To Screen, or Not to Screen

Just because we can do something that will improve health outcomes – does that mean we should do it? I ask because a recent article in Science (1) raised an interesting question: should all children be screened for type 1 diabetes? After all, blood tests are available that can predict the onset of the disease years in advance. And tepilizumab, which can delay the onset of the condition, is now available in the USA. So why not simply screen all children and keep those at risk healthier for longer?

Well, mental health experts might object to a mass screening program to spare youngsters from health anxiety – itself a detrimental condition (2). Reports suggest that health anxiety amongst children has increased since the COVID-19 pandemic (3), when screening for infection became commonplace. Many of us may have observed young family members obsessively washing hands or repeatedly questioning their chances of survival during that time. Could screening children for diabetes cause them to grow up with a gnawing fear of developing a dreadful, incurable illness? Might it lead to years of hypervigilance, self-monitoring, detrimental Googling, and overuse of medical care?

Pandemic aside, health screening is somewhat alien to most children. They might be tested for a range of conditions before and immediately after they are born, and then offered no further tests until middle or old age. And though inoculations – which kids are more likely to experience – undoubtedly raise their awareness of deadly diseases, they also allay the fears of contracting them. Screening, it could be argued, might do the opposite.

Economists may also have concerns about such a scheme. Less than one percent of children are likely to test positive for diabetes biomarkers; health authorities might find it difficult to justify the huge bill for mass screening versus potential savings to the costs of treating adolescents with diabetes.

Might there be a compromise that addresses both of the above-mentioned barriers? Perhaps families should decide whether their children should be screened? 

In any case, questions like those raised here are guaranteed to divide opinions – and The Pathologist team is always interested to hear yours. Join the debate by dropping us an email: [email protected].