Screening for colorectal cancer in ulcerative colitis: dubious benefits and high costs.

Leading articleScreening for colorectal cancer in ulcerative colitis: dubious benefits and high costs The primary role of the medical profession is to diagnose and treat members of the population who identify themselves as being 'sick' in some way.In this situation 'patients' approach the doctors.It is only recently that doctors have involved themselves in 'screening' apparently healthy members of the population in order to diagnose disease at a presymptomatic stage, when it is presumed treatment will be more effective.In this context of 'screening,' the contract between the doctor and the patient has an ethical element not present in ordinary clinical diagnosis and treatment.Elaborating on this point, Thomas McKeown, in the late 1960s, wrote: When a patient seeks medical advice the doctor's position, ethically, is relatively simple: he undertakes to do his best with the knowledge and resources available to him.He cannot be criticized when the state of medical knowledge does not enable him to treat effectively or even diagnose accurately the condition for which his advice is sought; nor can he undertake in all cases to assemble the full range of facilities for investigation and treatment from which his patients might conceivably benefit.The position is quite different in screening, when a doctor or public medical authority takes the initiative in investigating the possibility of illness or disability in persons who have not complained of signs or symptoms.There is then a presumptive undertaking, not merely that abnormality will be identified if it is present, but that those affected will derive benefit from subsequent treatment or care.This commitment is at least implicit, and except for research and the protection ofpublic health, no one should be expected to submit to the inconvenience of investiga- tion or the anxieties of case-finding without the prospect of medical benefit.The obligation exists even when the patient asks to be screened, for his request is then based on the belief that the procedure is of value, and if it is not it is for the medical people to make this known.'