Antenatal Screening
Screening in antenatal terms is used to check if their is anything wrong with the baby before it is born, therefore giving the parents a chance to prepare and decide what path they would like to take - whether to continue with the pregnancy or not if something is wrong. It allows them not to 'be in the dark' about the health of their baby and if something is wrong, allows time for decisions to be calmly made. Antenatal screening is carried out before birth and provides the parents of the infant with information about the health of their unborn child.

The most common procedures of antenatal screening are amniocentesis, which can diagnose sickle cell anemia, spina bifida and downs syndrome, and CVS, which is done earlier than amniocentesis and as a safer alternative. Having amniocentesis carries a slight chance of miscarriage so the parents have to weight up whether or not they are prepared to take the chance. The parents could find out what disorders the baby could of had, but they will have to deal with the guilt or regret if it causes miscarriage. Some people will be prepared to take the chance, as they will be certain about the health of the baby, although some will not take the test as they would of kept the baby even if wasn't healthy.

Target groups which antenatal tests will be offered to are to mother's who are over 35 at the time of the pregnancy, if there is a history of disease or disorder in the family or if a previous child has a condition. This is because these groups are more likely to be effected by disorders which could be picked up by the screening process, and so will be more successful and effective.

Antenatal screening includes bio chemical results, which are blood tests carried out on a woman for the levels of chemicals, for example, looking for a high amount of AFPC which could indicate Spina Bifida. It also could be genetic screening on the foetus (amniocentesis or CVS), which checks for chromosomal abnormalities, or an ultrasound of the foetus to check for physical abnormalities.

There are many advantages to antenatal screening, most to do with the physiological advantages in preparing the parents with the status of their baby. The parents will have to think about many things when deciding whether to carry on witht he pregnany, or terminating it. These include the quality of life the child will have when it ages, for example with down's syndrome and dwarfism these are illnesses which will majorly effect the child throughout it's like, and so the parents will have to decide if they can continue with the commitment of caring for the effected child. Also, who will look after the child when the parents die, which is another reasons why the over 35's are targeted for screening, and whether the child will be looked after by care or siblings within the family. Also, the parents will have to decide if they have enough time and money to look after the child, and to pay for care, medicine, treatments and specialist help, which also brings to them having to take into consideration how many children they already have and how a new child with difficulties would fit within the family. A family with lots of children already may not be able to cope, and so may terminate the pregnancy, however a family with no current children may be more able to cope and so are more likely to carry on with the pregnancy. Antenatal screening helps parents decide on these choices with the most knowlage they can currently have, and so decide with a well informed mind.

Although, there are things which prevent people from choosing screening. For example, religious people may believe that God has given them the life, and so it is perfect just the way it is. Some religions see disabilities as a 'test' from God, and other religions do not allow abortions due to the Sanctity Of Life. Other expected parents may not take the offered screening tests as they have already decided they will love the baby regardless of whether it is healthy or not, and also if the couple have previously struggled to conceive they will be less likely to terminate the pregnancy.

Roughly 1/100 infants tested for down's syndrome using amniocentesis will have a positive result. This may not at first glance seem very cost effective, but diagnosing a condition early means that expense could be saved further down the line. You also have to weigh up the gain, in that the one family who has the child with down's now has all the information to make the right choices for them, and isn't wandering around in the dark.

Child and infant screening
The purpose of screening in children and infants is to check for disease or disorders that if not treated or corrected early on could progress into something that needs more intensive treatment or could potentionally stunt development and affect the child for a longer period of time.

If a condition is detected early enough then it can be treated and managed through simple measures such as a change in diet or lifestyle, which is more cost-effective in the long run, as leaving it to develop would cause more expensive treatments to be needed. For example PKU (Phenylketonuria), if detected and managed, the child will not get brain damage, therefore will not have a lifelong disability and this reduces the cost to the NHS and tax payers. The cost of screening in the UK is expensive, therefore costs the NHS large sums of money, but if you compare this with the treatment costs for developed illnesses that would have been missed if not screened, then the screening process works out as very cost effective indeed. If screening did not happen in the UK, more children would develop conditions that could be prevented or treated easily, this costing the NHS more money in the long run.

