Talk:Screening (medicine)

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This article was the subject of a Wiki Education Foundation-supported course assignment, between 21 January 2020 and 15 May 2020. Further details are available on the course page. Student editor(s): Aamna11. Peer reviewers: Christinetranster, TheAlexRodriguez.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 08:48, 17 January 2022 (UTC)

Haha!
I just came here to write this article and here it is! Excellent! InvictaHOG 02:48, 5 December 2005 (UTC)
 * Definitely needs your input, though! Rewster 05:49, 5 December 2005 (UTC)

This is obviously an important topic which needs good definition, since it is likely to link to many other medical articles, and it is often controversial. The definition of screening provided by the UK National Screening Committee (NSC) is: "Screening is a public health service in which members of a defined population, who do not necessarily perceive they are at risk of, or are already affected by a disease or its complications, are asked a question or offered a test, to identify those individuals who are more likely to be helped than harmed by further tests or treatment to reduce the risk of a disease or its complications." (http://rms.nelh.nhs.uk/screening/default.asp?page=WHAT)

No discussion of screening is complete without mention of Wilson's criteria (Wilson and G Jungner in Principles and Practice of Screening for Disease, WHO 1968):

Knowledge of disease: The condition should be important. There must be a recognisable latent or early symptomatic stage. Natural course of condition, including development from latent to declared disease, should be adequately understood.

Knowledge of test: Suitable test or examination. Test acceptable to population. Case finding should be continuous (not just a "once and for all" project).

Treatment for disease: Accepted treatment for patients with recognised disease. Facilities for diagnosis and treatment available. Agreed policy concerning whom to treat as patients.

Cost considerations: Costs of case finding (including diagnosis and treatment of patients diagnosed) economically balanced in relation to possible expenditures on medical care as whole.

There is an excellent summary at http://www.patient.co.uk/showdoc/40000745/ if anyone is interested. The wilsons criteria are lifted directly from there as I do not have the original reference.Jellytussle 04:11, 14 December 2005 (UTC)


 * I just hadn't heard the name Wilson attached to the criteria, but they're obviously the well-known set of rules we all know and love. Certainly has room for major expansion and discussion and it is nice to know the original pair who set them forth. InvictaHOG 11:35, 14 December 2005 (UTC)


 * Wilson & Jungner's 1968 report to the World Health Organization provides the framework for most of if not all screening practices. I can't find a defined set of rules endorsed by the WHO though.

Um. The principles on http://www.cancerscreening.nhs.uk/prostate/index.html don't exactly match the ones listed

This makes NO sense
"In particular when screening for a condition of low probability the absolute number of false positives may be high although the percentage of false positives is very low; if the incidence of a condition is one in 10,000 and the probability of a false positive is 0.1%, 9 out of 10 positive results will be false."

Failed Math and Epi it seems. Even at a low incidence, if the test false positive probability is 32%, 3 out of 10 positives will be false. If it has a low incidence it should reflect on a low number of positives, not an increased false positive:real positive ratio. 186.2.136.221 (talk) 10:42, 10 December 2010 (UTC)


 * Using the example quoted (which is no longer in the article), if 100,000 people are tested, at 1/10,000 (i.e. 0.01%) there will be ten cases and therefore a maximum of ten true positives (usually 9 or less, since few screening tests would be 100% sensitive). But false positives at 0.1% would number 100. So out of 110 positives, 10 would be true and 100 false: but you won't know which are true until some more definitive investigation is performed. That's a 10:1 false to true positive ratio. As a disease becomes rarer, the false to true positive ratio increases, if the mechanism creating false positives remains the same.


 * If the follow-up investigation has to be a biopsy, then 110 people will have a biopsy, 10 true-positives will be detected and then treated. 100 others with false-positives will be happy to be all right but will have run the risk of adverse effects of minor surgery. The cost-benefit analysis of a screening programme has to take this into account. NRPanikker (talk) 22:05, 20 November 2021 (UTC)

Avoidance of bias
I've edited this section. A randomised controlled trial is not guaranteed to remove bias, but is the best way we know to minimise bias. Think of tossing a coin - it is possible to randomly end up with six heads followed by six tails, which is clearly biased. But extremely unlikely. Norman21 (talk) 18:47, 5 August 2011 (UTC)

Re-write
This article is very weak. I would like to propose a re-write, which I would be happy to put together, using some of the information currently in the article. ChrisSampson87 (talk) 14:36, 19 September 2012 (UTC)

WTF is the "screening effect?"
The article Fukushima_Daiichi_nuclear_disaster has this phrase:

"due to the screening effect"

It was written in reference to screening for some kind of thyroid issue. The words "screening effect" used to link here, but this page doesn't say anything about the "screening effect", so the link was removed.

I presume that this page used to describe the screening effect, but some deletionist came along and decided that if you want to know what it is, you can enroll in medical school or something. Is this what happened?

184.57.129.13 (talk) 14:16, 16 November 2014 (UTC)

Proposed merge with Cancer screening
Better handled under a single page, both pages miss valuable information that the other covers. Carl Fredrik talk 16:16, 10 March 2018 (UTC)
 * Oppose Cancer screening is a subset of screening generally and I do not have a problem with it being a separate subpage. Doc James  (talk · contribs · email) 18:11, 12 March 2018 (UTC)
 * Oppose I fail to see how a merge could work. Cancer screening has so much content that moving it here would be WP:UNDUE for discussion about the general concept. Both screening articles have quality problems and could use development. I am open to considering any plans for addressing the major problems, including merge, but I feel that a hasty merge would not be a certain improvement.  Blue Rasberry   (talk)  18:15, 12 March 2018 (UTC)
 * Strong oppose Both articles are lengthy and have hardly any content overlap. Merging would be incredibly destructive. Mvolz (talk) 12:10, 10 June 2018 (UTC)

Comments
It's not much that I don't think there can be two independent articles, as much as it is that in the current state they would be better served as a single article. The responses don't seem to adress this. Carl Fredrik talk 07:21, 21 March 2018 (UTC)

Add a section about mental health screening in schools
I am hoping to add a section about psychosocial assessments in youth behavioural health. For instance, the digital HEADSS assessment is being used in schools and clinics to help screen for mental health issues in youth and direct them to the counseling services they need. It is also validated by studies: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733175. Can we publish this?

School-based screening

Some schools in the U.S. have already introduced universal mental health screening programs for their students. For instance, schools in King County, Washington are screening youth behavioural health using the Check Yourself tool by Seattle Children’s Hospital. This tool offers a questionnaire for King County schools to measure, understand, and nurture individual students’ well-being by collecting information about lifestyle, behaviour, and social determinants of health. It also identifies at-risk youth and alerts school staff so they can direct students to the services they need. Hence, universal mental health screening programs are enabling schools to take a preventative approach to mental health issues.

Paprika 21:40, 26 July 2019 (UTC)

Theranos
Like most people, I have been following the Theranos trial and have just realised that it was a multi-phasic screening programme marketed directly to the public through pharmacies. The TV reports do not make that clear, but from what I can make out not all of the elements of a good screening programme were present, particularly quality control. I have seen no mention of arrangements for follow up, which would be difficult in the US health care system. It would be good if someone could examine the evidence at the conclusion of the trial and let us know how well Theranos performed as a component of health screening. NRPanikker (talk) 22:16, 20 November 2021 (UTC)