DOCTOR'S VIEW ARCHIVE

Iron Overload (Hemochromatosis) ... To Screen or Not to Screen?

July has been designated Hemochromatosis Screening Awareness Month in the United States but the question all year long everywhere in the world is: Whether to screen or not to screen? That is the question that divides the health care professionals who care for people with hemochromatosis, a disorder commonly called iron overload.

If not recognized and treated, iron overload can have dire consequences such as scarring of the liver (cirrhosis), diabetes, and heart failure.

The means to screen for iron overload are available. But they are not being used. Why? Because there is disagreement about whether screening should be done.

Some Areas of Agreement

There are several areas of agreement about iron overload (hemochromatosis). The condition is due to an inability to regulate iron absorption. Too much of the iron in food is absorbed from the intestine and passes into the blood stream. The extra iron accumulates in organs ever so slowly. Someone with hemochromatosis may typically have chemically detectable iron overload by age 30 but not experience even the first signs or symptoms of the disease (such as unusual weakness and fatigue, weight loss, bronzed skin (not caused by sunlight), joint and abdominal pains, impotence in men, and cessation of menstrual periods in women) until they are past 40.

There is also no disagreement about the genetic basis of hemachromatosis. About 1 in 9 people carries a gene for hemochromatosis but never develops the disease (although they can pass the gene along to their children) each child of a carrier runs a 25% risk of inheriting both of their hemochromatosis genes and joining the 1 in 300 Americans estimated to have the disease.