Some people would argue against this, as only 1 in 2600 children and infants that are screened have it, thus the NHS is doing 2599 'unnecessary' procedures. However, it does save the one child that is detected with PKU from brain damage and a life of suffering.
There is also the benefits to the family which are gained; early detection prevents the parents the lifelong commitment, stress and financial burden of having to look after a disabled child, and also prevents the child from falling behind their peers, therefore giving them a greater chance of a normal life.

PUT THIS IN A TABLE
PKU - Heel prick test, which is quite painful for the baby and may cause it to cry - if not screened and the baby has high levels of phenylalanine in their blood due to not having the enzyme to break it down then it will cause brain damage - the child will not be able to meet its potential as it has brain damage, therefore it's quality of life will be limited.
Thalassaemia - also the heel prick blood test - the child will require regular blood transfusions to provide the haemoglobin that the body needs - this would mean that the child would be in and out of hospital (blood is needed every two to four weeks), and will also be tired often, so will not be able to participate fully in activities.
Dental - a routine check will involve a visual examination of the teeth and surface probing - if not screened then if improper care is taken of the teeth it will cause pain and loss of teeth - this means that the child will have problems speaking, eating and the arrangement of the mouth may develop wrong.
Sight - a routine eye check will involve reading from a snellen chart, and also a refraction test if a problem is detected - if not treated it will effect the child's language and ability to read - this will effect their lives by hindering their progress at school, therefore stunting their learning.
Hearing - a hearing test for a child will normally involve them being introduced to a series of sounds, and identifying whether they respond correctly to them - if not screened the child will lack in hearing, therefore effecting their language development - this means that the child will not be able to communicate effectively.
Hip dysplasia - the test involves manipulate the baby’s hips to check the stability of the hip joints looking for a clunking noise - if not screened then it will cause problems with the physical development which means the infant will not be able to crawl or walk properly - this effects the child's life as it will potentionally not be able to walk and so will have problems with mobility.

Adult screening
It is especially important to carry on being screened as you age, as the older you get, the more likely the body is to make mistakes due to mitosis, therefore such disorders such as cancer are more probable to arise.

When diseases are detected early enough through screening it means that the treatment is more likely to be successful, the patient is more likely to survive, they are mire likely to recover fully and also the treatment will cost less as the disease has not advanced.

Examples of adult screening include regular eye tests, hearing tests and blood tests.

As you get older, screening processes will look for certain disease and malfunction that are more common as you age. Screening in the form of an eye test can detect Glaucoma, which could cause blindness if not treated due to the build-up of pressure within the eye, therefore screening could identify this problem arising, and tackle it before it progresses too far. An eye test could also detect Astigmatism (when the cornea is not a perfectly curved shape0, which could be easily corrected through glasses and prevent sight problems which will worsen if not corrected, and therefore cost the NHS more money.

Adult screening is expensive, as more serious conditions are likely to arise with age, which take more money to identify and treat. Although, if no screening procedures existed then the condition would most likely go unnoticed until it was too late, or until treatment costed a substantial amount of money to treat in comparison to what it would cost to treat if caught early though the methods of screening. Not getting screening and the progression of the disease could also pose a greater risk to the patient's life.

To reduce the cost to the NHS, specific people are targeted for certain screening tests; those most at risk. For example, all woman over the age of 40 are invited for a breast screening as the risk factor increases the older you are, or if you have a previous family history of cancer.

Regular screening for cancers such as of the breast, cervical and testicular take place usually before symptoms occur, as the lump may not be big enough to feel through self-screening, and it means that the cancer can be treated earlier (if detected) and so the patient will have a higher chance of a successful and quicker recovery.

As adults, patients are able to choose whether or not to get screened, as apposed to parents or carers decided for them when they are still underage. There are some people who decide against getting screened, whether or not they are offered. These include those with religious beliefs which conflict with the procedures of screening; some religions (such as Jehovah witness) would disagree with the intervention of science do to them believing that God has his reasons for giving them the illness, and other religions would believe it to be a 'test' from God.
Others would rather live in the unknown as to is they have a disease or disorder as they would find it hard to accept the truth that they are ill, have given up hope (if they are too old or have an history), or are scared to know they outcome of the tests, especially if it runs in the family.