The public health related goal of organized screening tests is to find people who have developed early-stage medical conditions or asymptomatic diseases by periodically re-examining asymptomatic individuals.
Screening thus serves a dual purpose: it excludes or confirms the existence of the tested condition or disease. In this form, screening tests isolate the truly healthy from the asymptomatic persons, and on the other hand, it “filters out” the only seemingly healthy people in whom the disease is still hidden and causes no symptoms.
If the result of the screening test justifies further examination, with the help of organized screening programs patients are referred to a so-called clinical diagnostic test following the defined patient path. Primary health care services, including the GP service, play an important role in organizing these examinations.
Screening programs can reduce the mortality of diseases, since the disease can be detected much earlier than without a screening test. Patients screened and diagnosed during screening programs often have significantly better chances of recovery or survival thanks to early detection.
Diseases that can be tested with screening programs
As in other developed countries, the biggest public health challenge in Hungary is chronic non-communicable diseases. In recent decades, the incidence of cancer has risen significantly in all developed countries around the world. Cancer is a particularly serious public health problem in Hungary, accounting for almost a quarter of all deaths. In Hungary, after cardiovascular mortality, malignant tumors are the second most common cause of death: about 32-33 000 people die from cancer each year, although one third of tumor related deaths could be prevented.
In the working age population (25–64 years) in both sexes the mortality rate of cancer exceeds the mortality of cardiovascular diseases. This contributes significantly to the population decline. In terms of premature death and potential years of life lost, cancer claims the first spot in Hungary.
According to the current state of medicine, early detection of the disease and early treatment are the most promising public health strategies to reduce the mortality and the disease burden of cancer, because the effectiveness of treatment depends on disease progression to a large extent.
Cancer development is a multi-stage process, which takes years, during which, in case of certain diseases, it is possible to detect and screen before the onset of symptoms.
As of today, three types of screening have been shown to be effective:
- cervical screening,
- breast screening, and
- colorectal screening.
It is currently worth initiating a population screening program in these three types of screening against cervical, breast and colorectal cancer. For this purpose, an organized screening system has been set up in Hungary to involve as many of the target population at risk as possible on the basis of age.
Under the direction of the National Center for Public Health (Nemzeti Népegészségügyi Központ, NNK), the following organized screenings are carried out in Hungary:
- As required by law, 51/1997. (XII. 18.) NM decree:
- breast screening: mammography of women aged 45-65 years every 2 years;
- cervical screening: cytological examination of women aged 25-65 years.
- within the framework of the priority project EFOP 1.8.1 Complex Public Health Screenings:
- colon screening: a 2-step screening for men and women aged 50 to 70 years with an average risk of colon cancer (step 1: detection of blood in the faeces by immunochemistry followed by colonoscopy in those with a non-negative step 1).
In Hungary, participation in public health related organized screening is voluntary and based on informed consent. Attendance is an important indicator of the quality of organized screening, which expresses the proportion of people who accepts the invitation and participates in the screening.
Screening tests available nationwide
The health promotion screening buses touring the country also reach settlements far from screening centers and make targeted cervical screening and other screening tests available to the public.
On the buses:
- cervical screening,
- oral screening,
- cardiovascular risk screening is available.
In addition, individual counseling is provided in the following areas:
- melanoma risk reduction counseling;
- dermatoscopic dermatological examination;
- smoking cessation support;
- assessment of body composition;
- blood pressure measurement;
- reproductive and sexual health counseling;
- responsible pregnancy counseling;
- drug prevention and other lifestyle counseling.
Regarding screening tests it is extremely important to provide care for those who are found during the screening, therefore screening is performed by health care providers who also ensure the follow-up and treatment of these people.