Screening for Disease

Moderator –Dr H.N.Sangolli.

Presenter - Dr Sachin .V.
Desai

09/05/2012 1
Headings
 Definition
 Types of screening.
 Objectives of screening.
 Iceberg Phenomenon of disease.
 Concept of screening .
 Screening v/s diagnostic tests.
 Concept of lead time.
 Uses of screening.
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Definition of screening
“The search for unrecognized
disease or defect by means of
rapidly applied tests,
examinations or other procedures
in apparently healthy individuals”

K. PARK
09/05/2012 3
Types of screening
Mass screening
High risk screening
Multiphasic screening

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Types of screening
Mass screening
Whole population, or a subgroup of
population is offered the screening
test irrespective of the particular risk
the
individual may contract the disease or
not(e.g.-tuberculosis)
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..
High risk (Selective
screening)
Applied to selective high risk
groups
 screening for Ca. Cx in low
socioeconomic women
 Diabetes in 40 and above.
 Prostrate screening in 60 and
above.
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Multiphasic screening
Two or more screening tests are
applied to a large number of
people at one time rather than to
carry out separate screening tests
for a single disease.

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Multiphasic screening
cont..
Screening for risk factors – Preventive

measures applied before actual

disease occurs . Questionnaires, clinical
examination, investigation,
measurement.
e.g chemical and haematological tests
on blood and urine samples ,LFT
/audiometry/visual acuity
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..
Disadvantages of multiphasic
screening are increased cost of
screening tests.

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Objectives of screening
To ensure early detection of a disease

among individuals, so that prompt

treatment may be instituted e.g.

“Prospective Screening”;

protect the community from disease, that

the person being screened e.g. screening

the blood units for HIV.

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Objectives
 For entry into certain forms of
occupations (armed services,
industries, etc.) with a view to “weed
out” those who are unfit or whose
existing health status may be
adversely affected by occupational
conditions e g hypertension
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Stages of early detection of
cases

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Progressive stages of
screening

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Advantages of
screening
Improved prognosis –
Elimination, postponement of
death from disease.
Non fatal conditions –
Improved quality of life style.
Resources for treatment and
follow-up – Less consumption.
Correct negative test –
Reassures those without disease.
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Disadvantages of
screening
Prolonged period of morbidity – e.g.
cancer.
Diagnosis of a pseudo disease – over
treatment of healthy screening
(False positive).
False negatives – not diagnosing
underlying disease.
Test itself risky – mammography for
breast cancer.
Expensive technology – Increased
financial cost for health services.
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Iceberg phenomenon

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..
Floating tip –is what the
physician sees in the community.
i.e. clinical cases
Vast submerged portion of the
iceberg represents the hidden
mass of the disease.
Waterline –represents the
demarcation of between the
apparent and in apparent
disease. 09/05/2012 17
Concept of screening

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Concept of screening
A is the usual path for the
outcome of the disease
B is the outcome expected when
the disease is detected at the
earliest possible moment.
B-A is the benefit of the
screening test 09/05/2012 19
Concept of Lead time

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Lead time
Lead time is the advantage
gained by screening i.e. the
period between the diagnosis by
early detection and diagnosis by
other means.

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Screening v/s diagnostic tests
Screening test Diagnostic test
Done on apparently healthy Done on those with indications
of sick
Applied to groups Applied to single patients
Test results are arbitrary and Diagnosis is not final but
final modified in light of new
evidence ,diagnosis is the sum
of all evidence
Based on one criterion or cut Based on evaluation of a
off point number of symptoms, signs
(e.g. diabetes) and laboratory
findings.
Less accurate More accurate
Less expensive More expensive
Not a basis of treatment Used as basis of treatment
The initiative comes from the The initiative comes from a
investigator or agency patient with a complaint.
providing care
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Uses of screening
Case detection
“Prescriptive screening” – Presumptive
identification of unrecognised disease not
arising from patients request e.g. Neonatal
screening (PKU,PTB,HDN)
Control of disease

“Prospective screening” for benefits of

others – e.g. immigrants screening for
infectious diseases like tuberculosis to
protect the home population

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Uses cont..
Research Purposes
Chronic diseases – cancers,
hypertension,
initial screening for prevalence, next
screening for incidence.
Educational opportunities

Public awareness
Educating health professionals.
Conserving physicians time.

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Case finding
Case finding is the use of clinical
or laboratory tests to detect
disease in individuals seeking
health care for other reasons e.g.
VDRL test to detect syphilis in
pregnant
women

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THANK YOU ..
..criteria
Evaluation of a screening test
Sensitivity
Specificity
Evaluation of a screening
programme
dealt by Dr chandrika
doddihal

09/05/2012 26
Referances
Oxford textbook of public health
by Walter W. Holland, Rager
Deteb and George Knox, 4th
Edition.
Textbook of Community Medicine
by Sundar Lal, Adarsh, Pankaj.
Textbook of preventive and social
medicine by K. Park, 21st Edition

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