Prevention. How much harm? How much benefit? 3. Physical, psychological and social harm

Area of Science:

• Medical Ethics
• Public Health
• Preventive Medicine

Background:

• Preventive programs aim to detect diseases early but can lead to unintended harm.
• Harm can manifest physically, psychologically, socially, or ethically (e.g., lack of informed consent).
• Adverse effects occur across the screening cascade: the procedure, follow-up investigations, and treatment.

Purpose of the Study:

• To identify and categorize the types of harm associated with preventive screening programs.
• To analyze where in the screening cascade the greatest harm occurs.
• To provide examples of procedures and consequences that lead to harm.

Main Methods:

• Literature review and analysis of potential harms in preventive screening.
• Categorization of harm into physical, psychological, social, and ethical domains.
• Examination of the screening cascade stages and their associated risks.

Main Results:

• Physical harms include procedural risks (e.g., venipuncture, biopsy) and lifestyle changes (e.g., diets, surgery).
• Psychological and social harms encompass anxiety, fear of results, labeling, and false reassurance.
• The most significant harm is concentrated in the investigation of abnormal results and subsequent treatment phases.

Conclusions:

• Preventive screening, while beneficial, carries inherent risks that must be carefully managed.
• Understanding the full spectrum of harm, particularly from follow-up and treatment, is crucial for ethical implementation.
• The low positive predictive value of many screening tests contributes to psychological distress due to false positives.