Screening

Definition
Presumptive identification of unrecognized disease by
application of a procedure to sort out apparently

well persons who probably have a disease from

those who probably do not.
Screening tests are not intended to be diagnostic...

Screening
Issues relating to the screening tests
Validity

Sensitivity
Specificity

Predictive values

Positive
Negative

Purpose of screening
It is carried out in a hope that earlier diagnosis and
subsequent treatment favorably alters the natural
history of the disease in a significant proportion of those
who are identified as positives

Types of screening
Mass screening, no selection of population (e.g.,

checking all infants for hearing problems)

Selective screening (e.g., by age and sex:

mammograms for women aged over 40)

Multiphase screening (a series of tests, as family

doctors do at annual health exams)

When to screen??

The Principles of Screening

The choice of disease for which to screen;
The nature of the screening test or tests to be used;
The availability of a treatment for those found to have
the disease;
The relative costs of the screening.

Screening Test Criteria

Simplicity
Safety

Rapidity
Ease of administration
Cost
Repeatability

Validity of a screening test (Accuracy)

Sensitivity
Probability that a person who has a disease will test
positive for that disease by the screening test.
Specificity
Probability that a person who is free of a disease will test
negative for that disease by the screening test.

Validity of a screening test

Sensitivity of a test is the ability of the test to
detect disease in all those who actually have
the disease(i.e., correctly identify all those who
have the disease)

Specificity of a test is the ability of the test to

rule out disease in all those in whom the
disease is actually absent (i.e., correctly identify
all those who do not have the disease).

Validity
An ideal screening test is one that is 100% sensitive and
100% specific.
In practice this does not occur.

2*2 table
The simplest cross tabulation is a 2 x2 table
A 2 x 2 table is one which has only two rows
and two columns.

Validity
....... an example

Disease status

Screening
test's result

Present

Absent

Total

Positive

TP

FP

TP + FP

Negative

FN

TN

Total

TP + FN

FP + TN

(All Diseased)

(All Non-diseased)

(All test positives)

FN + TN
(All test negatives)

1000

interpreting the cells

a+c = All those who actually have the
disease.
b+d = All those who actually do not
have the disease.
a+b = All those who test positive on
the screening test.
c+d = All those who test negative on
the screening test

Validity
....... an example
Disease status

Screening
test's result

Present

Absent

Total

Positive

80

100

180

Negative

20

800

820

Total

100

900

1000

Validity
....... an example

Sensitivity

Specificity

TP / TP + FN

TN / FP + TN

80/100 = 0.8 or 80%

800/900 = 0.888 or 88.8%

Probability (chance) that a

diseased individual will be
correctly identified by a
screening test.

Probability (chance) that a

disease free individual will be
identified as such by a
screening test.

Predictive values (Yield)

Positive
Probability that a person who tests positive for a disease
indeed has the disease.
Negative
Probability that a person who tests negative for a disease
is indeed disease free.

Yield of screening test

Positive predictive value (PV+) is the proportion of
disease positive in test positives.
Or
is the probability that an individual with a positive screening
result has the disease
Negative predictive value (PV-) is the proportion of
disease negative in test negatives.
Or
is the probability that an individual with a negative screening
result do not have the disease

Predictive values
Disease status

Screening
test's result

Present

Absent

Total

Positive

80

100

180

Negative

20

800

820

Total

100

900

1000

Predictive values
Positive
TP / TP + FP
80/180 = 0.444 or 44.4%
Probability (chance) of
having the disease given a
positive test.

Negative
TN / TN + FN
800/820 = 0.975 or 97.5%
Probability (chance) of not
having the disease given a
negative test.

Predictive values
Disease status

Screening
test's result

Present

Absent

Total

Positive

400

56

456

Negative

100

444

544

Total

500

500

1000

Predictive values
.

Positive

Negative

TP / TP + FP
400/456 = 0.877 or 87.7%

TN / TN + FN
444/544 = 0.816 or 81.6%

Probability (chance) of
having the disease given a
positive test.

Probability (chance) of not

having the disease given a
negative test.

Prevalence
P= Total # of Diseases Individuals
________________________
Total Population
P =

a+c
________________
a+b+c+d

X 100

Logic of Screening
Apparently well population
Screening test

Negative results
Disease
FN

No disease
TN

Positive results
Disease No disease
TP
FP

Summary
Screening ????
Validity

Sensitivity
Specificity

Predictive values

Positive
Negative