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

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 [1, 2], 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 [4, 5]. 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 ([6, 7]; 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 …