Screening programs

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 Screening for Disease Control
• Screening: The application of a disease-
detection test in asymptomatic apparently healthy
individuals.

• It means testing of apparently healthy individuals

to detect unrecognized cases or those under high
risk of getting the disease.

• Purpose: To classify individuals with respect to

their likelihood of having a particular disease.

• Screening procedure itself does NOT formally

diagnose illness. 2
Objectives
• Early case finding
• Better control & prognosis
• To know the true size of a disease or problem
• Research studies

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 Types of screening program

1. Selective screening :
for high risk group.
e.g. tuberculin test for T.B. contact
2. Mass screening :
For large number of people irrespective
to their risk status.
e.g. mass radiography for T.B.

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 Natural History of Disease
Detectable subclinical
disease

Susceptible Subclinical Clinical Stage of Recovery,

Host Disease Disease Disability, or Death

Diagnosis
Point of required
Exposure

Onset of
symptoms

Screening
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 Early Intervention in the Natural
History of Disease
Good HEALTH
OUTCOMES
Health Cure
Control
Disability
Disease
Onset Symptoms Care Diagnosis Therapy Death
Seeking

Early detection through

Screening
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7
 screening

● Examination of asymptomatic people

likely
● Classification as
unlikely
….. to have a disease

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🞂 “Unlikely” referred to next
screening cycle
🞂 “Likely” further testing for
diagnosis

yes no
referred to next
treatment screening cycle

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 Flow diagram for
a screening program

Population
Screenin
g test
Test -ve Diagnosti
Test +ve
c
procedur
es
Unaffected Affected

Re-screen Re-screen Intervention

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 Screening Test
Concerned with a Functional Definition of
Normality versus Abnormality

Screening Test

Norma Abnorma
11 l l
WHO criteria for screening:
1. The disease should be important public
health problem
2. There should be a latent stage of the disease.
3. Natural history of disease should be
adequately understood.

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WHO criteria for screening:
4-There should be a suitable screening test or
examination that can detect the condition
5-The test should be acceptable

6- Facilities for the confirmation of the diagnosis

and treatment should be available.

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7-There should be an effective and acceptable
treatment for the condition if identified in an early
stage
8-There should be an agreed upon policy on whom to
treat.

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9). The total cost of finding a case should be economically
balanced in relation to medical expenditure as a whole.

10-Case finding should be a continuous process, not just a

“once and for all” project

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 Requirements of a good screening test

● Acceptable
● Rapid
● Inexpensive
● Harmless
● Simple and easy to done
● Valid
● with good predictive values
● reliable

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 Examples of screening tests

1. Mass miniature radiography → T.B.

2. Hemoglobin → anemia
3. Cytological examination → cancer cervix
4. Glycosuria → D.M.
5. E.C.G.
6. Blood pressure measured
7. Blood cholesterol examination

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 Diseases for which screening
has been recommended
● Cervical cancer
● Breast cancer
● Ovarian cancer
● Colorectal cancer
● Skin cancer
● Diabetes
● Hypertension
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 Calculate:
● PV+ =19/118=16%
19 ● PV-= 1881/1882=99.99 9