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Thursday, 23 August, 2001, 23:11 GMT 00:11 UK
Better Down's tests 'ignored'
Scans can help pick up the syndrome in unborn children
Few pregnant women are being offered the best available screening for Down's Syndrome, a report says.

And the study in the British Medical Journal suggests that other combinations of tests currently being used are less efficient and more costly to the NHS.

It means that more women than necessary are undergoing further investigations which carry the risk of miscarriage.

One in every 700 babies born in the UK has a extra slice of genetic material which means they are born Down's syndrome.

It causes degrees of mental disability, and sometimes heart defects and hearing and sight problems.


The double test fares poorly in our analysis - at no extra cost you could move to a better test

Dr Stuart Logan, study author
Many parents choose to abort a baby should they discover the presence of Down's syndrome, even though many will reach 60 years of age.

There are many different types of screening test for Down's syndrome - doctors are trying to find those women most at risk, so that as few as possible have to be offered the more risky procedures which give a firm diagnosis.

The most commonly-offered tests in the UK are offered the so-called "double test", a combination of two types of blood test in the second trimester of their pregnancy.

Worst performer

However, according to the latest study, this is one of the poorest-performing, both in terms of its accuracy and "cost efficiency".

Ranked highest are two tests involving an ultrasound scan at 12 weeks called a nuchal fold test.

This looks for differences in the appearance of the space at the back of the baby's neck which can suggest Down's.

Nuchal fold testing in isolation was effective, the study found, although the most effective was to offer it in combination with four types of blood test in the second trimester - a so-called integrated test.

However, only 7% of women are offered nuchal fold testing, and only 3% are offered the quadruple test.

One of the study's authors, Dr Stuart Logan, a senior lecturer in epidemiology at the Institute of Child Health in London, said that the introduction of more efficient tests could save the NHS money - and possibly prevent parents opting to terminate unaffected children because of unreliable results.

He said: "The double test fares poorly in our analysis - at no extra cost you could move to a better test.

"If you are going to offer people screening, you are doing it because you want to offer them choice, and give them the best information to make that choice.

"The test which can do that is not being offered in a large proportion of UK hospitals."

A spokesman for the Down's Syndrome Association said: "It is important that medical professionals do not fall into the trap of assuming what parents' wishes will be by stating - as in this case - that better testing will directly 'result in fewer affected babies'.

"A test result is simply information and it is wrong to make assumptions about the final outcome - an outcome that should be decided by the parents who have to make difficult choices, often under time pressure."

 WATCH/LISTEN
 ON THIS STORY
The BBC's Daniel Sandford
"As evidence increases some NHS hospitals are offering the new test"
Report author Dr Stuart Logan
"We need to get much better about how we offer information"
See also:

04 Mar 00 | Health
Test for Down's 'waste of money'
31 Oct 00 | Health
Down's patient in bid for surgery
30 May 00 | Health
Down's risk 'misdiagnosed'
06 Feb 00 | Health
Test safer for unborn babies
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