Which prescriptive screening programmes are worth while?

Prescriptive screening is defined as screening for diseases solely for the benefit of the individuals participating in the programme. Currently used screening programmes are examined at each stage of life-antenatal, postnatal, school age, adult life, and old age. It is concluded that most disorders for which screening can be confidently recommended for the benefit of the individual are those occurring in children: screening infants for phenylketonuria, hypothyroidism, visual and auditory impairment, and probably congenital dislocation of the hip. Subject to parents' informed consent to participate, antenatal screening for Down's syndrome and neural tube defects is effective in high risk populations. Screening programmes to detect in school children visual and auditory defects and dental diseases are worth while. Two major problems arise in most programmes--firstly, how to achieve a high compliance rate of the population in attending for screening and accepting subsequent treatment; secondly, how to determine what treatment, if any, should be offered to borderline cases. Further evaluation of these problems is required for many programmes.