Screening Tests: a Review with Examples

Overview

Journal Inhal Toxicol

Publisher Informa Healthcare

Specialty Toxicology

Date 2014 Sep 30

PMID 25264934

Citations 171

Authors

L Daniel Maxim

Ron Niebo

Mark J Utell

Affiliations

Soon will be listed here.

Abstract

Screening tests are widely used in medicine to assess the likelihood that members of a defined population have a particular disease. This article presents an overview of such tests including the definitions of key technical (sensitivity and specificity) and population characteristics necessary to assess the benefits and limitations of such tests. Several examples are used to illustrate calculations, including the characteristics of low dose computed tomography as a lung cancer screen, choice of an optimal PSA cutoff and selection of the population to undergo mammography. The importance of careful consideration of the consequences of both false positives and negatives is highlighted. Receiver operating characteristic curves are explained as is the need to carefully select the population group to be tested.

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References

Hawkins D, Garrett J, Stephenson B . Some issues in resolution of diagnostic tests using an imperfect gold standard. Stat Med. 2001; 20(13):1987-2001. DOI: 10.1002/sim.819. View

Swensen S, Jett J, Sloan J, Midthun D, Hartman T, Sykes A . Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med. 2002; 165(4):508-13. DOI: 10.1164/ajrccm.165.4.2107006. View

Manrai A, Bhatia G, Strymish J, Kohane I, Jain S . Medicine's uncomfortable relationship with math: calculating positive predictive value. JAMA Intern Med. 2014; 174(6):991-3. PMC: 4955674. DOI: 10.1001/jamainternmed.2014.1059. View

Shumway-Cook A, Brauer S, Woollacott M . Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000; 80(9):896-903. View

Lam S, McWilliams A, Mayo J, Tammemagi M . Computed tomography screening for lung cancer: what is a positive screen?. Ann Intern Med. 2013; 158(4):289-90. DOI: 10.7326/0003-4819-158-4-201302190-00011. View

Schiffman M, Herrero R, Hildesheim A, Sherman M, Bratti M, Wacholder S . HPV DNA testing in cervical cancer screening: results from women in a high-risk province of Costa Rica. JAMA. 2000; 283(1):87-93. DOI: 10.1001/jama.283.1.87. View

Mayrand M, Duarte-Franco E, Rodrigues I, Walter S, Hanley J, Ferenczy A . Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007; 357(16):1579-88. DOI: 10.1056/NEJMoa071430. View

Aberle D, Adams A, Berg C, Black W, Clapp J, Fagerstrom R . Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365(5):395-409. PMC: 4356534. DOI: 10.1056/NEJMoa1102873. View

Croswell J, Baker S, Marcus P, Clapp J, Kramer B . Cumulative incidence of false-positive test results in lung cancer screening: a randomized trial. Ann Intern Med. 2010; 152(8):505-12, W176-80. DOI: 10.7326/0003-4819-152-8-201004200-00007. View

10.

van Nagell Jr J, DePriest P, Ueland F, DeSimone C, Cooper A, McDonald J . Ovarian cancer screening with annual transvaginal sonography: findings of 25,000 women screened. Cancer. 2007; 109(9):1887-96. DOI: 10.1002/cncr.22594. View

11.

Mertens L, Friedberg M . The gold standard for noninvasive imaging in congenital heart disease: echocardiography. Curr Opin Cardiol. 2009; 24(2):119-24. DOI: 10.1097/HCO.0b013e328323d86f. View

12.

Legro R, Finegood D, Dunaif A . A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1998; 83(8):2694-8. DOI: 10.1210/jcem.83.8.5054. View

13.

Bach P, Mirkin J, Oliver T, Azzoli C, Berry D, Brawley O . Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012; 307(22):2418-29. PMC: 3709596. DOI: 10.1001/jama.2012.5521. View

14.

Ng A, Garber J, Diller L, Birdwell R, Feng Y, Neuberg D . Prospective study of the efficacy of breast magnetic resonance imaging and mammographic screening in survivors of Hodgkin lymphoma. J Clin Oncol. 2013; 31(18):2282-8. DOI: 10.1200/JCO.2012.46.5732. View

15.

Li F, Sone S, Abe H, MacMahon H, Doi K . Malignant versus benign nodules at CT screening for lung cancer: comparison of thin-section CT findings. Radiology. 2004; 233(3):793-8. DOI: 10.1148/radiol.2333031018. View

16.

Elmore J, Miglioretti D, Reisch L, Barton M, Kreuter W, Christiansen C . Screening mammograms by community radiologists: variability in false-positive rates. J Natl Cancer Inst. 2002; 94(18):1373-80. PMC: 3142994. DOI: 10.1093/jnci/94.18.1373. View

17.

Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A . Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009; 10(4):327-40. DOI: 10.1016/S1470-2045(09)70026-9. View

18.

Casscells W, SCHOENBERGER A, Graboys T . Interpretation by physicians of clinical laboratory results. N Engl J Med. 1978; 299(18):999-1001. DOI: 10.1056/NEJM197811022991808. View

19.

LEVY P, KASS E . A three-population model for sequential screening for bacteriuria. Am J Epidemiol. 1970; 91(2):148-54. DOI: 10.1093/oxfordjournals.aje.a121122. View

20.

Friedewald S, Rafferty E, Rose S, Durand M, Plecha D, Greenberg J . Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014; 311(24):2499-507. DOI: 10.1001/jama.2014.6095. View