Screening Test

Screening Test
Definition: Application of simple test

on asymptomatic people (have no
sings and symptoms) to sort out the
apparently healthy from those had
illness. It important in prevention and
control, after screening we should
confirm diagnosis by golden test for
positive cases in screening and treat
them.
A diagnostic testis used to determine the
presence or absence of a disease when a
subject shows signs or symptoms of the
disease
The diagnostic test is performed after a
positive screening test to establish a
definitive diagnosis
Criteria for good screening
test:
1: Easy and quick test.
2: Acceptable and safe to people.
3: Not expensive.
4: Used for searching serious
problems.
5: Treatment should be available for
the problem.
Criteria for disease or problem
suitable for screening:
1. Highly prevalent.
2. Serious consequence of a disease.
3. No symptoms or signs at early stage.
4. Can be detected at relatively low cost
before the clinical stage starts.
5. Early treatment is available and
accessible that has been shown to reduce
morbidity and mortality.
Some Common Screening
Tests
Pap smear for cervical dysplasia or cervical cancer
Fasting blood cholesterol for heart disease
Fasting blood sugar for diabetes
Blood pressure for hypertension
Mammography for breast cancer
PSA test for prostate cancer
Fecal occult blood for colon cancer
Ocular pressure for glaucoma
TSH for hypothyroid and hyperthyroid
Types of screening
1. Mass screening: involve screening of
whole population e.g. chest X-ray to detect
T.B. in Iraq in 1980.
2. Multiple or multiphasic screening
involve the use of a variety of screening
tests on the same occasion e.g. to detect
peptic ulcer use Ba-meal then endoscopy.
Blood sugar followed by GTT
3. Targeted screening: involve screening
of a group of people with specific exposure
e.g. workers in high noise environment to
detect hearing defect (this type of
screening used to detect environmental
and occupational hazards).
4. Case finding screening or opportunistic
screening: is restricted type to patients
who consult health practitioner for other
purpose (screening for ca-breast in female
who come for urinary tract infection).
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 is the ability of a test to indicate
which individuals have the disease and which
do not, it consist of two components:
Sensitivity: It is the ability of a test to
give a positive finding when the person
tested truly had a disease.
Is a fixed characteristic of test
a
= a+c
Specificity: It is the ability of the test
to give a negative finding when the
person tested is free of the disease.
Is a fixed characteristic of test
= d
b+d
Yield from the Screening Test:
Predictive Value
Relationship between Sensitivity,

Specificity, and Prevalence of Disease
Prevalence is low, even a highly specific
test will give large numbers of False
Positives
Predictive Values
Positive predictive value (PPV)The
proportion of patients who test positive who
actually have the disease(a/a+b)
Negative predictive value (NPV)The
proportion of patients who test negative who are
actually free of the disease(d/c+d)
PPV and NPV are not fixed characteristics of
the test
PPV Primarily Depends On …
The prevalence of the disease in the
population tested, and the test itself
(sensitivity and specificity)
* False positive: Person without a
disease who were positive in the test.
= b
b+d
* False negative: Person with a
disease who were negative to test.
= c
a+c
Determining the Sensitivity, Specificity
of a New Test
Must know the correct disease status prior to
calculation
Gold standard test is the best test available It
is often invasive or expensive
Anew test is, for example, a new screening test

or a less expensive diagnostic test
Use a 2 x 2 table to compare the performance of
the new test to the gold standard test
Golden Test (diagnostic)
Diseased Non Total
diseased
Screenin
g test
+Ve a b a+b
-Ve c d c+d
Total a+c b+d a+b+c
+d
Reliability means that the results of a test or
measure are identical or closely similar each
time it is conducted
Because of variation in laboratory procedures,
observers, or changing conditions of test subjects
(such as time, location), a test may not
consistently yield the same result when repeated
Causes of variation
Intra-subject variation is a variation in the

results of a test conducted over (a short period
of) time on the same individual
The difference is due to the changes (such as
physiological, environmental, etc.) occurring to
that individual over that time period
Causes of variation
Inter-observer variation is a variation in the
result of a test due to multiple observers
examining the result
Intra-observer variation is a variation in the
result of a test due to the same observer
examining the result at different times
Adverse effects of Screening tests
Stress and anxiety caused by false

positive results
Unnecessary radiation/chemical exposure
and test discomfort
Prolonged knowledge of a disease with no
treatment
False sense of security over false negative
results
Overuse of medical resources

Screening Test

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Screening Test

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Screening Test

Definition: Application of simple test

Relationship between Sensitivity,

Anew test is, for example, a new screening test

Intra-subject variation is a variation in the

Stress and anxiety caused by false

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