Australia claims to have best cystic fibrosis screening


By Marilyn Bitomsky

BRISBANE, Australia (Reuters Health) – Australia has the best screening for cystic fibrosis (CF) in the world, according to a speaker at the Fourth Australian and New Zealand Cystic Fibrosis Conference.

Semi-retired paediatrician Professor John A. Dodge, who is honorary professor of child health at the University of Wales in Swansea, UK, told the conference that Australian physicians can therefore implement CF treatment earlier and thus avoid poor nutrition and other problems seen in children diagnosed late.

Australia is probably the first country to institute an effective national screening program, such that children are detected at just over 1 month of age on average, he said.

"The UK by comparison has taken a long time to convince the government that screening is important," Dr. Dodge commented. The problem, he said, is that people have questioned that it is possible to prove that early screening affects prognosis.

"That is impossible [to prove] because prognosis is improving all the time, so you can't pinpoint a time when it suddenly improves," he said. "Because the mean survival now is into the thirties, we would have to wait at least 30 years to see whether screening has had any beneficial effect. So we have been asking the wrong question."

The right question, Dr. Dodge said, aims at a shorter-term view. For example, is it possible to prevent the severe weight loss that occurs in the undiagnosed CF infant? It takes about 2 years after a CF diagnosis before a child reaches a normal growth percentile, he said. "If we can obviate or minimize that weight loss, we will see immediate short-term benefits."

Another reason for neonatal screening is that it allows the doctor to "get off to a good start with the family," he said. If the doctor goes to the family with the diagnosis, it is a shock. However, they may trust the doctor, knowing that he or she did not miss the CF. These parents are then more likely to comply with recommended treatment, he said.

However, if diagnosis is made at the age of 2 or 3 years, after the child has been in hospital several times and seen many different doctors, it is understandable if the family does not trust doctors, he noted.

Dr. Dodge added that the US was against screening for many years because of the possibility that the child would be denied health insurance. "So they made sure the child was properly registered in a health service before making any diagnosis–but that is bad medicine."

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