Considering Screening When There May Be Minimal Direct Benefit to the Child.

Abstract

* Abbreviation: CDC — : Centers for Disease Control and Prevention A core principle of screening is that there should be a direct benefit to the patient. This restriction undervalues the impact that screening could have by not considering the population-level benefits to others, including family members, close contacts of affected individuals, and the broader community. Screening for lead poisoning offers an example of how individual screening has resulted in long-term health improvements for many by identifying and abating lead from the environment. The US Preventive Services Task Force states that the balance of information regarding the benefits and harms of screening for elevated blood lead levels is insufficient to recommend for or against it.1 However, lead screening has been associated with significant overall public health improvement. In this commentary, we identify generalizable lessons about when it might be appropriate to screen even if there may be limited direct benefit to the child being screened. Childhood blood lead testing of asymptomatic children began in the 1970s.2 Initially, most blood lead screening was done through local health departments, maternal and child health programs, and other community-based organizations, with support from the Centers for Disease Control and Prevention (CDC) and other federal agencies. Screening was also recommended to occur within primary care and required for Medicaid-enrolled children at 1 and 2 years or by 6 years if not previously done. Regardless of setting, screening was often inconsistent. As late as 1998, only ∼20% of Medicaid-enrolled children had ever received a blood lead test.3 In addition, many children with elevated blood lead levels did not receive follow-up care.4,5 Specific … Address correspondence to Mary Jean Brown, ScD, RN, 157 Leeder Hill Dr #201, Hamden, CT 06517. E-mail: mbrown{at}hsph.harvard.edu