Community 5 Screening PDF

Screening for common diseases 82 0 SCreening for Common diSeaSeS D EF IN ITI ON O F S CR EENING  Application of relatively simple inexpensive test to large number of app...

Screening for common diseases 82 0 SCreening for Common diSeaSeS D EF IN ITI ON O F S CR EENING  Application of relatively simple inexpensive test to large number of apparently asymptomatic persons to classify them as most probably have or unlike to have the disease.  An initial examination only and positive responders require a second diagnostic examination.  ⇊ mortality by early detection and early treatment of a condition.  ⇊ incidence of a condition by identifying and treating its precursors.  ⇊ severity of a condition by identifying people with the condition and offering effective treatment.  ⇈ choice by identifying conditions or risk factors at an early stage in a life-course when more options are available. Note The aims of the screening programs should be stated in a public screening policy documented in law or an official regulation, decision or directive.  MASS SCREENING ◈ To whole population.  MULTIPLE SCREENING ◈ Use of variety of screening test in the same occasion.  TARGET SCREENING ◈ Screening for group at risk for specific disease. ◈ Relies on early detection of disease in people who present to health care providers for various complaints. OPPORTUNISTIC  ➮ Involves examining eyes of people with diabetes when opportunity SCREENING arises e.g., when they attend a diabetes clinic for treatment or an optometrist for a general check-up. Dr. Ziad Mahana 83  FAMILY MEDICINE Community - 5  In an effective screening program, the test must be… o Inexpensive. o Easy to administer. o With minimal discomfort and morbidity to the participant.  The results must be… o Reproducible. o Valid. o Able to detect the disease before its critical point. Wilson & Jungner’s principles of screening (WHO criteria)  The condition should be an important health problem.  There should be an accepted treatment for patients with recognized disease.  Facilities for diagnosis and treatment should be available.  There should be a recognizable latent or early symptomatic phase.  There should be a suitable test or examination.  The test should be acceptable to the population.  The natural history of the condition, including development from latent to declared disease, should be adequately understood.  There should be an agreed policy on whom to treat as patients.  The cost of case-finding (including a diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.  Case-finding should be a continuous process and not a “once and for all” project.  Adequate education and training.  Provided by physicians and their co-workers with skills needed for the preventive work.  The pattern of financing preventive activities.  This represents the 2nd major and operatively relevant segment where preventive activities are concerned.  Conducting preventive programs in accordance with the guidelines. Dr. Ziad Mahana 84  FAMILY MEDICINE Community - 5  Improve prognosis for some cases detected by screening.  Reassurance for those with negative test results. ADVANTAGES  Less medical treatment for some early cases.  ⇈ information on natural history of disease and benefits of treatment at early stage.  Covers only those patients visiting the GP’s office on their own initiative.  Longer morbidity in cases where prognosis is unaltered. DISADVANTAGES  False reassurance for those with false negative result.  Anxiety and sometimes morbidity for those with false positive results.  Unnecessary intervention for those with false positive results. ◈ Regarding… o The patient.  COST OF THE TEST o Time cost. o Discomfort & Anxiety. o Resources of the hearth services. ◈ Depend on… o Sensitivity of the test.  YIELD OF THE TEST o Prevalence of unrecognized cases. o Extent of previous screening. Dr. Ziad Mahana 85  FAMILY MEDICINE Community - 5 Can detect pregnancy complications & fetal anomalies.  Infectious diseases (Hepatitis B – HIV – Syphilis). ANTENATAL  Inherited conditions (Thalassemia & other hemoglobin disorders).  Fetal screening tests (Anomaly scan - Screening for spina bifida).  Down's syndrome by chorionic villus sampling (CVS) & amniocentesis.  Metabolic disorder phenylketonuria (PKU).  Congenital hypothyroidism NEWBORN  Visual & auditory screening.  Weight & height screening for early detection for delayed growth.  Cardiovascular disease.  Type 2 Diabetes mellitus. ADULT  Osteoporosis.  Hypothyroidism.  Cancer. Cholesterol screening: Performed by a blood test. ➲ People with high cholesterol measurements from a blood sample have a higher risk for cardiovascular disease (CVD), than those with cholesterol in the normal range. ➲ Studies have shown that people with high cholesterol can reduce their risk for heart disease by lowering their cholesterol.  The long preclinical phase of type 2 diabetes (DM) 10-12 years or longer provides ample opportunity for screening.  While there is good evidence that interventions in patients with impaired glucose can delay the onset of DM for 3-6 years, it is too early to know whether these interventions prevent DM ever the long term or if they have an impact on DM complications. Dr. Ziad Mahana 86  FAMILY MEDICINE Community - 5 ⚠️ RISK FACTORS: ⎚ Smoking. ⎚ Weight loss. ⎚ Family history. ⎚ Low calcium or vitamin D intake. ⎚ Sedentary lifestyle.  