Screenings in Finland 2014 : The present state of health care screenings and future prospects
sosiaali- ja terveysministeriö
2015
Julkaisusarja:
Publications 2014:19This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.
Julkaisun pysyvä osoite on
http://urn.fi/URN:ISBN:978-952-00-3744-4Tiivistelmä
The screenings to promote health have long traditions in Finland. Since 2003 the working group on screenings set up by the Ministry of Social Affairs and Health has evaluated the health care screening programmes being carried out, those proposed to be carried out and their methods.
According to the Health Care Act, local authorities must organise screenings in accordance with the national screening programme for the municipal residents. Those are listed in the Screenings Decree: screening for breast cancer for women aged 50 to 69 years at about two years’ intervals, screening for cervical cancer for women aged 30 to 60 years at five years’ intervals, and prenatal screenings for pregnant women. Prenatal screening comprises general ultrasound during early pregnancy, finding a risk of chromosomal abnormalities, and ultrasound for finding severe structural abnormalities.
The screenings are steered nationally by both standards and in a less binding form by information. Apart from the screenings prescribed by the Decree, the organisers of screenings can choose fairly independently both the screenings offered and how they are implemented. National steering has been increased in several countries in regard to the screening of individual diseases so as to ensure equality. A wide discussion in society about the objectives and effects of screenings provides a good basis for the steering.
Including a new screening test in the national screening programme demands a great deal of preparatory work. Public debate and an efficient support for the implementation further the acceptability of a screening and contribute to establishing uniform practices. Those also increase the participation activity of the target population. In the present report, the introduction of prenatal screenings is used as an example of preparing a new screening and embedding it in practice in Finland.
A screening should produce enough health benefits to be justified from the perspective of public health. Therefore there must be a good understanding of the benefits, costs and societal impacts of a screening until a decision is made to start a new screening programme. Many screenings have been started on the initiative of health care professionals without particular steering. In Finland the effectiveness of statutory screenings has also been assessed afterwards. Sometimes the evaluation of a screening shows that it is not useful enough to be started. The present report deals with the following screenings evaluated by the working group on screenings: infection screening in early pregnancy, streptococci screening during pregnancy, screening for metabolic disorders in newborn infants, screening for aorta-aneurysma, and newborn hearing screening
The effectiveness of certain cancer screenings has been proved, but all cancer screenings are not necessarily useful. There must be a balance between the advantages and disadvantages of a screening. The application of a screening test that has proved effective in a research design in a population screening programme may prove less effective than was expected. The screening registers are important in view of evaluating and monitoring the implementation of the screenings, participation in them and above all their effectiveness at the population level.
Health examinations are included in the report since screenings and health examinations are not distinguished very clearly in public debate. Health examinations may include elements of screening but the aim of health examinations is not only to find diseases and precursors to them but also to support people’s health, wellbeing and work ability. In health examinations of children and adolescents the focus is on monitoring and supporting their health and development, and as regards adults on promoting their health, functional capacity and work ability.
We hope that the information and experiences conveyed by the report will be of benefit when planning screenings, their steering and quality monitoring in the future.
According to the Health Care Act, local authorities must organise screenings in accordance with the national screening programme for the municipal residents. Those are listed in the Screenings Decree: screening for breast cancer for women aged 50 to 69 years at about two years’ intervals, screening for cervical cancer for women aged 30 to 60 years at five years’ intervals, and prenatal screenings for pregnant women. Prenatal screening comprises general ultrasound during early pregnancy, finding a risk of chromosomal abnormalities, and ultrasound for finding severe structural abnormalities.
The screenings are steered nationally by both standards and in a less binding form by information. Apart from the screenings prescribed by the Decree, the organisers of screenings can choose fairly independently both the screenings offered and how they are implemented. National steering has been increased in several countries in regard to the screening of individual diseases so as to ensure equality. A wide discussion in society about the objectives and effects of screenings provides a good basis for the steering.
Including a new screening test in the national screening programme demands a great deal of preparatory work. Public debate and an efficient support for the implementation further the acceptability of a screening and contribute to establishing uniform practices. Those also increase the participation activity of the target population. In the present report, the introduction of prenatal screenings is used as an example of preparing a new screening and embedding it in practice in Finland.
A screening should produce enough health benefits to be justified from the perspective of public health. Therefore there must be a good understanding of the benefits, costs and societal impacts of a screening until a decision is made to start a new screening programme. Many screenings have been started on the initiative of health care professionals without particular steering. In Finland the effectiveness of statutory screenings has also been assessed afterwards. Sometimes the evaluation of a screening shows that it is not useful enough to be started. The present report deals with the following screenings evaluated by the working group on screenings: infection screening in early pregnancy, streptococci screening during pregnancy, screening for metabolic disorders in newborn infants, screening for aorta-aneurysma, and newborn hearing screening
The effectiveness of certain cancer screenings has been proved, but all cancer screenings are not necessarily useful. There must be a balance between the advantages and disadvantages of a screening. The application of a screening test that has proved effective in a research design in a population screening programme may prove less effective than was expected. The screening registers are important in view of evaluating and monitoring the implementation of the screenings, participation in them and above all their effectiveness at the population level.
Health examinations are included in the report since screenings and health examinations are not distinguished very clearly in public debate. Health examinations may include elements of screening but the aim of health examinations is not only to find diseases and precursors to them but also to support people’s health, wellbeing and work ability. In health examinations of children and adolescents the focus is on monitoring and supporting their health and development, and as regards adults on promoting their health, functional capacity and work ability.
We hope that the information and experiences conveyed by the report will be of benefit when planning screenings, their steering and quality monitoring in the future.