Under supervision

Prof.Dr/ Nabila Elsayed Sabola

2021-2022
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Objectives of the lecture: -

 Define screening and screening tests.

 Determine purpose of screening.

 Explain World Health Organization guidelines of screening for disease.

 Differentiate between different types of screening.

 Demonstrate different examples on screening programs.

 Explain factors affecting screening for specific disease.

 Discuss limitations of screening.

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Outlines:
 Introduction

 Definition of Screening

 Definition of screening tests

 The purpose of screening

 Who gets screening

 World Health Organization guidelines of screening for disease.

 Types of screening

 Examples on screening programs

 Factors affecting screening for specific disease

 Limitations of Screening

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Introduction
Screening interventions are designed to identify conditions which could at some
future point turn into disease, thus enabling earlier intervention and management in
the hope to reduce mortality and suffering from a disease. Although screening may
lead to an earlier diagnosis, not all screening tests have been shown to benefit the
person being screened; over diagnosis, misdiagnosis, and creating a false sense of
security are some potential adverse effects of screening.

Definition of Screening:-
it is a strategy used to look for unrecognized conditions or risk markers. This
testing can be applied to individuals or to a whole population. The people tested
may not exhibit any signs or symptoms of a disease, or they might exhibit only one
or two symptoms, which by themselves do not indicate a definitive diagnosis

Definition of screening tests:-

Screening tests could be loosely defined. A screening test is a measure to detect a
potential health problem or disease. (Proactive rather than reactive)

The purpose of screening: -

early detection: helping to reduce the risk of disease, or to detect a condition early
enough to treat it most effectively
For example, a person having an HbA1c test for diabetes as part of a screening
program could be found to have prediabetes. Diet and lifestyle changes combined
with regular monitoring tests can allow someone with prediabetes to avoid
developing type 2 diabetes.

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Who gets screening?
Screening programs are tailored toward those who the disease is most likely to
affect and where the most benefit can be gained. For example, when looking at
cervical cancer screening, several factors are taken into consideration in choosing
who to screen including:

 Sex. Men cannot get cervical cancer (they do not have a cervix!) so only
women are tested.
 Age. Women below the age of 25 are less likely to be affected by cervical
cancer, so the majority of women will be offered the test from the age of 25
(This may differ for some women depending on medical and family history).
 Screen a woman for Human Papilloma Virus (HPV) – which is present in
the majority of cervical cancer cases. The HPV vaccine was introduced in
Australia in 2007 and many young Australians are vaccinated, reducing the
spread of HPV. However, not all women are vaccinated and there is still a
risk of cervical cancer even in vaccinated women meaning it’s important for
women to take part in screening.

World Health Organization guidelines of screening for disease:-

 The screening program should be in respond to a recognized need.
 The objectives of screening should be defined at the outset.
 There should be a defined target population.
 There should be scientific evidence of screening effectiveness.
 The programmer should integrate education, testing, clinical services
and management.
 The programmer should ensure informed choice, confidentiality and
respect for autonomy.

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  The programmer should promote equity and access to screening for
the entire target population.
 There should be quality assurance, with mechanisms to minimize
potential risks of screening.
 Program evaluation should be planned from the outset.

Types of screening: -
 Mass screening:
The screening of a whole population or subgroup. It is offered to all,
irrespective of the risk status of the individual.
 High risk or selective screening:
High risk screening is conducted only among at-risk populations.
 Multiphasic screening:
Where various diagnostic procedures are employed during the same
screening programfor the purpose of detecting disease. Procedures may
include health questionnaire, clinical examination, ranges of measurements
and investigations, etc.…

Examples on screening programs:

In many countries there are population-based screening programs.
Common screening programs include:
• Cancer screening for example:
o Mammography to detect breast cancer
o Colonoscopy and fecal occult blood test to detect colorectal
cancer
o Dermatological check to detect melanoma

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 • A purified protein derivative (PPD) test to screen for exposure to
tuberculosis
• Beck Depression Inventory to screen for depression
• Alpha-fetoprotein, blood tests and ultrasound scans for pregnant
women to detect fetal abnormalities
• Ophthalmoscopy or digital photography for diabetic retinopathy
• Ultrasound scan for abdominal aortic aneurysm
• Screening for metabolic syndrome
• Screening for potential hearing loss in newborns

Factors affecting screening for specific disease: -

Several factors need to be assessed when making a decision about screening for a
disease, these include but are not limited to:

1. Is there a screening test available?

For some conditions there may not be a test available that is suitable for screening
for the purpose of early detection or identifying those at high risk.

