. carriers. undiagnosed cases).g. The floating tip represents what the physician sees in his practice. subclinical cases.Iceberg Phenomenon of Disease  The submerge portion of the iceberg represents the hidden mass of the disease (e.

examinations or other procedures in apparently healthy individuals“ .Concept of Screening  Defined as "the search for unrecognized disease or defect by means of rapidly applied tests.

e.  Those who are found to have positive test results are referred to a physician for further diagnostic work-up.g.Screening and Diagnostic Tests  A screening test is not intended to be a diagnostic test. test for anemia and glucose tolerance test. .  There are some tests which are used both for screening and diagnosis..


with acceptable yield 5. Condition should be an important health problem 2. The cost of screening and case finding should be economically balanced in relation to medical care as a whole . There should be a recognizable early or latent stage 3. There should be an accepted treatment for persons with condition 4. The screening test is valid. The test should be acceptable to the population to be screened 6.Principles for Screening Programs 1. reliable.

Criteria for Evaluating a Screening Test •Validity: provide a good indication of who does and does not have disease -Sensitivity of the test -Specificity of the test •Reliability: (precision): gives consistent results when given to same person under the same conditions •Yield: Amount of disease detected in the population. relative to the effort -Prevalence of disease/predictive value .

Validity of Screening Test (Accuracy) .Sensitivity: test detecting true cases of disease? (Ideal is 100%: 100% of cases are detected) -Specificity: test excluding those without disease? (Ideal is 100%: 100% of non-cases are negative) .

likelihood of re-screening .Where do we set the cut-off for a screening test? Consider: -The impact of high number of false positives: anxiety. cost of further testing -Importance of not missing a case: seriousness of disease.

which does not arise from a patient's request.People are examined for the benefit of others.. screening of immigrants from infectious disease such as tuberculosis and syphilis to protect the home population.g.Uses of screening  a) Case detection . e. .the presumptive identification of unrecognized disease.  b) Control of disease . To make sure that appropriate treatment is started early.

. cancer.) Educational opportunities .) Research purposes . Screening may aid in obtaining more basic knowledge about the natural history of such diseases.  d. screening for diabetes) provide opportunities for creating public awareness and for educating health professionals.Uses of screening  c. hypertension.screening programs (as for example.e.g.

Types of Screening  Mass screening  High risk selective screening  Multiphasic screening .

Types of Screening  a. .) Mass screening  screening for a particular disorder offered to all. irrespective of the particular risk individual.

epidemiologists have extended the concept of screening for disease to screening for "risk factors" .Types of Screening b. One population subgroup where certain diseases (e.) High risk or selective screening  Screening will be most productive if applied selectively to high risk groups.. hypertension. diabetes. breast cancer) tend to be aggregated is the family. By screening the other members of the family (and close relatives) the physician can detect additional cases.g.  More recently.

Types of Screening c. .) Multiphasic screening  the application of two or more screening tests in combination to a large number of people at one time than to carry out separate screening tests for single diseases.

Criteria for Screening  Before a screening program is initiated. a decision must be made whether it is worthwhile. scientific and if possible financial justification. .  The criteria for screening are based on two considerations:  DISEASE to be screened  TEST to be applied. which requires ethical.

g.Criteria for Screening = The Disease  Facilities should be available for confirmation of the diagnosis  There is an effective treatment  There is good evidence that early detection and treatment reduces morbidity and mortality  The expected benefits (e. . the number of lives saved) of early detection exceed the risks and costs.