Screening programmes are social interventions as much as they are medical, and as such they benefit from scrutiny informed by social theory. Screening gives rise to a range of uncertainties and the debates and controversies that result are rarely confined to policy makers and health professionals. Contestations about the science underlying screening are common, and frequently enter the public sphere, engaging with wider societal themes and normative questions. The uncertainties of screening and the need to balance potential benefits against possible harms are often underestimated and underrepresented within these. In this paper, I consider the contribution of social theory to navigating the uncertainties of screening. In doing so, I focus in particular on two relatively recent developments: first, the marked shift, at least in policy terms, towards screening based on an individual’s informed consent, having weighed up the possible harms and benefits; and second, the emerging focus on overdiagnosis and overtreatment. I highlight some important ways in which social theory can add value by helping us gain analytical purchase on these issues.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Armstrong, D. 1983. Political anatomy of the body. Cambridge: Cambridge University Press.
Armstrong, D. 1993. Public health spaces and the fabrication of identity. Sociology 27 (3): 393–410.
Armstrong, D. 1995. The rise of surveillance medicine. Sociology of Health & Illness 17 (3): 393–404.
Armstrong, N. 2005. Resistance through risk: Women and cervical cancer screening. Health, Risk and Society 7 (2): 161–176.
Armstrong, N. 2007. Discourse and the individual in cervical cancer screening. Health 11 (1): 69–85.
Armstrong, N., and H. Eborall. 2012a. The sociology of medical screening: Critical perspectives, new directions. Chichster: Wiley-Blackwell.
Armstrong, N., and H. Eborall. 2012b. The sociology of medical screening: Past, present and future. Sociology of Health & Illness 34 (2): 161–176.
Armstrong, N., and P. Hilton. 2014. Doing diagnosis: Whether and how clinicians use a diagnostic tool of uncertain clinical utility. Social Science and Medicine 120: 208–214.
Armstrong, N., V. James, and M. Dixon-Woods. 2012. The role of primary care professionals in women’s experiences of cervical cancer screening: A qualitative study. Family Practice 29 (4): 462–466.
Armstrong, N., and E. Murphy. 2008. Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk. Social Science and Medicine 67 (7): 1074–1082.
Armstrong, N., and E. Murphy. 2012. Conceptualizing resistance. Health 16 (3): 314–326.
Baum, M. 2013. Harms from breast cancer screening outweigh benefits if death caused by treatment is included. BMJ 346 (7892): f385.
Blomberg, K., A. Forss, B.M. Ternestedt, and C. Tishelman. 2009. From ‘silent’ to ‘heard’: Professional mediation, manipulation and women’s experiences of their body after an abnormal Pap smear. Social Science and Medicine 68 (3): 479–486.
BMJ. 2017. http://www.bmj.com/too-much-medicine. Accessed 29 Apr 2017.
Braun, V., and N. Gavey. 1999. ‘With the best of reasons’: Cervical cancer prevention policy and the suppression of sexual risk factor information. Social Science and Medicine 48: 1463–1474.
Burrows, R., S. Nettleton, and R. Bunton. 1995. Sociology and health promotion: Health, risk and consumption under late modernism. In The sociology of health promotion: Critical analyses of consumption, lifestyle and risk, ed. R. Bunton, S. Nettleton, and R. Burrows, 1–9. London: Routledge.
Bush, J. 2000. “It’s just part of being a woman”: Cervical screening, the body and femininity. Social Science and Medicine 50 (3): 429–444.
Carter, S. 2017. Overdiagnosis, ethics and trolley problems: Why factors other than outcomes matter. British Medical Journal 358: 3872.
Castel, R. 1991. From dangerousness to risk. In The foucault effect, ed. G. Burchell, C. Gordon, and P. Miller, 281–298. London: Harvester Wheatsheaf.
Chapple, A., S. Ziebland, P. Hewitson, and A. McPherson. 2008. What affects the uptake of screening for bowel cancer using a faecal occult blood test (FOBt): A qualitative study. Social Science and Medicine 66 (12): 2425–2435.
Chen, J.Y., H. Eborall, and N. Armstrong. 2014. Stakeholders’ positions in the breast screening debate, and media coverage of the debate: A qualitative study. Critical Public Health 24 (1): 62–72.
Choosing Wisely UK. 2017. http://www.choosingwisely.co.uk/. Accessed 29 Apr 2017.
Cochrane, A.L., and W.W. Holland. 1971. Validation of screening procedures. British Medical Bulletin 27 (1): 3–8.
