) Conflict of Interest:None declared |
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