Screening high-risk populations: a challenge to primary medical care.

The organizational, educational, and policy implications of screening high-risk populations are considered for five selected conditions: (a) the role of pregnancy-risk indices for the identification of high-risk women as it relates to the efficient use of perinatal and neonatal intensive care centers; (b) screening school-age children for conductive hearing loss, with emphasis on the role of complete otologic examination, threshold testing, and tympanometry in children with a history of recent or recurrent middle ear disease; (c) the efficacy of Pap smears in reducing mortality from cervical cancer; (d) the current status of clinical examination and mammography for detecting breast cancer; and (e) the problems inherent in diagnosing and treating hypertension. Because of the increasing costs of new technology that have not yet been adequately tested, health professionals bear an increasing obligation to require scientific evidence of the efficacy of the screening procedures before instituting large-scale programs.