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Population Screening
Population screening, as defined by the World Health Organisation (WHO), is
presumptive identification of unrecognised disease or defects by means of tests,
examinations or other procedures that can be applied rapidly. Screening is intended
for people who do not have the symptoms of the disease, or condition being
screened and can identify a pre-disease abnormality or early disease.
The aim of screening for a disease is to reduce the burden of the disease, mortality
and morbidity in the community. Screening does not guarantee that disease will not
occur, or if it occurs, that it can be cured.
WHO Principles of early disease detection
Condition
•
The condition should be a significant health problem
•
There should be a recognisable or early symptomatic stage
•
The natural history of the condition, including development from latent to
declared disease should be adequately understood
Test
•
There should be a suitable test
•
The test should be acceptable to the population
Treatment
•
There should be accepted treatment for patients with recognised disease
Screening program
•
There should be an agreed policy on whom to treat as patients
•
Facilities for diagnosis and treatment should be available
•
The cost of case finding should be economically balanced in relation to possible
expenditure on medical care as a whole
•
Case finding should be a continuing process and not a 'once and for all' project
It is important to distinguish between population-based screening and opportunistic
case-finding.
Population-based screening is where a test of offered systematically to all individuals
in the defined target group within the framework of agreed policy, protocols, quality
management monitoring and evaluation.
Opportunistic case-finding occurs when a test is offered to an individual without
symptoms.
The Screening Process
DEFINED TARGET POPULATION
RECRUITMENT
Targeted population encouraged to
participate in screening
SCREENING
Targeted population who
particpate in screening
ASSESSMENT
Screened population who
require further
assessment
DIAGNOSIS
Assessed
participants
diagnosed with
the disease
OUTCOME
Reduce
morbidity and
mortality from
disease
SCREENING IN AUSTRALIA
Tuberculosis was the first disease for which a screening test was used from 1949
and by 1960s, community wide X-rays were introduced. By 1976, screening for
tuberculosis ceased as illness and death from the disease had been significantly
reduced.
In 1989, an evaluation of both breast and cervical cancer screening was undertaken
in Australia. In 1991, BreastScreen Australia and the National Cervical Screening
Program were introduced following recommendations from National Breast cancer
Screening Evaluation and the National Cervical Cancer Screening Evaluation. The
Bowel Cancer Screening Pilot Program was conducted from 2002-2004 and
following evaluation on acceptability and cost effectiveness, the National Bowel
Cancer Screening program was introduced in 2006.12