Conrad, P. 1992. Medicalization and social control. Annual Review of Sociology 18: 209–232.
Conrad, P. 2005. The shifting engines of medicalization. Journal of Health and Social Behavior 46 (1): 3–14.
Conrad, P. 2007. The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: The Johns Hopkins University Press.
Cox, S.M., and W. McKellin. 1999. ‘There’s this thing in our family’: Predictive testing and the construction of risk for Huntington disease. Sociology of Health & Illness 21 (5): 622–646.
Davison, C., S. Macintyre, and G.D. Smith. 1994. The potential social impact of predictive genetic testing for susceptibility to common chronic diseases: A review and proposed research agenda. Sociology of Health & Illness 16 (3): 340–371.
Forss, A., C. Tishelman, C. Widmark, and L. Sachs. 2004. Women’s experiences of cervical cellular changes: An unintentional transition from health to liminality? Sociology of Health & Illness 26 (3): 306–325.
Gale, N.K., G.M. Thomas, R. Thwaites, S. Greenfield, and P. Brown. 2016. Towards a sociology of risk work: A narrative review and synthesis. Sociology Compass 10 (11): 1046–1071.
Gillespie, C. 2012. The experience of risk as ‘measured vulnerability’: Health screening and lay uses of numerical risk. Sociology of Health & Illness 34 (2): 194–207.
Gillespie, C. 2015. The risk experience: The social effects of health screening and the emergence of a proto-illness. Sociology of Health & Illness 37 (7): 973–987.
Godlee, F. 2016. Start stopping smartly. BMJ 353: i3209.
Gøtzsche, P.C., and K.J. Jørgensen. 2011. The breast screening programme and misinforming the public. Journal of the Royal Society of Medicine 104 (9): 361–369.
Gøtzsche, P.C., and M. Nielsen. 2011. Screening for breast cancer with mammography. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD001877.
Green, J. 2004. The new public health. In Key concepts in medical sociology, ed. J. Gabe, M. Bury, and M.A. Elston, 233–237. London: Sage.
Green, E.E., D. Thompson, and F. Griffiths. 2002. Narratives of risk: Women at midlife, medical ‘experts’ and health technologies. Health, Risk and Society 4 (3): 273–286.
Griffiths, F., E. Green, and G. Bendelow. 2006. Health professionals, their medical interventions and uncertainty: A study focusing on women at midlife. Social Science and Medicine 62 (5): 1078–1090.
Grob, R. 2008. Is my sick child healthy? Is my healthy child sick?: Changing parental experiences of cystic fibrosis in the age of expanded newborn screening. Social Science and Medicine 67 (7): 1056–1064.
Gummersbach, E., G. Piccoliori, C. Oriol Zerbe, A. Altiner, C. Othman, C. Rose, and H.H. Abholz. 2010. Are women getting relevant information about mammography screening for an informed consent: A critical appraisal of information brochures used for screening invitation in Germany, Italy, Spain and France. European Journal of Public Health 20 (4): 409–414.
Hallowell, N. 1999. Doing the right thing: Genetic risk and responsibility. Sociology of Health & Illness 21 (5): 597–621.
Hallowell, N., A. Arden-Jones, R. Eeles, C. Foster, A. Lucassen, C. Moynihan, and M. Watson. 2006. Guilt, blame and responsibility: Men’s understanding of their role in the transmission of BRCA1/2 mutations within their family. Sociology of Health & Illness 28 (7): 969–988.
Heath, I. 2014. Role of fear in overdiagnosis and overtreatment-an essay by Iona Heath. BMJ. https://doi.org/10.1136/bmj.g6123.
Hersch, J., A. Barratt, J. Jansen, L. Irwig, K. McGeechan, G. Jacklyn, H. Thornton, H. Dhillon, N. Houssami, and K. McCaffery. 2015. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: A randomised controlled trial. The Lancet 385 (9978): 1642–1652.
Hersch, J., J. Jansen, and K. McCaffery. 2016. Informed and shared decision making in breast screening. In Breast cancer screening: An examination of scientific evidence, ed. N. Houssami, and D. Miglioretti, 403–420. London: Academic Press.
Heyman, B., G. Hundt, J. Sandall, K. Spencer, C. Williams, R. Grellier, and L. Pitson. 2006. On being at higher risk: A qualitative study of prenatal screening for chromosomal anomalies. Social Science and Medicine 62 (10): 2360–2372.
Hicks, L.K. 2015. Reframing overuse in health care: Time to focus on the harms. Journal of Oncology Practice 11 (3): 168–170.
