Introduction to Epidemiology (PH 752) – Spring 2015

Exercise 8
Screening

LEARNING OBJECTIVES
 Define and calculate sensitivity, specificity, and positive and negative predictive value
 Discuss how the parameters of a screening tool can influence its utility
 Describe how the usefulness of screening depends on the disease, the characteristics of
the screening test, and the population in which it will be used.

I. Table 1 shows the results obtained in a new screening test for hypercholesterolemia (high
cholesterol) in which 10,000 people were screened. Anyone scoring above the cut-off point of
200 mg/dL, was classified as positive for hypercholesterolemia. These results were compared
against a “gold standard” diagnostic test for cholesterol that is considered to be completely valid
and reliable (i.e. the “truth”).

Table 1
Screening Disease No Disease Total
Positive 125 25 150
Negative 375 9475 9850
Total 500 9500 10000

1. Compute and interpret the sensitivity of the new screening test.

2. Compute and interpret the specificity of the new screening test.

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 Introduction to Epidemiology (PH 752) – Fall 2011

3. Compute and interpret the positive predictive value (PPV) of the new screening test.

4. Compute and interpret the negative predictive value (NPV) of the new screening test.

II. The screening cut-off point was then lowered to 90mg/dL. Using this cut-off point, 230
people tested positive on the screening test. Of these, 66 people tested negative on the diagnostic
test (that is, they did not have hypercholesterolemia). This yields Table 2.

Table 2
Screening Disease No Disease Total
Positive 164 66 230
Negative 336 9434 9770
Total 500 9500 10000

5. Compute the sensitivity, specificity, PPV and NPV of the screening test with the new cutoff.

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 Introduction to Epidemiology (PH 752) – Fall 2011

6. How does lowering the screening cut-off point affect sensitivity, specificity and PPV of the
test? Why?

7. How does lowering the screening cut-off point affect the number of false positives and false
negatives? What are the respective “costs” associated with false positives and false negatives?

8. If the cut-off point were raised to 220mg/dl, how would you expect it to affect the specificity,
sensitivity and PPV of the test?

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 Introduction to Epidemiology (PH 752) – Fall 2011

9. Assume the prevalence of hypercholesterolemia increased from 5% to 8%. Given the same
sensitivity and specificity of the screening test in question 5, would the PPV change and if so,
how? (hint, construct a new 2x2 table with the new prevalence and keeping the Specificity and
Sensitivity the same).

Screening Disease No Disease Total

Positive A= B= A+B=
Negative C= D= C+D=
Total A+C= B+D= 10000
Fill-in the 2x2 table

10. What factors are important in deciding if screening for a disease is worthwhile?