Screening for cardiovascular risk: public health imperative or matter for individual informed choice?

The National Screening Committee has recommended a paradigm of informed choice for participants in all screening programmes. Theresa Marteau and Ann Louise Kinmonth examine the potential consequences of applying such a policy to screening for risk of coronary heart disease in primary care Current recommendations for the primary prevention of coronary heart disease in groups at high risk depend on screening through primary care and provision of risk related advice or treatment.1 Criticisms of these recommendations highlight the lack of evidence for the cost effectiveness of multiple risk factor interventions delivered through primary care. 2 3 We propose that this lack of effectiveness may, in part, reflect how people are invited for screening. The public health approach most often used focuses on maximising participation in screening rather than on informed participation. We consider here the implications of offering primary preventive services for cardiovascular disease within a framework of informed choice. #### Summary points Invitations for cardiovascular screening tend to emphasise the benefits of participation, neglecting the possible harms and uncertainties that such screening entails A policy shift is occurring towards ensuring that people invited to participate in any screening programme do so on the basis of an informed choice The impact of conducting cardiovascular screening within an informed choice paradigm is unknown Presenting the uncertainties associated with the assessment and reduction of cardiovascular risk has the potential to be more cost effective than screening conducted in a traditional, public health paradigm if it results in participants who are more motivated to reduce their risks It also has the potential to increase inequalities by reducing the number of people most at risk who participate in screening Evaluation of the operation of an informed choice approach to cardiovascular risk assessment is needed We searched Medline and PsycINFO databases for systematic literature reviews relating to …