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Disease Screening

Screening involves testing apparently healthy individuals to detect unrecognized disease. It can help control disease spread in a community and provide data on disease prevalence and incidence. Screening tests should detect conditions with serious consequences, high prevalence, detectable pre-clinical phases, and effective treatments. An ideal screening tool is feasible, acceptable, reliable, and valid by accurately distinguishing those with and without disease compared to a gold standard. Screening programs aim to maximize true positive results and minimize false positive results, which waste resources without health benefits.

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33 views

Disease Screening

Screening involves testing apparently healthy individuals to detect unrecognized disease. It can help control disease spread in a community and provide data on disease prevalence and incidence. Screening tests should detect conditions with serious consequences, high prevalence, detectable pre-clinical phases, and effective treatments. An ideal screening tool is feasible, acceptable, reliable, and valid by accurately distinguishing those with and without disease compared to a gold standard. Screening programs aim to maximize true positive results and minimize false positive results, which waste resources without health benefits.

Uploaded by

Bryan Fjb
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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DISEASE SCREENING

DR EVARISTO KUNKA
DEFINITION

• Screening is defined as the search for unrecognized disease or defect by means of rapidly
applied tools in apparently healthy individuals not seeking medical care”

• It is "searching for diseases in apparently normal people


EXAMPLES OF SCREENING TESTS

• Screening tools could be not all types of screening have to be done by health care providers

• Test consisting a series of questions

• Instrument to measure a parameter

• Medical examination

• Radiological test

• Laboratory test
DIFFERENCE BETWEEN SCREENING AND

• Periodic examination
• Case finding
• diagnosis
PERIODIC EXAMINATION

Seeking of medical care at intervals to evaluate health status and to detect any health
problem without the presence of any complaint.

In periodic examination, different systems are looked at and a series of investigations are
applied.
CASE FINDING

• The use of a clinical, laboratory or non laboratory test to detect disease in individuals
seeking health care for other reasons.

• The aim of identifying diabetes among pregnant women is an example of case finding.
DIAGNOSIS

A procedure to confirm or refute the existence of a disease or abnormality among those


seeking medical care with a specific complaint.

Achieved by obtaining medical history, clinical examination and the application of


laboratory or non laboratory tests
Uses of screening tests

• Case detection; It is identification of unrecognized disease or defect that doesn’t arise


from patients’ request

• Control of diseases; This is with the purpose to prevent the transmission of the disease to
healthy community members
• Research purposes; initial screening is conducted to estimate the prevalence of a disease
and subsequent screening will provide data on the incidence
Types of screening programs

• Mass screening; applied to the whole population or population subgroups as adults,


school children, industrial’s workers irrespective of their risk.

• High risk or selective screening; applied to a selective population subgroups who are at a
high risk.
• Among high risk population, the disease is more likely to be prevalent and the screening will
result in a better yield.
Eligible condition for screening

• Major public health problem and/or have serious consequences

• High prevalence among screened population

• Have a detectable pre-clinical phase

• Availability of test for detection in pre-clinical phase

• Evidence that early detection reduces morbidity and mortality

• Available facilities for the confirmation of the diagnosis

• Agreed-on policy whom to treat as a patient

• Available of effective treatment for the disease if identified

• Expected benefits of early detection out-weight the risks and costs of screening
EXAMPLES OF SCREENING

• Blood pressure for hypertension

• Fasting blood sugar level for diabetes

• Pap smear for cervical cancer

• Mammogram for breast cancer

• PSA for prostate cancer generally speaking, cancers that have screening tests are less likely to cause death

• Hepatitis C antibodies using antibody tests

• Thyroid hormone from blood cord for hypothyroidism in newborn

• Hip examination for congenital hip dislocation in the newborn


IDEAL SCREENING TOOL

• Feasibility
• Simple, inexpensive, capable of wide application

• Acceptability
• Acceptable by the people to whom it is intend to be applied

• Reliability (precision) “reproducible”


• Consistent results on repeated application on the same individual under same
circumstances

• Validity (accuracy)
• Ability to distinguish between those who have and those who don’t have the disease as confirmed by a gold standard
VALIDITY

• Validity of the test reflects its “accuracy” compared to a gold standard.

• To test a new diagnostic or screening test for a certain disease, we compare its values with the known gold

standard test to determine its validity

• Validity has two components

• Sensitivity: ability of the test to detect correctly those who truly have the condition (true positive)

• Specificity: ability of the test to detect correctly those who truly don’t have the condition (true negative)
PREVALENCE & PREDICTIVE VALUE
YIELD OF THE TEST

• Low positive predictive value of a test is a waste of resources; very few of those who tested
positive will be found to have the condition

• High positive predictive value is desirable in screening program; detecting and bringing into care
subjects with the condition at a pre-clinical stage

• Positive Predictive value increases considerably with the increase in the prevalence of the
condition among the screened population.
PROBLEMS WITH FALSE RESULTS

• False positive results are referred to as adverse effects


or errors of screening

• False positive result is not desirable

• It is a waste of resources; incurring the cost of the screening


and the confirmation of the diagnosis

• Unnecessary exposure of subjects to the hazards of the test

• Emotional strain of being a probable case


CORRECT RESULTS

True positive result is desirable


It is money well spent
Bringing subjects with the condition into care
Subjects who incurred the hazards of screening and confirmation of the diagnosis will
benefit from therapeutic intervention
True negative result is desirable
Reassurance that they are free from the condition

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