Screening

• A screening test is done to detect potential

health disorders or diseases in people who do
not have any symptoms of disease.
– Early detection
– Lifestyle changes
– Surveillance
– Reduce the risk of disease
– Detect it early enough to treat it most effectively
• The condition should be an important health
problem
• There should be a recognisable latent or early
symptomatic stage
• The natural history of the condition, including
development from latent to declared disease,
should be adequately understood
• There should be an accepted treatment for
patients with recognised disease
• There should be a suitable test or examination
that has a high level of accuracy
• The test should be acceptable to the population
• There should be an agreed policy on whom to
treat as patients
• Facilities for diagnosis and treatment should
be available
• The cost of screening (including diagnosis and
treatment of patients diagnosed) should be
economically balanced in relation to possible
expenditure on medical care as a whole
• Screening should be a continuing process and
not a ‘once and for all’ project.
 Potential harms from screening

• Adverse outcomes for some individuals.

• False negative results
– Delays in diagnosis and treatment.
– False sense of security and ignore warning
symptoms.
– Legal action by people whose cancers appear to
have been missed.
 Potential harms from screening

• False positive result

– People without the disease undergo follow-up
testing that may be uncomfortable, expensive, and,
in some cases, potentially harmful.
– Psychological consequences such as anxiety for
both the patient and their family.
• Screening for cancer can lead to overdiagnosis – the
detection of cancer that would never harm the
individual in their lifetime.
• The reasons for this include:
– Detection of slow-growing or indolent cancers
– High-resolution technologies detecting smaller and often
the least aggressive types of cancer
– People dying from other causes (competing mortality).
 Strategies for cancer screening
• Continuing education strategies
• Guidelines development and implementation
• Innovative organizational initiatives
• Financial incentives
• Patient-based approaches
 Methods of screening
– Case-finding
– Mass screening
– Multiphasic screening
– Opportunistic screening
– Periodical health examination
– Prescriptive screening
– Targeted screening
 SCREENING PROGRAMMES
• Organized
– There should be a documented policy
– The screening test should be part of a pathway of
care
– The eligible/target population should be defined
– The eligible/target population should be invited to
screening at regular intervals
– Diagnosis and treatment of screen-positive
individuals
• Opportunistic screening
– Does not have systematic invitation mechanisms
– Service user–service provider interactions
– On demand or on an ad hoc basis
– Individuals outside of the eligible group.
 Cancer screening registries
• Maintaining a database of screening records of individuals along the screening
pathway
• Inviting eligible persons to commence screening
• Holding a single, consistent screening record for each participant
• Maintaining records of screen-positive individuals related to their participation to
evaluate outcomes
• Holding a record of diagnosis (both pre-cancer and cancer as applicable)
• Reminding participants when they are due or overdue for screening
• Providing a safety net/failsafe mechanism for participants who are screened
positive
• Linking with other relevant information systems to enable quality assurance,
monitoring and evaluation of the screening programme