In recent years, the UK Government has continued to expand preventive health screening, particularly for adults over 40, with the goal of detecting disease early—before symptoms become serious or irreversible. However, the strategy remains controversial. Many question whether more screening always leads to better outcomes, especially given the extensive checks already offered in general practice.

To guide public health policy, screening programmes must meet well-established international standards. In 1968, the World Health Organization commissioned a foundational report that led to the publication of “Principles and Practice of Screening for Disease” by Wilson and Jungner. Their work remains the cornerstone of screening policy today.

The 10 principles of effective screening

As Hippocrates warned, “First, do no harm.” Wilson and Jungner’s criteria are designed to ensure screening does more good than harm:

1. The condition should be a significant health concern.

2. Its natural progression must be well understood.

3. It should be detectable at an early stage.

4. Early treatment must improve health outcomes.

5. A reliable and validated test must be available.

6. The test must be acceptable to patients.

7. There must be capacity to treat those identified.

8. Screening should be repeated at appropriate intervals.

9. Benefits should outweigh potential harms.

10. The cost must be proportionate to the health gains.

(Source: WHO Bulletin, adapted by Andermann et al., 2008)

UK screening programmes: what’s included?

Based on these criteria, the UK National Screening Committee (UK NSC) has approved screening for numerous conditions, including:

• Breast cancer (women aged 50+)

• Cervical cancer (women aged 25+)

• Bowel cancer (adults aged 60+)

• Retinal screening for diabetics (aged 12+)

• Antenatal screening for foetal anomalies

• School-age checks for vision, hearing, height, and weight

• Annual chlamydia screening for sexually active adults under 25

GPs also routinely screen for blood pressure, diabetes, obesity, and lifestyle risks like smoking and alcohol use.

The prostate cancer debate

One major condition not included in national screening is prostate cancer. While evidence shows that screening with PSA (Prostate-Specific Antigen) tests can reduce mortality by up to 20%, it also leads to high overtreatment rates. Prostate cancer often progresses slowly, and many cases wouldn’t affect lifespan if left undiagnosed.

The PSA test is known for false positives, leading to unnecessary biopsies, weeks of anxiety, and the risk of treating non-aggressive cancers. According to past reviews, 48 men need to be treated to save one life. As of the most recent updates, the UK NSC has not endorsed a national prostate cancer screening programme, citing a failure to meet multiple Wilson-Jungner principles.

The future of genetic screening

Emerging technologies—especially genetic testing—are increasingly affordable and fast. However, they raise new ethical, financial, and clinical challenges for public health systems.

The now well-known decision by Angelina Jolie to undergo a preventive double mastectomy due to the BRCA1 gene mutation ignited global debate. If such preemptive actions were applied population-wide, the impact on healthcare budgets and counselling services would be immense.

A balanced approach to prevention

“Prevention is better than cure” remains a powerful public health mantra—but only when prevention is strategically targeted, scientifically supported, and cost-effective.

Over-screening risks false reassurance, anxiety, and resource drain, while under-screening may miss preventable disease. As technologies evolve, the UK—and other nations—must continually re-evaluate what prevention truly means in a 21st-century context.