Screening for iron overload: lessons from the hemochromatosis and iron overload screening (HEIRS) study.
BACKGROUND
The HEmochromatosis and IRon Overload Screening (HEIRS) Study provided data on a racially, ethnically and geographically diverse cohort of participants in North America screened from primary care populations.


METHODS
A total of 101,168 participants were screened by testing for HFE C282Y and H63D mutations, and measuring serum ferritin concentration and transferrin saturation. In the present review, lessons from the HEIRS Study are highlighted in the context of the principles of screening for a medical disease as previously outlined by the World Health Organization.


RESULTS
Genetic testing is well accepted, with minimal risk of discrimination. Transferrin saturation has high biological variability and relatively low sensitivity to detect HFE C282Y homozygotes, which limits its role as a screening test. Symptoms attributable to HFE C282Y homozygosity are no more common in individuals identified by population screening than in control subjects.


CONCLUSIONS
Generalized population screening in a primary care population as performed in the HEIRS Study is not recommended. There may be a role for focused screening in Caucasian men, with some debate regarding genotyping followed by phenotyping, or phenotyping followed by genotyping.
Adams
Paul
P
Department of Medicine, London Health Sciences Centre, London, Canada. padams@uwo.ca
Barton
James C
JC
McLaren
Gordon D
GD
Acton
Ronald T
RT
Speechley
Mark
M
McLaren
Christine E
CE
Reboussin
David M
DM
Leiendecker-Foster
Catherine
C
Harris
Emily L
EL
Snively
Beverly M
BM
Vogt
Thomas
T
Sholinsky
Phyliss
P
Thomson
Elizabeth
E
Dawkins
Fitzroy W
FW
Gordeuk
Victor R
VR
Eckfeldt
John H
JH
D005006:Ethnicity; D005260:Female; D020022:Genetic Predisposition to Disease / Q000208:ethnology; D005820:Genetic Testing / Q000941:ethics; D005838:Genotype; D006432:Hemochromatosis / Q000175:diagnosis* / Q000208:ethnology* / Q000235:genetics* / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism; D008297:Male; D008403:Mass Screening / Q000941:ethics / Q000379:methods / Q000592:standards; D009154:Mutation; D009656:North America
D007501:Iron