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Chapter 10 - Screening Tests

Published online by Cambridge University Press:  02 May 2020

Thomas B. Newman
Affiliation:
University of California, San Francisco
Michael A. Kohn
Affiliation:
University of California, San Francisco
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Summary

While screening tests share some features with diagnostic tests, they deserve a chapter of their own because of important differences. Whereas we generally do diagnostic tests on sick people to determine the cause of their symptoms, we generally do screening tests on healthy people with a low prior probability of disease. The problems of false positives and harms of treatment loom larger. In Chapter 4, on evaluating studies of diagnostic test accuracy, we assumed that accurate diagnosis would lead to better outcomes. The benefits and harms of screening tests are so closely tied to the associated treatments that it is hard to evaluate diagnosis and treatment separately. Instead, we compare outcomes such as mortality between those who receive the screening test and those who don’t. We postponed our discussion of screening until after our discussion of randomized trials because randomized trials are a key element in the evaluation of screening tests. Finally, because decisions about screening are often made at the population level, political and other nonmedical factors are more influential. Thus, in this chapter, we focus explicitly on the question of whether doing a screening test improves health, not just on how it alters disease probabilities, and we pay particular attention to biases and nonmedical factors that can lead to excessive screening.1

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Chapter
Information
Evidence-Based Diagnosis
An Introduction to Clinical Epidemiology
, pp. 250 - 279
Publisher: Cambridge University Press
Print publication year: 2020

