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.
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,
3. Positive test will be followed by a
diagnostic test or procedure to
ensure disease.
 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- periode periode periode Illness
pathogenesis period
phase Pathogenesis phase
Natural History of Disease

PREPATOGEN PATHOGEN
ESIS ESIS
SUSCEPTIBI ADAPTATI EARLY CLINIC
LITY ON DISEASE
EARLY PROTECTION OF
DISEASE

Screening should be
performed here
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".
2. Morbidity and / or mortality
meaningful if untreated.
3. There are effective therapies,
4. Beneficial early treatment outweigh
further cases.
example;
5. TB with tuberculin test; feasible
6. Ca lung with chest X-ray; not
feasible
CONDITION OF SCREENING

1. Sufficiently sensitive and specific

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.
TYPES OF SCREENING
1. Mass screening
2. Selective screening
3. Single disease screening
4. Multiphasic screening
5. Case finding
 Screening is
performed on
TYPES OF SCREENING the entire
population
Ex: mass x-
1. Mass screening ray surveys or
2. Selective screening blood pressure
screening on
3. Single disease screening
the entire
4. Multiphasic screening community
who visit the
5. Case finding health services
 Only done at
TYPES OF SCREENING certain
proportions, with
a target
1. Mass screening population based
on certain ratios
2. Selective screening Objective: To
reduce the
3. Single disease screening negative impact
of screening
4. Multiphasic screening Ex:
Pap's smear in
5. Case finding women aged> 40
yr for the
detection of
cervical Ca;
Mammography
screening for
women who have a
family history of
suffering Ca.
TYPES OF SCREENING
Only
performed on
1. Mass screening
one disease
2. Selective screening Ex:
Screening
3. Single disease screeningagainst
4. Multiphasic screening tuberculosis
So it is
5. Case finding more focused
on the
disease
TYPES OF SCREENING
1. Mass screening For some
2. Selective screening diseases on a
particular visit
3. Single disease screening Very simple,
easy, cheap,
4. Multiphasic screening widely accepted
Objective:
5. Case finding health evaluation
(insurance )
Ex: Ca
examination,
with checks BP,
blood sugar,
choles, etc
TYPES OF SCREENING
1. Mass screening
2. Selective screening
3. Single disease screening
4. Multiphasic screening
one step in coping with the
5. Case finding outbreak of where to find
the source of infection and
the presence or seeking
new cases in the
community
 The main objective is to
TYPES OF SCREENING find a source of
transmission by collecting
The
data main
aboutobjective
the people is to
1. Active case findingswhofind
hada contact
new case withby the
collecting
patient BEFORE
data about thethe
Backward tracingpeople patient
who had
fell contact
ill
Forward tracing with the patient AFTER
the patient fell ill
2. Passive Case Findings
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
 Illustration table
Measurement
of the Gold
Standard
Positive Negativ Total
e

Measur Positive TP +
ement TP FP
FP
of
screeni Negativ FN +
ng tool e FN TN
TN

TP + FP +
N
FN TN
Validity Value
Criterias for assess a Screening Test;
Validity: the The
ability ofcan
test a test to determine where
predict
people who have a disease
perfectly/ and who are not
completely;
Where is all that +
Valid if: based on ST is really
sick
Where is all that -
based on ST is really
not sick
Components of validity:
Sensitivity
Specifity
Validity Value
Measurement
of the Gold
Standard
Positive Negativ Total
Sensitivity: e

= TP/(TP + FN)
Measur Positive TP +
ement TP FP
FP
of
screeni Negativ
Specifity: ng tool e FN TN
FN +
TN
= TN/(TN + FP) TP + FP +
N
FN TN

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.
Disease
Depend on: 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
PREDICTIVE VALUE
Measurement
of the Gold
Standard
Positiv Negati Total
PPV = TP/(TP + FP) e ve
Measu Positiv
TP +
remen e TP FP
NPV = TN/(TN + FN)
t of FP
scree Negati
ning FN +
ve FN TN
tool TN
TP + FP +
N
FN TN
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. Variation in
examination methods
Factors affecting the consistent results:
(eg. Sit or lay position
in BP measurement)
1. Method Variation Inter-observer
Variations within the
subject itself
variability: (eg,
a mismatch
2. Observer Variation measurement
between the of body
temperature is
measurement results of
adifferent
differentbetween
observerday
and night)
Intra-observer
variability: one
observer to read the
results differently
within a different time
 Example;
Biopsy

Positiv Negati Total

e ve

Paps Positiv
Smea e 69 131 200
r
Negati
ve 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