Screening enthusiasts focus on the benefits in terms of cancer morbidity and mortality, and for a disease that is as much feared as cancer, this is a powerful motive for the public too. However expansion of screening programs may also increase people's sense of risk or to put it the other way, undermine the illusion of health. With some screening programs identifying precursor risks (e.g. HPV infection) in a much higher proportion of the population than would ever have been likely to develop cancer, then the barriers between health and disease are blurred further. This is striking in the metabolic field where huge proportions of the population are identified with hypertension, insulin resistance, or hyperlipidemia, potentially creating an almost population-wide perception of compromised health status. The growth in personalized genetic testing - which will increasingly offer quantitative risk feedback rather than just testing for the presence or absence of highly penetrant mutations, will also add to the blurring of boundaries between health, disease risk, and disease. Ultimately this might lead to a paradigm shift in understanding of the health-disease continuum, perhaps with positive consequences for health, but in the meantime, it is important to get a better understanding of how lay models of health and disease are changing and how screen-detected abnormalities fit into the picture.
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