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Iron Overload, Public Health, and Genetics |

Introduction to Supplement on Iron Overload, Public Health, and Genetics

Adele L. Franks, MD; and James S. Marks, MD, MPH
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From Centers for Disease Control and Prevention; Atlanta, GA 30341. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Iron Overload, Public Health, and Genetics.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Requests for Reprints: Adele L. Franks MD, Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-24, 4770 Buford Highway, Atlanta, GA 30341; e-mail, alf1@cdc.gov. Current Author Addresses: Dr. Franks: Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-24, 4770 Buford Highway, Atlanta, GA 30341. Dr. Marks: Office of the Director, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-40, 4770 Buford Highway, Atlanta, GA 30341.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(11_Part_2):923-924. doi:10.7326/0003-4819-129-11_Part_2-199812011-00001
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The past few years have witnessed a growing awareness that iron overload diseases are not as rare as was previously believed. One particular form of primary iron overload disease-hereditary hemochromatosis-has received increasing attention because it seems to be more common than many other serious genetic disorders [1], it can be detected before clinical symptoms develop [12], and its complications can be safely prevented through the early use of therapeutic phlebotomy [3]. For these reasons, it has been suggested that phenotypic screening for hereditary hemochromatosis should be a routine part of health care for adults [45]. Efforts to estimate the cost-effectiveness of such screening have used available information on disease expression, costs of specific disease manifestations, and existing laboratory tests and have concluded that screening can indeed be cost-effective ([67]; Messonier M. Personal communication). A group of experts convened by the Centers for Disease Control and Prevention [CDC] in February 1996 considered 1) whether screening for hereditary hemochromatosis was warranted and 2) the relative merits of the biochemical laboratory tests of iron status that might be useful for screening. The group favored movement toward routine screening for all adults. Yet, much remains to be learned about the penetrance and expressivity of hereditary hemochromatosis (and, thus, the burden of disease that may be preventable) and about the patient age and disease stage at which detection is most beneficial.

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