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 rest. 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 ill Caucasian men, with some debate regarding genotyping followed by phenotyping, or phenotyping followed by genotyping.