2. How common is the condition?

Screening a large number of people for a condition that is rare in somewhere is of
limited benefit. Therefore screening for a condition is often confined to a specific
section of the population based on certain risk factors

for example, newborn screening is offered for each newborn baby. This is because
early detection and treatment can save lives and allow children to lead a healthy
life.

3. How serious is the condition?

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Screening tests are usually focused on conditions that may be fatal or have very
serious health impacts such as severe physical and mental disability if left
untreated. However, screening can be broader than this.

For example, testing for infectious diseases that could be passed on to others (for
example tuberculosis screening for immigrants), or genetic screening for
prospective parents to know if they are carrying a gene associated with a serious
disease that may be passed on to a child.

4. Can the condition be treated? (And does early detection make any difference?)
Some serious conditions have no cure and limited treatment options, screening
program help to reduce risk of occurrence by early diagnosis.

5. Cost vs benefit.
The cost of providing the screening program is weighed up against the benefits of
catching the disease early or preventing it from developing. The benefit to the
patient is clear but economic benefits are also include:

 the cost of treating a disease e.g. cancer at a later stage. is more expensive to
the health system
 the cost to the person’s illness or disability resulting from untreated illness.

These costs can range from the economic impact of lost productivity, time off
work, family members acting as careers, as well as the cost of disability support
services and economic loss where someone is unable to participate in work and the
community more broadly.

Limitations of Screening
Although screening can detect medical conditions at an early stage before
symptoms present while treatment is more effective than for later detection. Like

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any medical tests, the test result may incorrectly show positive for those without
disease (false positive), or negative for people who have the condition (false
negative).

Limitations of screening programs can include:

 Screening can involve cost and use of medical resources on a

majority of people who do not need treatment.
 Adverse effects of screening procedure (e.g. stress and anxiety,
discomfort, radiation exposure, chemical exposure).
 Stress and anxiety caused by over diagnosis.
 Stress and anxiety caused by a false positive screening result.
 Unnecessary investigation and treatment of false positive
results.
 A false sense of security caused by false negatives, which may
delay final diagnosis.

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References:
 "To Screen or Not to Screen? - The Benefits and Harms of Screening Tests".
NIH News in Health. National Institutes of Health. March 2017. Retrieved
12 January 2020. Screening tests are given to people who seem healthy to
try to find unnoticed problems. They’re done before you have any signs or
symptoms of the disease.
 ^ O'Toole, Marie T., ed. (2015). Mosby's medical dictionary (9th ed.). St.
Louis, Mo.: Elsevier/Mosby. Kindle loc. 145535. ISBN 978-0-323-08541-0.
OCLC 788298656. screening, n., 1. a preliminary procedure, such as a test
or examination, to detect the most characteristic sign or signs of a disorder
that may require further investigation.
 ^ "screening, n.". Oxford English Dictionary. March 2017. Retrieved 12
January 2020. ... 8. a. Medical examination of a person or group to detect
disease or abnormality, esp. as part of a broad survey rather than as a
response to a request for treatment.
 ^ O’Sullivan, Jack W; Albasri, Ali; Nicholson, Brian D; Perera, Rafael;
Aronson, Jeffrey K; Roberts, Nia; Heneghan, Carl (11 February 2018).
"Overtesting and undertesting in primary care: a systematic review and
meta-analysis". BMJ Open. 8 (2): e018557. doi:10.1136/bmjopen-2017-
018557. PMC 5829845. PMID 29440142.
 ^ O’Sullivan, Jack W.; Heneghan, Carl; Perera, Rafael; Oke, Jason;
Aronson, Jeffrey K.; Shine, Brian; Goldacre, Ben (19 March 2018).

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"Variation in diagnostic test requests and outcomes: a preliminary metric for
OpenPathology.net". Scientific Reports.

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