(MT-MLS102) | BATCH 2024

COLLEGE OF MEDICAL LABORATORY SCIENCE – DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE

PREPARED BY: CORINNE RENIVA SCREENING

LECTURER: PROF. JOHN MARTIN DELOS REYES

DEFINITION
Screening: relates to the early detection of disease, precursors
of disease and susceptibility of disease in individual who do not
show any signs of the disease
: not already conclusive
: confirmatory - give patient to confirm or detect
presence of disease

: presumptive identification of those who probably have disease

form those who do not have by means of rapidly applied test in
apparently healthy individuals (WHO)
: common sample used: whole blood or serum
Mausener & Bahn, 1985
: presumptive identification of unrecognized disease or defect
by the application of tests, examinations or other procedures
which can be applied rapidly to sort out apparently well person
who probably have a disease from those who probably do not
Advantage: more accessible for people that is far away from
urban areas
Opportunistic Screening: application of test procedure
(inquiry, examination, or investigation) during a consultation
initiated by patient for another reason
: there can be no monitoring
Organized Screening: program wherein screening test will be
implemented with a group of individuals that can be
presumptively having the disease
: immediate data showing the collectiveness of result that
participated

ICEBERG OF DISEASE OBJECTIVES OF SCREENING PROGRAMS

 Undertaken as part of an epidemiologic survey
to determine the frequency or to describe
the natural history of a condition;
 Prevention of contagion and protection of
public's health
 Detection of disease precursors of disease as
a guide to medical care of individuals
(prescriptive screening)

USES OF SCREENING

: effective during onset of disease = early treatment Uses of Screening

SCREENING PHASES Case Detection Perspective Screening

Case/Disease Prospective Screening
Pre-clinical Phase
Control
1. Exposure to pathogen
Research Natural History of Disease
2. Biological onest of disease - where screening
Health Education Public Awareness
is effective = early treatment
3. Symptoms Appear

Disease Prevention and Control RENIVA | 2021

 SCREENING PROCESS  Poor subject motivation: most of the people
Confirmatory: additional lab procedures does not really think that there is a need for
them to participate
: very low percentage from positive to negative
High Risk Strategy: there will be a criteria to specify individuals
to be included
 Cost effective
 Intervention appropriate to individual
 Subject Motivated
 Small chance in reducing the disease
incidence
 Fails to deal with root cause of disease

BENEFITS AND LIMITATIONS OF SCREENING

BENEFITS LIMITATIONS
Improved prognosis for some Hazard of screening
cases detected by screening (venipuncture, radiation)

Less radical treatment which Resource costs (diversion of

cures some early cases scarce resources to
screening program)
SCREENING VS. DIAGNOSTIC TESTS
SCREENING DIAGNOSTIC Reassurance for those with False reassurance for those
negative test results with false negative results
Suggestive clinical picture
Asymptomatic
*with symptoms Anxiety and sometimes
anxiety for those with false
Large group positive results
Single subject
*survey

Less accurate
Accurate
*needs confirmatory EXAMPLES OF SCREENING TESTS
*quality control in laboratories
*doesn’t have specificity
Infancy Pregnancy Adults Elderly
Not conclusive Conclusive Growth
*needs further testing *it is accurate Weight Lipid profile Cancer
charts
Expensive
Less expensive Metabolic Blood
*automated (with use of CBC Depression
machine) Screening pressure
Not basis for treatment
Basis for treatment Blood Vitamin
*for surveying only Hearing test BMI
sugar Deficiency

TYPES OF SCREENING TEST CRITERIA FOR A SUCCESSFUL SCREENING TEST

Mass Screening Test (Population Approach): did not have
criteria to select specified group pf people to be tested
 Not cost effective
 Potential to alter the root cause of disease
 Small benefit to individual
 Large chance to reduce disease incidence
Disease Criteria
 Present in population screened
 High burden and of high public health concern
 Screening and intervention must improve
outcome: followed up with an intervention
 Known natural history of the disease

SCREENING RENIVA | 2021

Test Criteria Example:
 Reliable [[ A 90% sensitivity means that 90% of the diseased people
 Valid: control line must be colored, otherwise, screened by the test will give a “true positive” and the remaining
invalid 10% a “false negative results]]
 Simple and inexpensive
 Very safe
 Acceptable to subjects and providers
 Cost effective
 Exit strategy

Successful Criteria b. Specificity

Reliability : ability of the test to correctly identify those who do not have
: results can be repeatedly done and will give same results the disease
: repeatability, reducibility, precision : true negative
: getting the same results, when the test repeated in same d/(b + d)
target individuals in the same settings
Example:
Causes of Unreliability
o Observer variation
[[ A 90% specificity means that of the non-diseased people
screened by the test, 90% will give a “true negative” result, and the
o Subject variation - biological
remaining 10% a “false positive results]]
o Technical method error variation: due to
malfunctioning of rapid test kit

Acceptability
The test should not be:
 Painful
 Unsafe c. Positive Predictive Value
 Discomforting/Embarassing : proportion of individuals with positive test (with the disease)
 Socially/believes not accepted
PPV = a/(a+b)
Validity: ability of the test to distinguish between who has the
diseases and who does not. : gaano kataas yung probability with these patients ang nag
positive, ilan sakanila ang true positive

d. Negative Predictive Value

: proportion of individuals with negative test (without the
disease)
NPV = d/(c+d)

Effects on Predictive Value

Prevalence/Sensitivity/Specificity Predictive Value

Prevalence Increase PPV Increases
NPV Decreases
a. Sensitivity Prevalence Decreases PPV Decreases
: ability of the test to truly identify those who have the disease NPV Increases
: true positive
a/(a+c) Specificity Increases PPV Increases
Sensitivity Increases NPV Increases

SCREENING RENIVA | 2021

 Prevalence Decreases PPV Decreases TEST A TEST B
NPV Increases
Sensitivity = 80% Sensitivity = 90%
Specificity = 60% Specificity = 90%

THE OVAL REPRESENTS THE 200 PEOPLE WHO

HAVE THE DISEASE

Prevalence Increase PPV Increases Table 1. Results of Screening with Test A

NPV Decreases

OF THE 200 PEOPLE WHO

e. Yield HAVE THE DISEASE
: amount of previously unrecognized disease that is diagnosed
and brought to treatment as a result of screening
Influenced by the:
 Sensitivity of the test
 Prevalence of the
unrecognized disease Table 1. Results of Screening with Test B
 Testing format
 Frequency of screening
 Extent of participation in the
screening program

SIMULTANEOUS TESTING
Net Sensitivity Using the Two Simultaneous Tests

Given
o n = 1,000 persons

o Prevalence of disease = 20%

OF THE 200 PEOPLE WHO
o Number of persons w/ disease = 200 HAVE THE DISEASE
o Number of persons w/out disease = 800

SCREENING RENIVA | 2021

 Sensitivity = 80% Sensitivity = 90%
Specificity = 60% Specificity = 90%

THE OVAL REPRESENTS THE 800 PEOPLE WHO

DO NOT HAVE THE DISEASE

Table 1. Results of Screening with Test A

OF THE 800 PEOPLE WHO

HAVE THE DISEASE

Table 1. Results of Screening with Test B

Net Specificity Using the Two Simultaneous Tests

Given:

o n = 1,000 persons

o Prevalence of disease = 20%

o Number of persons w/ disease = 200

o Number of persons w/out disease = 800 OF THE 800 PEOPLE WHO

HAVE THE DISEASE

TEST A TEST B

SCREENING RENIVA | 2021

Thus, the Net Specificity using both tests simultaneously

SCREENING RENIVA | 2021