5/22/2014

SCREENING

IRWIN ARAS
Community Medicine Department
FMUH

DEFINITION
WHO-Regional Committee for Europe, 1957:
Attempts to identify a disease that is clinically
unclear using certain examinations or other
procedures which can be used to quickly
distinguish those who appeared healthy but
have the nature of really sick or healthy.
healthy

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DEFINITION
Mc Keown, 1968:
Medical investigations carried out not by the
patient preference in getting advice for
specific complaints
Detection of emerging diseases in a healthy
population
Application of the test to people who are
asymptomatic with the aim to group them into
groups which may suffer from certain diseases

THE NATURE OF SCREENING

1. An early detection of the disease, namely the
detection of early stage disease and see the
magnitude of health problems in the
community,
2. Not a diagnostic tool
tool,
3. Positive test will be followed by a diagnostic
test or procedure to ensure disease.

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Natural History of Disease

Agent already in the host body Death
Agent has not
entered into the Symptoms can be
body of the observed Cronic
host, but it
comes in
contact Clinical horizon Carrier
between the
two. If there is a
disruption in the Symptoms can not be Heal
Agent
equilibrium observed defects
entered
state, then the into the Perfect
agent can enter Host heal
Incubation Early diease Late diease End of
Pre
Pre-- periode periode periode Illness
pathogenesis period
phase Pathogenesis phase

Natural History of Disease

PREPATOGENESIS PATHOGENESIS

SUSCEPTIBILITY ADAPTATION EARLY DISEASE CLINIC

EARLY PROTECTION OF DISEASE

Screening should be performed here

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Aims of Screening

General
Detect the disease as early as possible so as to reduce morbidity
and mortality and improve quality of life

Specific

Research / survey
Protection of public health
Prescriptive (for the advice / instructions given)
Lowering morbidity and mortality
Improving quality of life
Given the scale of the problem

Disease Criterias
1. Prevalence quite "high".
"high"
2. Morbidity and / or mortality meaningful if
untreated.
3. There are effective therapies,
therapies
4. Beneficial early treatment outweigh further
cases.
example;
1. TB with tuberculin test; feasible
2. Ca lung with chest X-ray; not feasible

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CONDITION OF SCREENING
1. Sufficiently sensitive and specific test
test,,
2. Tests can be accepted by society, safe,
harmless, inexpensive and simple,
3. Diseases or problems that will be
screened is a serious public health
problem.
problem

TYPES OF SCREENING
1. Mass screening
2. Selective screening
3. Single disease screening
4. Multiphasic screening
5. Case finding

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TYPES OF SCREENING
Screening is
performed on the
entire population
1. Mass screening Ex: mass x-ray
surveys or blood
2. Selective screening pressure screening on
3. Single disease screening the entire community
who visit the health
4. Multiphasic screening services
5. Case finding

TYPES OF SCREENING
Only done at certain
1. Mass screening proportions, with a target
population based on
2. Selective screening certain ratios
Objective: To reduce the
3. Single disease screening negative impact of
screening
4. Multiphasic screening Ex:
Pap's smear in women
5. Case finding aged> 40 yr for the
detection of cervical Ca;
Mammography screening
for women who have a
family history of suffering
Ca.

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TYPES OF SCREENING
1. Mass screening
Only performed on
2. Selective screening one disease
Ex: Screening
3. Single disease screening against tuberculosis
4. Multiphasic screening So it is more
focused on the
5. Case finding disease

TYPES OF SCREENING
1. Mass screening
2. Selective screening
For some diseases on a
3. Single disease screening particular visit
Very simple, easy,
4. Multiphasic screening cheap, widely accepted
Objective: health
5. Case finding evaluation (insurance )
Ex: Ca examination,
with checks BP, blood
sugar, choles, etc

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TYPES OF SCREENING
1. Mass screening
2. Selective screening
3. Single disease screening
4. Multiphasic screening
5. Case finding one step in coping with the outbreak
of where to find the source of
infection and the presence or seeking
new cases in the community

TYPES OF SCREENING
The main objective is to find a
source of transmission by
collecting data about the people
The main objective is to find a
1. Active case findings who had contact with the
new case by collecting data
patient BEFORE the patient fell ill
Backward tracing about the people who had
contact with the patient AFTER
Forward tracing the patient fell ill
2. Passive Case Findings

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STAGES OF SCREENING
Stage of define problem

Stage of define method of data collection

Stage of define population

Stage of apply screening

Stage of streghten screening

Stage of preparation and follow-up reports

Conditions of Screening Tool

In determining the type of examination tool for
screening test, we should consider to:
1. Validity value
2. Predictive value

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Illustration table

Measurement of the
Gold Standard

Positive Negative Total

Measure Positive
ment of TP FP TP + FP
screening
tool Negative
FN TN FN + TN

TP + FN FP + TN N

Validity Value
Criterias for assess a Screening Test;
Validity: the ability of a test to determine where people who
have a disease and
T who
The arepredict
test can not perfectly/
completely;
Valid if: Where is all that + based on
ST is really sick
Where is all that - based on
ST is really not sick

Components of validity:
Sensitivity
Specifity

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Validity Value
Measurement of the
Gold Standard

Positive Negative Total

Sensitivity:
= TP/(TP + FN) Measure Positive
ment of TP FP TP + FP
screening
tool Negative
Specifity: FN TN FN + TN

= TN/(TN + FP)
TP + FN FP + TN N

A tool is stated to have a high validity value if:

sensitivity and specificity close to 100%

PREDICTIVE VALUE
Definition: The probability of illness to a medical
examination.
Depend on: Disease Prevalence
Specifity of ST

Type of PV :
1. Positive Predictive Value (PPV): percentage of
those with positive test results who are really sick
2. Negative Predictive Value (NPV): percentage of
those with negative test results who are really not sick

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PREDICTIVE VALUE
Measurement of
the Gold Standard

Positive Negative Total

PPV = TP/(TP + FP)
Measure Positive
ment of TP FP TP + FP
NPV = TN/(TN + FN) screenin
g tool Negative
FN TN FN + TN

TP + FN FP + TN N

A tool is stated to have a high predictive value

if: PPV and NPV close to 100%

Reliability
Reliability: the ability of a tool to deliver consistent results,
when the examination is done more then once, in the same
individuals and the same conditions.
Factors affecting the consistent results:
Variation in examination
1. Method Variation methods (eg. Sit or lay position in
BP measurement)
Variations within the subject
2. Observer Variation itself (eg, measurement
Inter-observer of abody
variability:
temperature
mismatch is different
between the between
day and night)results of a different
measurement
observer
Intra-observer variability: one
observer to read the results
differently within a different time

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Example;
Biopsy

Positive Negative Total

Paps Positive
Smear 69 131 200

Negative
1 2.049 2.050

70 2.180 2.250

Determine the prevalence, sensitivity,

specifity, PPV & NPV!

THANK YOU
Telp; 08124262546
Email; irwinaras@gmail.com

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