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References

Eddy, D. Common screening tests. Philadelphia: American College of Physicians; 1991.Google Scholar
Moore, TJ. Deadly medicine: why tens of thousands of heart patients died in America’s worst drug disaster. New York: Simon & Schuster; 1995. 349pp.Google Scholar
Law, J, Faulkner, K. Cancers detected and induced, and associated risk and benefit, in a breast screening programme. Br J Radiol. 2001;74(888):1121–7.CrossRefGoogle Scholar
Riggs, BL, Hodgson, SF, O’Fallon, WM, et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med. 1990;322(12):802–9.Google ScholarPubMed
WHO. W.H.O. cooperative trial on primary prevention of ischaemic heart disease using clofibrate to lower serum cholesterol: mortality follow-up. Report of the Committee of Principal Investigators. Lancet. 1980;2(8191):379–85.Google Scholar
Epstein, AE, Hallstrom, AP, Rogers, WJ, et al. Mortality following ventricular arrhythmia suppression by encainide, flecainide, and moricizine after myocardial infarction. The original design concept of the Cardiac Arrhythmia Suppression Trial (CAST). JAMA. 1993;270(20):2451–5.CrossRefGoogle Scholar
Haynes, RB, Sackett, DL, Taylor, DW, Gibson, ES, Johnson, AL. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med. 1978;299(14):741–4.CrossRefGoogle ScholarPubMed
Rubin, SM, Cummings, SR. Results of bone densitometry affect women’s decisions about taking measures to prevent fractures. Ann Intern Med. 1992;116(12 Pt 1):990–5.CrossRefGoogle ScholarPubMed
Fyro, K, Bodegard, G. Four-year follow-up of psychological reactions to false positive screening tests for congenital hypothyroidism. Acta Paediatr Scand. 1987;76(1):107–14.CrossRefGoogle ScholarPubMed
Barton, M, Morley, D, Moore, S, et al. Decreasing women’s anxieties after abnormal mammograms: a controlled trial. JNCI. 2004;96:529–38.Google ScholarPubMed
Lee, T, Brennan, T. Direct-to-consumer marketing of high-technology screening tests. New Engl J Med. 2002;346(7):529–31.CrossRefGoogle ScholarPubMed
Braveman, P, Tarimo, E. Screening in primary health care: setting priorities with limited resources. Geneva: World Health Organization; 1994.Google Scholar
Marantz, PR. Blaming the victim: the negative consequence of preventive medicine. Am J Public Health. 1990;80(10):1186–7.CrossRefGoogle ScholarPubMed
Newman, TB. The power of stories over statistics. BMJ. 2003;327(7429):1424–7.CrossRefGoogle ScholarPubMed
Bishai, D. Hearts and minds and child restraints in airplanes. Arch Pediatr Adolesc Med. 2003;157(10):953–4.CrossRefGoogle ScholarPubMed
Daniels, N. Why saying no to patients in the United States is so hard. Cost containment, justice, and provider autonomy. N Engl J Med. 1986;314(21):1380–3.CrossRefGoogle ScholarPubMed
Mariner, WK. Rationing health care and the need for credible scarcity: why Americans can’t say no. Am J Public Health. 1995; 85(10):1439–45.CrossRefGoogle ScholarPubMed
Eddy, DM. Breast cancer screening in women younger than 50 years of age: what’s next? Ann Intern Med. 1997;127(11):1035–6.CrossRefGoogle ScholarPubMed
Schwartz, LM, Woloshin, S, Fowler, FJ Jr., Welch, HG. Enthusiasm for cancer screening in the United States. JAMA. 2004;291(1):71–8.CrossRefGoogle ScholarPubMed
Ernster, VL. Mammography screening for women aged 40 through 49 – a guidelines saga and a clarion call for informed decision making. Am J Public Health. 1997;87(7):1103–6.CrossRefGoogle Scholar
Feinstein, AR, Sosin, DA, Wells, CK. The Will Rogers phenomenon: improved technologic diagnosis and stage migration as a source of nontherapeutic improvement in cancer prognosis. Trans Assoc Am Phys. 1984;97:1924.Google Scholar
Olivotto, IA, Truong, PT, Speers, CH. Staging reclassification affects breast cancer survival. J Clin Oncol. 2003;21(23):4467–8.CrossRefGoogle ScholarPubMed
Woodward, WA, Strom, EA, Tucker, SL, et al. Changes in the 2003 American Joint Committee on Cancer staging for breast cancer dramatically affect stage-specific survival. J Clin Oncol. 2003;21(17):3244–8.CrossRefGoogle ScholarPubMed
Welch, HG. Should I be tested for cancer? Maybe not, and here’s why. Berkeley: University of California Press; 2004.Google Scholar
Esserman, LJ, Thompson, IM Jr., Reid, B. Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA. 2013;310(8):797–8.CrossRefGoogle Scholar
Esserman, LJ, Thompson, IM, Reid, B, et al. Addressing overdiagnosis and overtreatment in cancer: a prescription for change. Lancet Oncol. 2014;15(6):e234–42.CrossRefGoogle Scholar
Hofmann, B, Welch, HG. New diagnostic tests: more harm than good. BMJ. 2017;358:j3314.CrossRefGoogle ScholarPubMed
Marcus, PM, Bergstralh, EJ, Fagerstrom, RM, et al. Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up. J Natl Cancer Inst. 2000;92(16):1308–16.CrossRefGoogle ScholarPubMed
