Screening for
Dr. SyedDisease
Abdul Wadood Shah
Assistant Professor
Department of Community
Medicine
Isra University Hyderabad Sindh
Screening
• The early detection of
– disease
– precursors of disease
– susceptibility to disease
in individuals who do not show
any signs of disease
BASIS OF SCREENING
Screening for disease
“Screening is the search for unrecognized disease
or defect by means of rapidly applied tests,
examinations or other procedures in apparently
healthy individuals.”
“Screening includes methods; technique;
procedure and examinations for early and rapid
detection of unrecognized disease or defect in
apparently healthy persons.”
A screening program tests people for a disease or
condition before they have symptoms of the
disease.
• Case detection
Also known as ‘Prescriptive screening’ it is defined as
presumptive identification of unrecognized disease which
doesn't from patient’s request.
• Control of disease
Also known as ‘prospective screening’ ie people are
examined for benefit of others.
• Research purposes
Screening may aid in obtaining basic knowledge about
natural history of diseases whose etiology/pathogenesis is
obscure.
• Educational opportunities
Helpful in creating public awareness & educating health
Mass Screening
It is screening of whole population or a sub group
It has gone
out of use nowadays.
High Risk / Selective Screening
It is most productive because it is applied to selectively to
the high risk group on the basis of epidemiological research
Multi Phasic Screening
It is application of two or more screening tests in
combination to large no. of people at one time than to carry
Cont…
• Multipurpose screening
• Opportunistic screening
Purpose of Screening
• Aims to reduce morbidity and mortality from
disease among persons being screened
• Is the application of a relatively simple,
inexpensive test, examinations or other
procedures to people who are asymptomatic,
for the purpose of classifying them with
respect to their likelihood of having a
particular disease
– A means of identifying persons at increased risk
for the presence of disease, who warrant further
evaluation
Examples of Screening Tests
• Questions
• Clinical Examinations
• Laboratory Tests
• Genetic Tests
• X-rays
Goel
Screening tests to be applied
The test must satisfy the criteria of
acceptability,
repeatability,
validity besides others like
yield,simplicity, safety,rapidity,ease
of adsministration & of cost.
Screening test
[Link]
The test should be acceptible to all the
peoples at whom it is aimed.
[Link]
The test must give consistent results
when repeated more than once on
same individual or material under
same [Link] depends upon 3
major factors.
• 3 factors on which repeatability
depends upon are
[Link] variation
(a)Intra observer variation
(b)Inter observer variation
[Link] variation
[Link] related to technical methods
• [Link]
It refers to what extent the test accurately
measures which it purports to measure.
Eg: glycosuria is a useful test for screening for
diabetes,but a more valid test is the glucose
tolerence test.
It has two components sensitivity &
specificity.
True positives & True negatives
True positives
It means that the patients who actually have the
disease and the screening test also detects or declares
that they have the disease (+ve by screening test).
True Negatives
It means that patients who actually do not have the
disease and the screening test also detects/results that
they do not have the disease
(-ve by screening test) .
False negatives & False positives
False negatives
It means that the patients who actually have the
disease and the screening test detects or results that
they does not have the disease
(-ve by screening test)
It amounts to giving them false reassurance.
False positives
It means that patients who actually do not have the
disease and screening test detects or declares them that
they having disease (+ve by screening test) .
Yield
It is the amount of previously unrecognized disease that is
diagnosed as a result of the screening efforts.
It depends upon many factors – Sensitivity & specificity of the
test, prevalence of the disease, the participation of
individuals in the detection programme.
Hence to enhance the yield high risk population are usually
selected.
Higher the Yield, higher is the efficiency of screening
programme.
Validity of Screening Tests
Key Measures
• VALIDITY
• Sensitivity
• Specificity
• PREDICTIVE VALUE
• Positive Predictive Value
• Negative Predictive Value
Terminology
Validity is analogous to accuracy
The validity of a screening test is how well
the given screening test reflects another
test of known greater accuracy
Def: The ability of a screening test to
correctly identify those having disease and
those do not having disease
Validity assumes that there is a gold
standard to which a test can be compared
Disease
Present Absent
a b a+b
Screening
Positive
Test
Negative c d c+d
N
a+c b+d
Disease
Present Absent
True False
Screening
Positive positives positives
Test
False True
Negative negatives negatives
Sensitivity
• It is define as the ability of a test to identify
correctly all those who have the disease. i.e. true
positive.
• (true positive rate)
• tells us how well a “+” test picks up diseased
ones
Disease
yes no
a
Screening
+ a b a+b Sensitivity =
Test
- c d c+d a+c
a+c b+d N
Specificity
• It is define as the ability of a test to identify
correctly those who do not have disease
(healthy) i.e. “true negative”.
• (true negative rate)
• tell us how well a “-” test detects no disease
Disease
yes no
d
Screening
+ a b a+b Specificity =
Test
- c d c+d b+d
a+c b+d N
Predictive Value
• Measures whether or not an individual
actually has the disease, given the results
of a screening test
• It reflects diagnostic power of the test.
• Predictive value of a positive test reflects
the probability that a patient with a
positive test result has in fact the disease
in question.
Disease
Present Absent
a b a+b
Screening
Positive
Test
Negative c d c+d
a+c b+d N
Positive Predictive Value
• Proportion of individuals who test
positive who actually have the disease
Disease
yes no
a
Screening
+ a b a+b P.P.V. =
Test
- c d c+d a+b
a+c b+d N
Negative Predictive Value
• Proportion of individuals who test
negative who don’t have the disease
Disease
yes no
d
Screening
+ a b a+b N.P.V. =
Test
- c d c+d c+d
a+c b+d N
A test is used in 50 people with disease and
50 people without. These are the results.
Disease
Present Absent
48 3 51
Screening
Positive
Test
Negative 2 47 49
50 50 100
Paneth
Disease
Present Absent
48 3 51
Screening
Test Positive
Negative 2 47 49
50 50 100
Sensitivity = 48/50
Specificity = 47/50
Positive Predictive Value = 48/51
Negative Predictive Value = 47/49 Paneth
Criteria for a Successful
Screening Program
• Disease
– present in population screened
– high morbidity or mortality; must
be an important public health
problem
– early detection and intervention
must improve outcome
Criteria for a Successful
Screening Program
• Disease
– The natural history of the disease
should be understood, such that
the detectable sub-clinical disease
stage is known and identifiable
Criteria for a Successful
Screening Program
• Screening Test
– should be relatively sensitive and
specific
– should be simple and inexpensive
– should be very safe
– must be acceptable to subjects and
providers
Criteria for a Successful
Screening Program
• Have an Exit Strategy
– Facilities for diagnosis and appropriate
treatments should be available for
individuals who screen positive
– It is unethical to offer screening when
no services are available for
subsequent treatment
Screening tests/ Diagnostic
tests
[Link] on apparently [Link] on those with
healthy. indication or sick.
[Link] on single
patient, all diseases are
[Link] on groups. consider.
[Link] on evaluation of
[Link] on one criteria a number of symptoms,
or cut-off point . sign and lab findings.
[Link] expensive.
[Link] accurate.
Less expensive.
[Link] as a basis for
[Link] basis for treatment.
treatment.
