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Screening 2010

Screening tests are used to identify unrecognized disease in apparently healthy people. Screening can help detect diseases early before symptoms appear. It is important that screening tests are acceptable, repeatable, valid, and have high sensitivity and specificity to accurately identify people who do and do not have the disease. Common screening tests examine for conditions like anemia, high blood pressure, cancer, and developmental delays.

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seethahere
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43 views

Screening 2010

Screening tests are used to identify unrecognized disease in apparently healthy people. Screening can help detect diseases early before symptoms appear. It is important that screening tests are acceptable, repeatable, valid, and have high sensitivity and specificity to accurately identify people who do and do not have the disease. Common screening tests examine for conditions like anemia, high blood pressure, cancer, and developmental delays.

Uploaded by

seethahere
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Screening for Disease

Learning Objectives

At the end of the session, the student would be able to

 Define Screening
 Explain the Need / Concept of Screening
 List the Uses of Screening
 State the different types of Screening
 List the Criteria for Screening
 Explain Sensitivity & Specificity
 List some common Screening tests
What is Screening?

 The search for unrecognized disease or


defect by means of rapidly applied tests,
in apparently healthy individuals.

Compare with a diagnostic test


Why Screening ?

 Its been long recognized by epidemiologists that the


pattern of disease in hospitals is very different from
that in a community.

Subclinical cases, undiagnosed cases, carriers


Concept of screening
Active search for disease among apparently healthy
people is a fundamental aspect of prevention

Historically – annual health examinations.


 Reach masses
 Conserve physician-time (technicians can apply)
 Simple, inexpensive lab tests

specific diseases – Tuberculosis, syphilis


specific groups – AN mothers, school children, Occup
Grps
Common Screening tests

 Pregnancy – Anemia, hypertension and Rh status,


toxemia, syphilis
 Infancy – Cerebral palsy, Hearing and visual defects,
haemoglobinopathies
 Middle aged woman – Hypertension, cancer and
diabetes
 Elderly – Nutritional disorders, Cancer, Glaucoma and
cataract
Concept of Lead Time
Disease First Final Usual
Onset Possible Critical Time of OUTCOME
point diagnosis diagnosis
A

Screening Time B

Lead Time
Uses of Screening
 Case Detection

 Control of Disease

 Research purpose

 Educational Opportunities
Types of Screening

Mass screening

High-risk or selective screening

Multiphasic screening
Criteria for Screening
Disease Test
! Important health problem
! Recognizable latent or early asymptomatic phase
! Natural h/o understood
! A test to detect the disease prior to onset of signs
! Facility to confirm diagnosis
! Effective treatment available
! Agreed-on policy on whom to treat (cut-offs)
! Evidence that early Dx&Rx reduces morbidity/mortality
Criteria for Screening
Test
! Acceptability
! Repeatability (Reliability or reproducibility)
a. Observer – Intra-observer / Inter-observer variation
b. Biological (subject) variation
c. Technical errors from instruments

! Validity (accuracy)
a. sensitivity b.specificity c. predictive value
Sensitivity & Specificity
GOLD STANDARD
Diseased Non-Diseased
Screening Test results

Positive a (True positive) b (false positive)

Negative c (false negative) d (True negative)


Sensitivity & Specificity
TRUTH
Guilty Not Guilty

Guilty a b
VERDICT

c d
Not Guilty
Acceptability

 It is important that the test should be acceptable to


people at whom it is aimed.

 Tests that are painful, discomforting or embarrassing


are not acceptable to the population.
Repeatability

 The test must give consistent results when repeated


more than once on the same individual or material
under the same conditions.

 It depends on three major factors namely the


observer variation, biological variation and the
errors relating to technical methods.
Validity

 Refers to what extent the test accurately measures which


it purports to measure or it is the ability to distinguish
those who have the disease from those who do not.
E.g. – GTT

 It has 2 components – sensitivity and specificity.

 Sensitivity, specificity and predictive accuracy are the


inherent properties of a screening test
Sensitivity

 Defined as the ability of the test to identify correctly


all those who have the disease, that is the true
positives

 90% sensitivity – 90% of the diseased people screened


by the test will give a true positive
Specificity

 Defined as the ability to identify correctly who do not


have the disease, that is true negatives

 90% of the specificity – 90% of the non diseased


persons will give true negative results

 10% of the people will be wrongly classified as


diseased
Cut-offs values and the problem of
borderlines

 In case of diagnostic tests that yield a quantitative


result, there will be an overlapping of the
distributions of an attribute for diseased and non
diseased persons

 False positives and false negatives comprise the area


of overlap
Predictive Accuracy

 The predictive value of a positive test indicates the


probability that a patient with a positive result has in
fact, the disease in question

 The more prevalent a disease is in a given population,


more is the accuracy of the predictive value
False Negatives

 False negatives mean that patients who actually have


the disease are told that they do not have the disease

 This could be detrimental if the disease is a serious


one and the screening test is unlikely to be repeated
in a short period of time

 High sensitivity tests have few false negatives


False Positives

 False positives mean that patients who do not have


the disease are told that they have

 A screening test with a high specificity will have few


false positives

 False positives bring discredit to the screening


programmes
Evaluation of screening test
 Sensitivity a/a+c
 Specificity d/b+d
 PPV a/a+b
 NPV d/c+d
 False Negative % c / a + c
 False Positive % b / b + d
Yield

 Yield is the amount of previously unrecognized


disease that is diagnosed as a result of screening
effort

 E.g., By limiting a diabetes screening programme to


persons over 40 years, you can increase the yield of
the screening test
Combination of Tests

 Two or more tests can be used in combination to


enhance the specificity or sensitivity of screening

 E.g. Syphilis
At the end of the session, the student would be able to

 Define Screening
 Explain the Need / Concept of Screening
 List the Uses of Screening
 State the different types of Screening
 List the Criteria for Screening
 Explain Sensitivity & Specificity
 List some common Screening tests
The End

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