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Unit Nine Screening12

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25 views18 pages

Unit Nine Screening12

Uploaded by

barajaalalaa133
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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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Unit nine:

Screening

November, 2017
Hawassa, Ethiopia

1
Session objectives
 Define screening
 List aim of screening program
 Calculate specificity and sensitivity of a test
 Calculate Positive predictive value and negative predictive
value a test
 List Success Factors for Screening Programs
 Describe potential source of bias in screening

2
Screening -Definition
 Screening is the presumptive identification of
unrecognized disease or defect by applying tests,
examinations or other procedures which can be applied
rapidly

 Screening tests sort out apparently well persons who


probably have a disease from those who probably do not

 A screening test is not intended to be diagnostic

3
Aim of screening program
 To reverse, halt, or slow the progression of disease more
effectively than would probably normally happen
 To alter the natural course of disease for a better outcome for
individuals affected
 Protect society from contagious disease
 Rational allocation of resources
 Selection of healthy individuals: employment, military…
 Research; study on natural history of diseases

4
Screening
 This concept has grown in strength in western populations
because of the increasing importance of cancer as a major
cause of death.
 Cancer with its insidious course and natural history which
moves from a localized and treatable phase to a widespread
and untreatable one is an example of a group of conditions
for which screening has been believed to be appropriate.
 Accurate early diagnosis of cancer (or pre-cancer) gives the
opportunity to start treatment before disease progresses,
thus potentially reducing the need for aggressive therapy,
reducing the likelihood of metastatic disease, and averting
cancer deaths

5
Screening
 It is important to note that screening is potentially expensive
and it is an intervention which is thrust upon the public
rather than a response to an individual seeking help.
 False negative tests are a constant source of concern and
there is often public outrage after such occurrences.
 False positive tests cause undue anxiety and wasted resources.
 The assessment of what is "true" or "false" depend on the
selection of a "gold standard".
 The ability of the screening test to differentiate between
those who are disease free from those who are affected is
called the test validity.

6
Screening test validity
 The screening test validity is measured by sensitivity and
specificity.

 Sensitivity is defined as the proportion of people with a


disease who have a positive test for the disease (a/a+c).
 Specificity is the proportion of people without the disease
who have a negative test (d/b+d).
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Example
 Calculate specificity and sensitivity of the test from the data
given in the table?

8
Screening Test Trade-offs

Sensitivity Specificity
 Disease serious & definitive  High risk with further
treatment exist diagnostic technique
 Disease is highly  High cost with further
communicable diagnostic techniques
 Subsequent evaluation of  No definitive treatment
positives is not costly and exist
has minimal risk

9
Predictive value
 When assessing the implications of a positive or negative test, the
sensitivity and specificity (which are more useful in deciding
whether to perform the test) are no longer of primary importance.
 Positive predictive value (or predictive value positive) (+PV =
a/a+b) is the probability of disease in a person with a positive
(abnormal) test result.
 Negative predictive value (or predictive value negative) (-PV =
d/c+d) is the probability of not having the disease when the test
result is negative (normal).
 Predictive value is sometimes called posterior or post-test
probability.

10
Success Factors for Screening Programs
 The health problem should be important enough to be worth
detecting.
 Availability of an acceptable intervention which is effective
 Presence of a recognizable latent or early "asymptomatic"
stage
 Presence of a suitable and acceptable test
 The natural history of the sisease should be adequately
undersood
 The cost of detecting the problem and its remedy should be
reasonable
 The screening program should be ongoing and not a one time
effort

11
Potential Source of Bias in Screening
 Self-selection (volunteer) bias
 Lead time bias
 Length Bias (chronicity and progression)

12
Lead time bias
 Lead time is the amount of time by which screening advances
the detection of the disease (i.e. the time between detection
by a screening test and detection without a screening test).

13
Lead time bias
 Even if the interval between the (unknown) biologic onset of
the disease and death is unchanged, earlier detection will
lengthen the interval between diagnosis and death so that
survival appears lengthened.

 Lead time bias results when a screening program creates the


appearance of delaying morbidity and mortality but in reality
does not alter the natural history.

14
Length Bias (chronicity and progression)
 Length bias results if tumors are heterogeneous in respect to
their aggressiveness, with slower growing tumors having a
more favorable prognosis (or at least longer time to death).

15
Length Bias (chronicity and progression)
 Slower growing tumors are more likely to be detected by
screening, since they are present and asymptomatic longer
than are rapidly growing, aggressive tumors.

 So tumors detected by screening will overrepresent slow


growing, hence survivable, tumors than will cancers detected
because of appearance of symptoms (the latter cases are
called "interval cases" because they are detected during the
interval between screens).

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Study Design for Evaluation of Screening
 Ideally experimental
 Most commonly used is cohort

17
Thank you!!!

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