Buys, SS, Partridge, E, Black, A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011;305(22): 2295–303.CrossRefGoogle ScholarPubMed
Pinsky, PF, Yu, K, Kramer, BS, et al. Extended mortality results for ovarian cancer screening in the PLCO trial with median 15 years follow-up. Gynecol Oncol. 2016;143(2):270–5.CrossRefGoogle Scholar
Andriole, GL, Grubb, RL, 3rd, Buys, SS, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310–9.CrossRefGoogle ScholarPubMed
Ilic, D, Djulbegovic, M, Jung, JH, et al. Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ. 2018;362:k3519.CrossRefGoogle ScholarPubMed
Bibbins-Domingo, K, Grossman, DC, Curry, SJ. The US preventive services task force 2017 draft recommendation statement on screening for prostate cancer: an invitation to review and comment. JAMA. 2017;317(19): 1949–50.CrossRefGoogle Scholar
Moynihan, R, Doust, J, Henry, D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012;344:e3502.CrossRefGoogle ScholarPubMed
Bell, KJ, Del Mar, C, Wright, G, Dickinson, J, Glasziou, P. Prevalence of incidental prostate cancer: a systematic review of autopsy studies. Int J Cancer. 2015;137(7):1749–57.CrossRefGoogle ScholarPubMed
Mistry, K, Cable, G. Meta-analysis of prostate-specific antigen and digital rectal examination as screening tests for prostate carcinoma. J Am Board Fam Pract. 2003;16(2):95101.CrossRefGoogle ScholarPubMed
Black, WC, Haggstrom, DA, Welch, HG. All-cause mortality in randomized trials of cancer screening. J Natl Cancer Inst. 2002;94(3):167–73.Google ScholarPubMed
Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet. 2000;355(9217):1757–70.Google Scholar
Welch, HG. Less medicine, more health: 7 assumptions that drive too much medical care. Boston: Beacon Press;2015. xxii, 218pp.Google Scholar
Pron, G. Prostate-specific antigen (PSA)-based population screening for prostate cancer: an evidence-based analysis. Ont Health Technol Assess Ser. 2015; 15(10):164.Google ScholarPubMed
Pinsky, PF, Blacka, A, Kramer, BS, et al. Assessing contamination and compliance in the prostate component of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. Clin Trials. 2010; 7(4):303–11.CrossRefGoogle ScholarPubMed
Ashton, HA, Buxton, MJ, Day, NE, et al. The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet. 2002;360(9345):1531–9.Google ScholarPubMed
Aberle, DR, Adams, AM, Berg, CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365(5):395409.Google ScholarPubMed
Andriole, GL, Grubb, RL 3rd, Buys, SS, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310–9.CrossRefGoogle ScholarPubMed
Vickers, AJ. Prostate cancer screening: time to question how to optimize the ratio of benefits and harms. Ann Intern Med. 2017;167(7):509–10.CrossRefGoogle ScholarPubMed
Buys, SS, Partridge, E, Black, A, et al. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011;305(22): 2295–303.CrossRefGoogle ScholarPubMed
Pinsky, PF, Yu, K, Kramer, BS, et al. Extended mortality results for ovarian cancer screening in the PLCO trial with median 15 years follow-up. Gynecol Oncol. 2016;143(2):270–5.CrossRefGoogle Scholar
Kimberlin, DW, Jester, PM, Sanchez, PJ, et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. N Engl J Med. 2015;372(10):933–43.CrossRefGoogle ScholarPubMed
Boppana, SB, Ross, SA, Novak, Z, et al. Dried blood spot real-time polymerase chain reaction assays to screen newborns for congenital cytomegalovirus infection. JAMA. 2010;303(14):1375–82.CrossRefGoogle ScholarPubMed
Bale, JF Jr. Screening newborns for congenital cytomegalovirus infection. JAMA. 2010;303(14):1425–6.CrossRefGoogle ScholarPubMed
Mastroiacovo, P, Bertollini, R, Corchia, C. Survival of children with Down syndrome in Italy. Am J Med Genet. 1992;42(2): 208–12.CrossRefGoogle ScholarPubMed

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  • Screening Tests
  • Thomas B. Newman, University of California, San Francisco, Michael A. Kohn, University of California, San Francisco
  • Book: Evidence-Based Diagnosis
  • Online publication: 02 May 2020
  • Chapter DOI: https://doi.org/10.1017/9781108500111.011
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Send book to Dropbox

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Dropbox.

  • Screening Tests
  • Thomas B. Newman, University of California, San Francisco, Michael A. Kohn, University of California, San Francisco
  • Book: Evidence-Based Diagnosis
  • Online publication: 02 May 2020
  • Chapter DOI: https://doi.org/10.1017/9781108500111.011
Available formats
×

Send book to Google Drive

To send content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about sending content to Google Drive.

  • Screening Tests
  • Thomas B. Newman, University of California, San Francisco, Michael A. Kohn, University of California, San Francisco
  • Book: Evidence-Based Diagnosis
  • Online publication: 02 May 2020
  • Chapter DOI: https://doi.org/10.1017/9781108500111.011
Available formats
×