Hood, C. 2011. The blame game: Spin, bureaucracy, and self-preservation in government. Princeton, NJ: Princeton University Press.
Howson, A. 1998. Embodied obligation: The female body and health surveillance. In The body in everyday life, ed. S. Nettleton, and J. Watson, 218–240. London: Routledge.
Howson, A. 1999. Cervical screening, compliance and moral obligation. Sociology of Health & Illness 21 (4): 401–425.
Jansen, J., V. Naganathan, S.M. Carter, A.J. McLachlan, B. Nickel, L. Irwig, C. Bonner, J. Doust, J. Colvin, A. Heaney, R. Turner, and K. McCaffery. 2016. Too much medicine in older people? Deprescribing through shared decision making. BMJ 353: i2893.
Johansson, M., K.J. Jørgensen, L. Getz, and R. Moynihan. 2016. “Informed choice” in a time of too much medicine-no panacea for ethical difficulties. BMJ 353: i2230.
Jutel, A. 2009. Sociology of diagnosis: A preliminary review. Sociology of Health & Illness 31 (2): 278–299.
Jutel, A. 2015. Beyond the sociology of diagnosis. Sociology Compass 9 (9): 841–852.
Jutel, A., and S. Nettleton. 2011. Towards a sociology of diagnosis: Reflections and opportunities. Social Science and Medicine 73 (6): 793–800.
Kavanagh, A.M., and D.H. Broom. 1998. Embodied risk: My body, myself? Social Science and Medicine 46 (3): 437–444.
Lotto, R., N. Armstrong, and L.K. Smith. 2016. Care provision during termination of pregnancy following diagnosis of a severe congenital anomaly—A qualitative study of what is important to parents. Midwifery 43: 14–20.
Lupton, D. 1995. The imperative of health. London: Sage.
Markens, S., C.H. Browner, and H. Mabel Preloran. 2010. Interrogating the dynamics between power, knowledge and pregnant bodies in amniocentesis decision making. Sociology of Health & Illness 32 (1): 37–56.
Marmot, M., D.G. Altman, D.A. Cameron, J.A. Dewar, S.G. Thompson, and M. Wilcox. 2012. The benefits and harms of breast cancer screening: An independent review. The Lancet 380 (9855): 1778–1786.
McCartney, M. 2014. Have we given guidelines too much power? BMJ 349: g6027.
McKie, L. 1995. The art of surveillance or reasonable prevention? The case of cervical screening. Sociology of Health & Illness 17 (4): 441–457.
Moynihan, R. 2011. Is your mum on drugs? BMJ 343: d5184.
Moynihan, R., J. Doust, and D. Henry. 2012. Preventing overdiagnosis: How to stop harming the healthy. BMJ 344 (7859): e3502.
Moynihan, R., D. Henry, and K.G.M. Moons. 2014. Using evidence to combat overdiagnosis and overtreatment: Evaluating treatments, tests, and disease definitions in the time of too much. PLoS Medicine 11 (7): e1001655.
Nettleton, S. 1995. The sociology of health and illness. Cambridge: Polity Press.
Nettleton, S., and R. Bunton. 1995. Sociological critiques of health promotion. In The sociology of health promotion, ed. R. Bunton, R. Burrows, and S. Nettleton, 41–58. London: Routledge.
NHS Choices. 2017. http://www.nhs.uk/Livewell/Screening/Pages/screening.aspx. Accessed 21 Apr 2017.
Petersen, A., and D. Lupton. 1996. The new public health: health and self in the age of risk. London: Sage.
Pfeffer, N. 2004. Screening for breast cancer: Candidacy and compliance. Social Science and Medicine 58 (1): 151–160.
Pilnick, A. 2008. ‘It’s something for you both to think about’: Choice and decision making in nuchal translucency screening for Down’s syndrome. Sociology of Health & Illness 30 (4): 511–530.
Pilnick, A., and R. Dingwall. 2011. On the remarkable persistence of asymmetry in doctor/patient interaction: A critical review. Social Science and Medicine 72 (8): 1374–1382.
Pilnick, A., and O. Zayts. 2012. ‘Let’s have it tested first’: Choice and circumstances in decision-making following positive antenatal screening in Hong Kong. Sociology of Health & Illness 34 (2): 266–282.
Pilnick, A., and O. Zayts. 2014. “it’s just a likelihood”: Uncertainty as topic and resource in conveying “positive” results in an antenatal screening clinic. Symbolic Interaction 37 (2): 187–208.
