SCREENING

`The presumptive identification of unrecognized disease or defect by the application of tests, examinations, or other procedures which can be applied rapidly. Screening tests sort out apparently well persons who probably have a disease from those who probably do not'

US COMMISSION ON CHRONIC ILLNESS (1 951)

NOTE;

Not intended to be diagnostic. GP best place (> 90% consult their GP over 5 yr period) Inverse care law worried well false positive/negative

WILSON & JUNGNER CRITERIA

1) Condition sought should be an Important public health problem 2) There should be an accepted treatment for patients with recognised disease and this treatment at an early, latent or presymptomatic stage should favourably influence prognosis 3) Facilities for diagnosis and treatment should be available 4) A Recognisable latent or early symptomatic stage 5) Opinions/definition of what is meant by a case of the target condition 6) Must be a suitable test with safety guaranteed 7) The Examination must be acceptable to the patient 8) The Natural history of the condition should be understood 9) Ideally an inexpensive test (cost) 10) Case finding is a continuous process

WHAT IS SCREENED IN ENGLAND AND WALES

Neoplasia Antenatal Neonatal

Breast Trisomy 21 Thyroid

Cervix Neural Tube PKU

Structural Deformity (Hips)

Rubella (Cataract)

Ovarian Toxoplasmosis

Bowel Blood Group

Thalassaemia / SSD

HIV

Syphilis

Gestational DM

BP

Asymptomatic Bacturia

Child Adult Hearing Chlamydia

Vision Familial Hypercholesterolaemia Growth / BP Development Diabetic Retinopathy Aneurysm Reading Osteoporosis Elderly Visiting / dementia Kidney disease / MSU

PATIENT IMPLICATION OF SCREENING

CONCLUSION OF OFFERING CERVICAL SCREENING TO 250,000

WOMEN IN BRISTOL IN 1999 WAS --

• IT HELPED A FEW

• HARMED THOUSANDS DISAPPOINTED MANY

• COST £1.5 M/YR

• KEPT A FEW LAWYERS AT WORK.

THERE IS A PUBLIC MISCONCEPTION RE PURPOSE/ACCURACY OF SCREENING

WE ARE ALL SCREENED FROM THE WOMB TO THE TOMB!

PROS

CONS

• DETECTS ASYMPTOMATIC DISEASE

• LIMITS DISEASE/SAVES LIVES

• SAVES £££ DETECTION OF RECURRENCE PROMOTES HEALTH ED. ENHANCES PT / DOC REL EPIDEMIOLOGY IDENTIFIES COMM AT RISK.

PROMOTES ANXIETY

• FALSE POS / NEG

UNNECESSARY REPEATS OVER DIAGNOSIS OvERTREATMENT FALSE REASSURANCE

• CONFIDENTIALITY

FAMILIAL SCREENING

Course Organisers 

web designed by Chris Wilkinson, North Worcestershire VTS