Although many individuals and organizations may endorse the goal of screening programs, the details and implementation are often controversial. For some types of screening, it can be quite challenging to weigh the human and economic costs and benefits and determine a clear recommendation.

For instance, in an article in the New England Journal of Medicine, Dr. Michael Barry (2009) indicates that “serial PSA [prostate-specific–antigen] screening has at best a modest effect on prostate-cancer mortality during the first decade of follow-up. This benefit comes at the cost of substantial over-diagnosis and overtreatment. It is important to remember that the key question is not whether PSA screening is effective but whether it does more good than harm.”
This week’s Learning Resources include articles about screening programs for four different diseases that contain potentially controversial recommendations. For this Discussion, you will select a disease and examine the epidemiological evidence to assess a recommendation for screening guidelines. In addition, you will consider possibilities for furthering policy to promote population health related to this disease.
To prepare:
• Review the four articles concerned with screening and public policy listed in this week’s Learning Resources. All four articles contain potentially controversial recommendations for screening and prevention.
• Select one article on which to focus for this Discussion.
• Analyze how the epidemiologic data could be used to formulate policy for improving population health.
By Day 3, post a cohesive scholarly response that addresses the following:
• Summarize the recommendations of your selected article. Discuss ethical considerations and whether or not you believe the recommendations are justified.
• Describe the epidemiological evidence in support of your position.
• Identify whether the screening program you review is population-based or high-risk based and how that influences your assessment.
• How can the reported data be used to move policy forward for improving population health around this issue?
By Day 6, respond to the postings of at least two colleagues who commented on an article you did notselect. Review his or her summary and make an argument to support a different position. Again, cite epidemiological evidence that supports your opposing view.
Reference:
Barry, M. J. (2009). Screening for prostate cancer—The controversy that refuses to die. New England Journal of Medicine, 360(13), 1351–1354. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMe0901166

Readings
• Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: Jones & Bartlett.
o Chapter 10, “Data Interpretation Issues”
o Chapter 11, “Screening for Disease in the Community”

Chapter 11 examines aspects of screening for disease, including characteristics of a good screening test and how screening programs can be evaluated.
Nash, D. B., Fabius, R. J., Skoufalos, A., Clarke, J. L. & Horowitz, M. R. (2016). Population health: Creating a culture of wellness (2nd ed). Burlington, MA: Jones & Bartlett Learning.
o Chapter 13, “Decision Support”

This chapter addresses measurement and analysis tools used to support decision making for improvement, accountability, and research related to population health. The three main purposes of measurement in population health (improvement, accountability, research) provide the framework for this chapter.

Note: You will need to review the following four articles to complete this week’s Discussion:
U.S. Preventive Services Task Force. (2009). Screening for breast cancer. Retrieved fromhttp://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm

This is a summary of the controversial USPSTF proposal regarding screening for breast cancer using mammography and breast self-examination. It includes the recommendations, rationale, and evidence supporting the proposal.
Alvarez, G. G., Gushulak, B., Rumman, K. A., Altpeter, E., Chemtob, D., Douglas, P., … & Ellis, E. (2011). A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates. BMC Public Health,11(3). Retrieved from http://www.biomedcentral.com/1471-2334/11/3


 

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