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Is screening the healthy any way to reduce strokes?


Beth Wilson

Exercise, diet and not smoking are the ways to cut stroke risk.

'Simply identifying abnormalities is not useful.'

'Simply identifying abnormalities is not useful.'

I RECEIVED a rather official-looking letter in the snail mail at my home. It looked professional with full colour medical diagrams of plaque build-up in arteries printed on good quality paper. It was from ''Screen for Life. Prevention for Peace of Mind'' urging me to avail myself of their ultrasound screening service for stroke. And for just a little more dosh, I could also have screening tests for heart rhythm, abdominal aortic aneurysm and peripheral arterial disease.

They had very obligingly made an appointment time for me at the Malvern East Uniting Centre, a rather odd choice of location for a medical service, I thought. A friend of mine also received a letter from them and was allocated an appointment at a yacht club. When I went for my guitar lesson that night, lo and behold Uncle Bob McGowan, my teacher, had also received a Screen for Life appointment at the Alma Sports Club.

The letter contained some rather alarming information about what was going on in my ageing body: ''As you age, fatty deposits known as plaque can build up in your arteries. You may not notice any symptoms but the silent danger is there.'' The letter did very little to allay my alarm, short of assuring me that for $199 their services could detect any risk to me. In tiny print at the bottom of the page the letter also advised me this money is not covered or reimbursed by Medicare.

The letter contained a quotation: ''Australia's National Stroke Foundation says strokes are preventable. Indeed, according to the World Health Organisation, the Stroke Alliance for Europe and the US National Stroke Association, 80 per cent of strokes can be prevented.''

Wondering if this meant the National Stroke Foundation was endorsing this service, I contacted them. They most certainly did not and now have a message on their website to say so: ''Screen for Life is not associated with or endorsed by the National Stroke Foundation. It is a private organisation offering screening services for cardiovascular disease including stroke. While Screen for Life is referring to one of our stroke statistics, this should not be seen as an endorsement of its services.

''If you are worried about cardiovascular disease including stroke, the National Stroke Foundation recommends you visit your doctor and ask for an assessment. Tests organised by your GP are often partially or totally covered by Medicare. The National Stroke Foundation does not support medical tests that may be unnecessary. Further information can be obtained from StrokeLine on 1800 STROKE (787 653).''

Screen for Life is linked with a multinational company, Life Line Screening, which operates in the United States and Britain. Indeed there are dozens of screening companies cashing in on this market overseas, and more will soon be seeking to operate in Australia. In Britain they offer a mobile screening service and claim to have screened more than 5 million people after intense marketing campaigns.

There is no specific regulator to deal with the practices of the screening companies, but Britain's Advertising Standards Authority investigated and upheld complaints about the bias in Life Line Screening advertising in 2008 and 2010. Regulation around these screening services is complex and inadequate, and Britain's Department of Health has asked the Royal College of Radiologists and the Royal College of Physicians for guidelines to set some standards.

I contacted renowned Australian stroke expert Professor Stephen Davis to find out his views. He explained that this type of widespread screening for asymptomatic people is not within any of the reputable Australian or international stroke guidelines and he is very concerned about it. ''There is no high-quality study anywhere in the world that has shown that screening of this type reduces the risk of stroke,'' he says.

Ultrasound for stroke is only useful when recommended by a doctor where the patient has had symptoms such as abnormality of speech, sudden vision weakness, general weakness, weakness in the arm or unsteadiness. Simply identifying abnormalities is not useful unless early preventive treatment is warranted, and there is a danger of false positive tests that may lead to harmful invasive procedures.

The major issue raised by concerned doctors is that many people will have some degree of thickening of the arteries but not be at risk. The tests could cause a lot of anxiety - in itself, a health issue. The most important things people can do to reduce their risk of stroke is to improve their lifestyle. The critical factor is exercise and Professor Davis advises that not exercising is as damaging to health as smoking. So, the take-home messages are don't smoke, moderate your alcohol use, get your weight under control, and see your doctor for regular check-ups including blood pressure and cholesterol.

Another problem with the screening of asymptomatic people is it may give a false sense of security. People may think, ''I had the test, I'm fine, another hamburger with the lot please and, oh yes, I will have a Coke and fries with that.'' There is, however, one real benefit of the screening, it is very healthy for the wallets of those providing it.

Beth Wilson is the Health Services Commissioner.

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