Screening

Sherine Shawky, MD, Dr.PH

Assistant Professor Public Health
King Abdulaziz University
College of Medicine
shshawky@hotmail.com
Epidemiology in Medicine

Foundation of medical research

Support for medical advancement
Essential in medical education &
practice
Boundary for biostatistics
 Learning Objectives
Understand the concept of
screening
Understand the characteristics of
health-related events suitable for
screening
Recognize the characteristics of
a screening program
 Performance Objectives
Apply screening for early detection
of risk factors & diseases
Identify the factors suitable for
screening
Evaluate the benefit of screening
 Screening
Screening is the process to
detect among healthy
people disorders or risk
factors of which they are
unaware
 Flow diagram for
a screening program
Population
Screening test
Test -ve Test +ve
Diagnostic procedures

Unaffected Affected

Re-screen Re-screen Intervention

 Types of screening
Mass
Multiple or multiphasic
Targeted
Case-finding or opportunistic
 Factors appropriate
for screening
Important health problem
High prevalence
Natural history understood
Long latent period
Early detection improves prognosis
 Evaluation of
a screening program
Reliability
Feasibility
Validity
Performance
Effectiveness
 Reliability
Biological variation
Program method
Intraobserver variability
Interobserver variability
 Feasibility
Acceptability Cost effectiveness
Quick Screening
Easy Diagnosis
Safe Follow-up
Intervention
 Validity
Sensitivity:
Probability to test positive among
truly affected
Specificity:
Probability to test negative among
truly unaffected
 Performance
PV+:- Probability to be affected
among test positives
PV-:- Probability to be unaffected
among test negatives
PCC:- Probability to be correctly
classified
 Effectiveness
Outcome measures:
Morbidity
Disability
Mortality
 Effectiveness
Bias
Patient self-selection
Lead time
Length
Study designs for screening
1. Correlation Studies
Use:
Description of population
Strength:
Suggest possibility of benefit
Limitation:
Can’t test hypothesis
Study designs for screening
2. Analytical Studies
Types: Advantage:
Case-control  Test hypothesis
Cohorts Limitation:
Use: Selection
Comparison Lead time
of rates  length
Study designs for screening
3. Randomized Trials
Use:
Comparison of rates
Strength:
Most valid test of hypothesis
Limitation:
Cost, ethics & feasibility
 Evaluation of screening
Affected
Screening

+ - Total
+ TP FP SP
- FN TN SN
Total TA TH GT
*Sensitivity= TP/TA *PV+ = TP/SP
*Specificity= TN/TH *PV-= TN/SN
*PCC= TP+TN/GT
 Conclusion
Objectives of screening
Reduce disease incidence
Reduce morbidity, disability &
mortality
Criteria for screening
Appropriate factor
Beneficial program
 Review Questions (Developed by the
Supercourse team)

• What is screening and what types of screening

can you name?
• What are the objectives of screening?
• For what type of diseases would it be
appropriate to set up screening programs? List
characteristics.
• How is screening program evaluated?