Screening for Disease (CM-341)
Practical Session
Dr. Halima Buni
Learning Objectives
Calculate and interpret the:
Sensitivity
Specificity
Predictive value of positive and negative test
Definition
Screening is defined as "the search for
unrecognized disease or defect by means of
rapidly applied tests, examinations or other
procedures in apparently healthy individuals”
The iceberg phenomenon in relation to
screening
A far larger proportion
of diseases is hidden
from view in the
community than is
evident to physician
or to the general
public.
(subclinical-carriers
and undiagnosed
cases)
The iceberg phenomenon in relation to
screening
At the beginning screening was limited to some
diseases e.g., TB, syphilis, or selected groups
such as antenatal mothers, school children and
occupational groups.
Now it is extended to cover many diseases and
related problems and risk factors.
Aims of screening
1. To sort out from large group of apparently healthy
persons those who have the disease or at risk
2. To bring them under medical supervision
treatment
3. To alter the natural history of the disease in
a significant proportion of those who are identified
as "positive"
Screening pathways
Evaluation of screening test
2X2 Table
Screening test Diagnosis Total
________________________________________
Results diseased not diseased
_______________________________________________________
Positive a b a+ b
(True +ve) (False +ve)
Negative c d c+d
(False -ve) (True -ve)
_______________________________________________________
Total a+c b+d a+b+c+d
Evaluation of screening test
1. Sensitivity = a / (a+c) x 100
2. Specificity = d / (d+b) x 100
3. Predictive value of the positive test = a / (a+b) x 100
4. Predictive value of the negative test = d / (d+c) x 100
5. Percentage of false negatives = c / (c+a) x 100
6. Percentage of false positives = b / (b+d) x 100
Evaluation of screening test
Sensitivity: the ability of a test to identify correctly all
those who have the disease, "true positive“
Specificity: the ability of a test to identify correctly
those who do not have the disease, "true negatives“
Predictive value of the positive test: Indicates the
probability that a patient with a positive test result has the
disease in question.
The predictive value of the negative test: Indicates the
probability that a patient with a negative test result doesn’t
have the disease in question.
Predictive value of a screening test
In practice, the ability to predict the presence or
absence of disease from test results is dependent
on the prevalence of the disease in the population
tested, as well as on the sensitivity and specificity
of the test.
The higher the prevalence, the more accurate will
be the predictive value of the screening test.
The predictive value of the a positive test result
falls as disease prevalence declines.
The Cut-off point
It is “the point at which the distributions
intersect, between normal and diseased”.
Choosing the right cut-off point is of vital
importance for screening purposes
Exercise 1:
The table below shows the results of
screening test for diabetes used on 10,000
persons. The cut-off point was 180 mg
/100 ml or above as +ve for diabetes.
Calculate sensitivity, specificity, predictive
value for the +ve test, and predictive value
for the -ve test.
True diagnosis
------------------ ---------------------------------------
S.T diabetic non diabetic total
-----------------------------------------------------------------------------
+ve 34 20 54
-ve 116 9830 9946
-----------------------------------------------------------------------------
Total 150 9850 10000
-----------------------------------------------------------------------------
Sensitevity = 34 / (34+116) x 100 = 22.6 %
Specificity = 9830 / (9830+20)x100 = 99.7 %
Pred. value of +ve test = 34/ (34+20) x 100 = 63.0 %
Pred. value of -ve test = 9830/(9830+116)x100 = 98.8%
Percentage of FN = 116 / (116+ 34) x 100 = 77.3%
,, ,, of FP = 20 / (20+9830)x 100= 0.20%
Exercise 3:
Neonatal screening for congenital hypothyroidism
Diagnostic test
Screening Diseased Normal Total
test
Positive …… 15 135
Negative 10 125 …….
Total 130 ……… 270
Calculate sensitivity
Exercise 3:
Neonatal screening for congenital hypothyroidism
Diagnostic test
Screening Diseased Normal Total
test
Positive 120 15 135
Negative 10 125 135
Total 130 140 270
The sensitivity = 92%
Thanks ☺
