Letter: Questions on antenatal screening for Down's syndrome
Your support helps us to tell the story
From reproductive rights to climate change to Big Tech, The Independent is on the ground when the story is developing. Whether it's investigating the financials of Elon Musk's pro-Trump PAC or producing our latest documentary, 'The A Word', which shines a light on the American women fighting for reproductive rights, we know how important it is to parse out the facts from the messaging.
At such a critical moment in US history, we need reporters on the ground. Your donation allows us to keep sending journalists to speak to both sides of the story.
The Independent is trusted by Americans across the entire political spectrum. And unlike many other quality news outlets, we choose not to lock Americans out of our reporting and analysis with paywalls. We believe quality journalism should be available to everyone, paid for by those who can afford it.
Your support makes all the difference.Sir: Cherrill Hicks' report (25 January) strikes an uncomfortable chord. In South Wales, serum screening for Down's syndrome began in 1990, with nearly 10,000 pregnancies followed through in the first year.
We became aware that the objective of the screening programme (usually to detect as many cases of Down's syndrome as possible) differs from that of individuals being offered screening (to make a personal choice).
The chance of Down's syndrome in a woman in her early twenties is roughly one in 2,000, but screening now inevitably projects worries about the problem to younger as well as older women. The blood test is less sensitive (39 per cent pick-up at age 25) in the younger women who have the most babies, and the problems of false positive results are relatively greater. In effect, the existence of the test is responsible for raising anxiety but may be less than helpful. It may also contribute to more frequent accidental miscarriages of unaffected foetuses.
For older mothers the risk predicted by the blood test is often not sufficiently different from her age risk to help her make a decision about an amniocentesis.
We now routinely modify our initial discussion to take the mother's age into account. Respect for individual values can only be met by careful preliminary explanation, however difficult.
This will often require greater resources and may lead to a lower uptake of tests. If resources really are saved from community budgets by screening (by avoiding the costs of care for people with Down's syndrome), perhaps some of the savings might be directed back to improving screening programmes themselves.
Yours faithfully,
ANDREW J. DAWSON, senior lecturer in obstetrics, University of Wales; TIM REYNOLDS, consultant in chemical pathology, Burton Group of Hospitals, Staffordshire; GILLIAN JONES, research midwife, University of Wales
Cardiff
Join our commenting forum
Join thought-provoking conversations, follow other Independent readers and see their replies
Comments