W 14

Question 1

What is screening?

Answer 1

1. testing (Qs, physical exams, labs) asymptomatic people
   Examples:
   - “annual physical”
   - Periodic (colonoscopies, gynecological exams, mammograms, PSA)

Question 2

What is the purpose and potential benefits of screening?

Answer 2

• detect diseases that are better treated before signs and symptoms show up and prevent people from suffering with or dying from them
• use knowledge of risk factors for disease to prevent or decrease the burden of the disease by modifying the risk factors

Question 3

For best results of screening “DISEASE” should be:

Answer 3

1. a significant public health problem
   - common and/or significant morbidity and/or mortality
2. treatable with these stipulations
   - the potential for cure increases with early detection
   - treatment is easily available

Question 4

For best results of screening “TEST” should be:

Answer 4

1. sensitive to pre-clinical disease
2. safe
3. inexpensive
4. easily accessible/available
5. lead to demonstrated improved health outcomes

Question 5

Define pseudodisease?

Answer 5

a condition detected by screening that does not require treatment because it will not adversely affect the patient’s life

Question 6

What are the types of pseudo-disease?

Answer 6

Type I: conditions that might not progress to symptomatic disease and may even regress
Type II: slowly progressive disease (conditions with a long detectable preclinical phase)

Question 7

What are the harms of screening?

Answer 7

• harms of tests (radiation, perforation from colonoscopy, cost, time)
• false positives:
  - psychological burden
  - further testing (over-testing)
  - over-treatment (even safe treatments impose burden, financial and otherwise)