Screening 1
TO REPEAT WHAT OTHERS HAVE
SAID,
REQUIRES EDUCATION,
TO CHALLENGE IT,
REQUIRES BRAINS.
Screening 2
“The search for unrecognized disease or
defect by means of rapidly applied tests,
examinations or other procedures in
apparently healthy individuals”
Screening is done for
Early detection of hidden cases
Applied to large masses of people
Minimal expenditures of time and money
Conserve the physician time
Screening 3
I. Case detection: it is defined as the
presumptive identification of
unrecognized cases.
II. Control of disease: People are
screened in the benefit of others.
III. Research purpose: For chronic
diseases whose natural history is not
known.
IV. Educational opportunities: Provides
opportunities for public awareness.
Screening 4
SCREENING AND DIAGNOSTIC TEST
SCREENI NG TEST DI AGNOSTI C TEST
1. Done on Apparently 1. Done on sick
healthy individuals
2. Applied to groups 2. Applied to individuals
3. Tests results are 3. Diagnosis is not final but
arbitrary and final modified in the light of
new evidence.
4. Based on one criterion 4. Based on evaluation of
or cut off point number of symptoms,
sign and lab findings.
5. Less accurate 5. More accurate
6. Less expensive 6. More expensive
7. Not a basis for 7. Basis for treatment
treatment
8. Initiative comes from 8. Initiative comes from
investigator patient.
Screening 5
TYPES OF SCREENING:
Mass Screening means the screening of
whole population.
High Risk Screening Applied selectively
to high-risk groups (Ca cervix in low
socioeconomic groups)
Multiphasic Screening Application of
two or more screening tests
(questionnaire and clinical examination).
Screening 6
1. Should be an important health problem
2. There should be recognizable latent or a symptomatic stage.
3. Natural history should be adequately understood.
4. There is a test available than can detect the disease before the
onset of signs and symptoms.
5. Facilities should be available for confirmation of diagnosis.
6. There is an effective treatment.
7. Agreed policy whom to treat.
8. There is good evidence that early detection and treatment
reduces mortality and morbidity.
9. Expected benefits exceed the risk and cost.
Screening 7
Acceptability (should not be painful,
discomforting or embarrassing)
Repeatability (the test must give consistent
results when repeated more than once.
Validity (Accuracy) To what extent the test
accurately measures, closeness with which
measured values agree with true values.
Screening 8
Validity has two components
Sensitivity and Specificity.
SENSITIVITY: Ability of test to identify correctly all
those who have the disease that is true positive.
SPECIFICITY: Ability of a test to identify correctly
those who do not have the disease that is true
negatives.
Screening 9
Predictive Value of a Positive Test: indicates the
probability that a patient with a positive test result has
in fact the disease in question.
Yield: is the amount of previously unrecognized
disease that is diagnosed as a result of the screening
test.
False Positive: Means patient who do not have the
disease are told that they have the disease.
False Negative: Means patient who have the disease
Screening 10
DISEASE
+VE
True +ve False +ve
TEST
-VE
False -ve True -ve
Screening 11
Screening
A B C D
Biologic Disease Symptoms Death
onset by detectable develop
screening
Detectable
Preclinical phase
Detectable preclinical phase in natural history of disease
Screening 12
POPULATION
TEST WITH DISEASE WITHOUT DISEASE
RESULTS
Positive Have Disease No Disease
And have positive test But have Positive test
True Positive (TP) False positive (FP)
Sensitivity Positive
Specificity
Predictive Value
Have Disease No Disease
But have Negative test And have Negative test
False Negative (FN) True Negative (TN)
Negative
Negative
Predictive Value
Screening 13
Sensitivity = TP .
TP+FN
Specificity = TN .
TN+FP
WITHOUT Total
TEST WITH DISEASE
RESULTS DISEASE
80 100 180
Positive
20 800 820
Negative
100 900 1000
Sensitivity = 80 x 100 = 80% .
100
Specificity = 800 x 100 = 89%
900
Screening 14
POPULATION
DISEASE TEST WITH DISEASE WITHOUT DISEASE
RESULTS
+VE -VE
Positive Have Disease No Disease
And have positive test But have Positive test
+VE True Positive (TP) False positive (FP)
True +ve False +ve
Test
Sensitivity
Positive
Specificity
Predictive Value
-VE False -ve True -ve
Have Disease No Disease
But have Negative test And have Negative test
False Negative (FN) True Negative (TN)
Negative
Negative
Predictive Value
Sensitivity = TP +ve Predictive value of
. the test.=
True positive
TP+FN True +ve + False +ve
Negative Predictive value
of the test =
Specificity =
True negatives
TN .
False Negative+ True
Negative
TN+FP
Screening 15
PREDICTIVE VALUE OF A TEST
If we screen a population, what proportion of
people who have the disease will be correctly
identified?
A different question is important for the physician
“If the test results are positive in this patient what
is the probability that this patient has the disease”.
This is called +ve predictive value of the test.
+ve Predictive value of the test.=
True positive
True +ve + False +ve
Screening 16
Negative Predictive value of the test.
What is the probability that a patient does not have the
disease if the test result is negative.
Negative Predictive value of the test =
True negatives
False negative +True negative
Screening 17
A B C D
Biologic Disease Symptoms Death
onset by detectable develop
screening
Detectable
Preclinical
phase
Detectable preclinical phase in natural history of disease
Screening 18
Lead Time Bias
Age in Years
35 40 42 45 50
Disease Women A Women B Women A
Biologic
detectable diagnosed diagnosed & B both
onset of by at at die of
disease screening screening symptoms cancer
Lead Time Bias
Screening 19
Screening 20
