25 Apr Study Finds More Harm Than Benefit From Screening All Young Athletes To Prevent Sudden Cardiac Death
Dr. Hans Van Brabandt
MedicalResearch.com Interview with:
Hans Van Brabandt, M.D.
Brussel, Belgium
MedicalResearch.com: What is the background for this study?
Dr. Van Brabandt: We have been asked by the Belgian government to assess the benefits and harms of pre-participation screening of young athletes. A number of Belgian cardiologists and screening physicians are intensely promoting such screening through mass media and were asking governmental support.
MedicalResearch.com: What are the main findings?
Dr. Van Brabandt: There is no solid evidence on the benefit of cardiovascular pre-participation screening, and certainty of harms it induces through numerous false-positives, making that such screening in young athletes cannot be defended.
– Italian investigators assert they have provided evidence for the benefit of screening. The single study on which they base their claim however is far from convincing. Unfortunately, more than 10 years after their first paper, they still did not make the majority of their data publicly available.
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Van Brabandt : Pre-participation screening should be abandoned since its harms outweigh the benefits.
The effectiveness of pre-participation screening to reduce the number of sudden cardiac deaths in young athletes has not been substantiated by solid evidence. Its potential to reduce sudden cardiac death is unlikely because of the poor diagnostic performance of a screening examination, and the uncertain effectiveness of the management of the diseases thus identified in asymptomatic people. Pre-participation screening induces harm because of the high number of false-positive test results leading to temporary or lifelong disqualification from competitive sports, avoiding exercise that is beneficial to their overall health, psychological harm, and medical follow-up and treatment with unknown benefit.
In preventive medicine, especially in asymptomatic youngsters, an intervention can only be justified if it is based on the highest level of randomized evidence that it will do more good than harm. This prerequisite is not met in pre-participation screening.
MedicalResearch.com: What should clinicians and patients take away from your report?
Dr. Van Brabandt : There are no randomised trials to assess the effectiveness of pre-participation screening (in contrast to screening for breast cancer, prostate cancer …). It is a pity that the Italians did not go for a randomised trial when they started mandatory screening in the early 70s. If they had done so, we would have had hard data now.
It is most improbable that an RCT on pre-participation will ever be conducted.
In my view, we have to accept the very low risk of sports-related sudden death in youngsters (1/100,000) since the advantages of sports are so much larger , both from a psychological and a physical point of view
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Last Updated on April 25, 2016 by Marie Benz MD FAAD