Some pitfalls in disease screening

Abstract

To the Editor . — Lefebvre and coworkers 1 and the accompanying editorial by Havas 2 raise several critical and appropriate parallels between screening efforts for hypertension and those for hypercholesterolemia. Al(Continued on p 1124.) (Continued from p 1121.) though their summary of labeling is thoughtful and apt, a few qualifications may be useful and important. The screening effort itself encompasses multiple complexities. The absolute number of individuals undergoing a screening may be less crucial than the number and proportion who were previously unaware of their condition. The hypertension literature3 suggests that many screenees had previously undergone similar screening and wished merely to verify the prior result. Close linkage to follow-up and treatment for sustained elevation represents another hurdle. To minimize unavailability for follow-up, several investigators demonstrated the feasibility of work-site programs, arguing the several advantages of a nearly "captive" audience. Haynes et al 4 observed dramatic elevations in illness absenteeism