Polzer, J., S.L. Mercer, and V. Goel. 2002. Blood is thicker than water: genetic testing as citizenship through familial obligation and the management of risk. Critical Public Health 12 (2): 153–168.
Power, M. 1997. The audit society: Rituals of verification. Oxford: Oxford University Press.
Raffle, A.E. 2001. Information about screening—is it to achieve high uptake or to ensure informed choice? Health Expectations 4 (2): 92–98.
Raspberry, K., and D. Skinner. 2011. Enacting genetic responsibility: Experiences of mothers who carry the fragile X gene. Sociology of Health & Illness 33 (3): 420–433.
Reed, K. 2009. ‘It’s them faulty genes again’: Women, men and the gendered nature of genetic responsibility in prenatal blood screening. Sociology of Health & Illness 31 (3): 343–359.
Roland, M. 2016. Should doctors be able to exclude patients from pay-for-performance schemes? BMJ Quality and Safety 25 (9): 653–656.
Rowley, E. 2007. On doing ‘being ordinary’: Women’s accounts of BRCA testing and maternal responsibility. New Genetics and Society 26 (3): 241–250.
Schwennesen, N., and L. Koch. 2012. Representing and intervening: ‘Doing’ good care in first trimester prenatal knowledge production and decision-making. Sociology of Health & Illness 34 (2): 283–298.
Steinberg, D.L. 1996. Languages of risk: Genetic encryptions of the female body. Women: A Cultural Review 7: 259–270.
Stephenson, N., C. Mills, and K. McLeod. 2017. “Simply providing information”: Negotiating the ethical dilemmas of obstetric ultrasound, prenatal testing and selective termination of pregnancy. Feminism and Psychology 27 (1): 72–91.
Thomas, G.M. 2014. Prenatal screening for Down’s syndrome: Parent and healthcare practitioner experiences. Sociology Compass 8 (6): 837–850.
Thornton, H. 2010. Communicating to citizens the benefits, harms and risks of preventive interventions. Journal of Epidemiology and Community Health 64 (2): 101–102.
Thornton, H. 2012. Re: Breast screening is beneficial, panel concludes, but women need to know about harms (rapid response). British Medical Journal 345: e7330.
Timmermans, S., and M. Buchbinder. 2012. Expanded newborn screening: Articulating the ontology of diseases with bridging work in the clinic. Sociology of Health & Illness 34 (2): 208–220.
Todorova, I.L.G., A. Baban, D. Balabanova, Y. Panayotova, and J. Bradley. 2006. Providers’ constructions of the role of women in cervical cancer screening in Bulgaria and Romania. Social Science and Medicine 63 (3): 776–787.
UK National Screening Committee. 2017a. https://www.gov.uk/government/groups/uk-national-screening-committee-uk-nsc. Accessed 21 Apr 2017.
UK National Screening Committee. 2017b. https://www.gov.uk/guidance/nhs-population-screening-explained. Accessed 21 Apr 2017.
Vassy, C., S. Rosman, and B. Rousseau. 2014. From policy making to service use. Down’s syndrome antenatal screening in England, France and the Netherlands. Social Science and Medicine 106: 67–74.
Ward, P.R., C. Coffey, and S. Meyer. 2015. Trust, choice and obligation: A qualitative study of enablers of colorectal cancer screening in South Australia. Sociology of Health & Illness 37 (7): 988–1006.
Wegwarth, O., L.M. Schwartz, S. Woloshin, W. Gaissmaier, and G. Gigerenzer. 2012. Do physicians understand cancer screening statistics? A national survey of primary care physicians in the United States. Annals of Internal Medicine 156 (5): 340–349.
Williams, C., J. Sandall, G. Lewando-Hundt, B. Heyman, K. Spencer, and R. Grellier. 2005. Women as moral pioneers? Experiences of first trimester antenatal screening. Social Science and Medicine 61 (9): 1983–1992.
Zapka, J.G., B.M. Geller, J.L. Bulliard, J. Fracheboud, H. Sancho-Garnier, and R. Ballard-Barbash. 2006. Print information to inform decisions about mammography screening participation in 16 countries with population-based programs. Patient Education and Counseling 63 (1–2): 126–137.
Natalie Armstrong is supported by a Health Foundation Improvement Science Fellowship.
About this article
Cite this article
Armstrong, N. Navigating the uncertainties of screening: the contribution of social theory. Soc Theory Health 17, 158–171 (2019). https://doi.org/10.1057/s41285-018-0067-4