U.S. Preventive Services Task Force (USPSTF) recommends routinely screening… o All women > 65 years. o Women aged 60-64 years at high risk for fracture.  Other than age, the major risk factors for osteoporosis are a weight of < 70 kg (Best predictor) and no estrogen therapy.  Although it is possible to reliably detect subclinical hypothyroidism, there is poor evidence that its treatment improves health outcomes.  Furthermore, over-treatment is a potential harmful consequence of treating sub clinical disease, and the long-term effects are unknown.  No definite recommendation for thyroid screening is found. ⚠️ RISK FACTORS: ⎚ Family history. ⎚ Menstruation lasting more than 40 years, beginning before 12 years or lasting after 55 years. ⎚ Hormonal therapy. ⎚ Obesity. ⎚ Smoking. ⎚ Previous uterine cancer. ⎚ 1st pregnancy after 30, or no pregnancy. Clinical breast examination (CBE): ➲ Most major authorities recommended regular CBE for women ≥ 50 years. ➲ The American cancer society recommends CBE every 3 years for women 20-39 years and annually thereafter. Dr. Ziad Mahana 87  FAMILY MEDICINE Community - 5 Screening mammography & MRI: ➲ Screening mammography has been shown to reduce deaths from breast cancer among women ages 40-74 years, especially those ages 50-69 years. ➲ Expert groups generally recommend that screening start at age 50 for women at average risk. ➲ A breast MRI imaging test is often used for women who carry a harmful mutation in the BRCA1 gene or the BRCA2 gene; these mutations increase the risk of breast cancer, as well as other cancers. Genetic testing: ➲ The USPSTF recommended that women whose family history is associated with an increased risk for mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. Women with a BRCA1 or BRCA2 mutation have a high risk (35%-84%) of developing breast cancer by 70 years of age. Low-dose computed tomography: A type of CT scan ➲ Has been shown to reduce lung cancer deaths among heavy smokers. ➲ Expert groups generally recommend screening of some current or former heavy smokers at ages 50 to 80. ⚠️ RISK FACTORS: ⎚ Early marriage and start of sexual life. ⎚ Clinical history of infection by HPV or the presence of condyloma acuminate. ⎚ Husband having more than this wife. Human papillomavirus (HPV) tests & Pap tests: Can be used alone or in combination ➲ These tests prevent the disease because they allow abnormal cells to be found and treated before they become cancer. ➲ According to family medicine guidelines in ministry of health & population (MOHP) pap smear should be done at age 21- 65 years. ➲ Recurrent vulvovaginal candidiasis: advise screening every 3 years starting from 21 to 65 years and refer client with suspected cervix. Dr. Ziad Mahana 88  FAMILY MEDICINE Community - 5 Colonoscopy, sigmoidoscopy & stool tests (High-sensitivity fecal occult blood tests & stool DNA tests): ➲ Have been shown to reduce the risk of dying from colorectal cancer. In addition to detecting colorectal cancer early. ➲ Colonoscopy & sigmoidoscopy can help prevent the disease from developing.  That's because these tests can find abnormal colon growths (polyps) that can be removed before they become cancer. ➲ Expert groups generally recommend that people who are at average risk for colorectal cancer have screening with one of these tests at ages 45-75 years. Prostate-specific antigen (PSA): A blood test often performed along with a digital rectal exam ➲ Expert groups no longer recommend routine PSA testing for most men because… o Many prostate cancers detected with PSA testing are not deadly. o Early detection and treatment of PSA-detected cancers has not been shown to reduce the chance of dying from prostate cancer. Alpha-fetoprotein: A blood test often performed along with ultrasound of the liver ➲ To detect liver cancer early in people at high risk of the disease. Dr. Ziad Mahana 89  FAMILY MEDICINE Community - 5 CA-125 blood test: Often done together with a transvaginal ultrasound ➲ Used to try to detect ovarian cancer early, especially in women with an increased risk of the disease. ➲ Although this test can help to diagnose ovarian cancer in women who have symptoms and can be used to evaluate the recurrence of cancer in women previously diagnosed with the disease, it has not been shown to be an effective ovarian cancer screening test. Transvaginal ultrasound imaging test: ➲ Can create pictures of a woman’s ovaries & uterus, is sometimes used in women who are at increased risk of ovarian cancer (because they carry a harmful BRCA1 or BRCA2 gene mutation). Women with BRCA1 or BRCA2 mutation are at 10%-50% risk of ovarian cancer by 70 years of age and may benefit from intensive screening or prophylactic surgery. National Health Initiatives in Egypt  The national breast cancer screening program.  The National Hepatitis Campaign.  The National School screening for anemia, obesity and dwarfism among school children.  Noor hayah initiative to screen school children for decreased visual acuity and blindness.  Screening of school children for decreased hearing acuity and deafness.  Egypt’s 100 million Health’ initiative. Dr. Ziad Mahana 90