PRINCIPLES AND PRACTICE OF SCREENING FOR …

PUBLIC HEALTH PAPERS No. 34

PRINCIPLES AND PRACTICE OF SCREENING FOR DISEASE

PRINCIPLES AND PRACTICE OF SCREENING FOR DISEASE

J. M. G. WILSON

Principal Medical Oflcer, Ministry of Health, London, England

G . JUNGNER

Chief, Clinical Chemistry Department, Sahlgren's Hospital, Gothenburg, Sweden

WORLD HEALTH ORGANIZATION

GENEVA

1968

6 World Health Organization 1968

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CONTENTS

Page

Preface . . . . . . . . . . . . . . . . . . 7 Introduction . . . . . . . . . . . . . . . 9 1. Definitions . . . . . . . . . . . . . . 11 2. Principles . . . . . . . . . . . . . . . 14 3. Practice . . . . . . . . . . . . . . . 40 4. Illustrative examples of screening for disease 78 5. Methodological trends in screening . . . . 134 6. Conclusions . . . . . . . . . . . . . . 146 References . . . . . . . . . . . . . . . . 151

PREFACE

The object of screeningfor disease is to discover those among the appar-

ently well who are infact sufering from disease. They can then beplaced

under treatment and, if the disease is communicable, steps can be taken

to prevent them from being a danger to their neighbours. In theory,

therefore, screening is an admirable method of combating disease, since

it should he@ detect it in its early stages and enable it to be treated ade-

quately before it obtains a firm hold on the community.

In practice, there are snags. In developing countries there is as a rule

such a vast burden of overt disease that the medical services are over-

whelmingly occupied with tlze treatment of patients coming to them with

often advanced stages of comnzunicable disease. With so much curative

work to do, they have little time, let alone resources in manpower and

money, to spend on looking for disease in its incipient stages, and their

preventive work consists largely of attempting to improve environmental

conditions.

In the developed countries, the communicable diseases have become

less important as killers than chronic diseases, often of insidious onset,

such as cancer and the cardiovascular diseases. The developed countries

have much greater resources than the developing countries, and can call on

more qualijied staf. And the diseases that have now come to thefore are

of such a nature that, fi detected early, they stand a reasonable chance

of being cured, whereas if not diagnosed until tlze patients come to the

doctor with clear-cut symptoms they

be incurable. In developed

countries, therefore, it would seem that the practice of screening for

disease should be widespread. That it is not so to the extent that might

be expected is due to a number offactors, among them the cost of screening

and the tendency in the medicalprofession to wait for patients rather than

actively to lookfor disease in thepopulation. Another factor undoubtedly is

inadequate knowledge of theprinciples andpractice of screeningfor disease.

This book attempts to set out the principles and practice of screening

for disease in a clear and simple way. It was commissioned by W H O

from its authors because screeningfor disease is now a subject of growing importance in developed countries, as is evidenced by the controversies over, for example, cytological testing for cancer of the uterine cervix or regular medical check-ups of key executive personnel. The book is concerned mostly with the chronic diseases of adults in developed countries. As communicable disease comes under control in the developing countries, however, the chronic diseases that occupy the limelight in the developed countries may be expected to increase in importance in them; in some of the developing countries this trend has already become apparent. It may therefore conj5dently be expected that screeningfor disease will grow in importance with time. Some knowledge of its principles and of what it entails in practice should form part of the intellectual equipment of all concerned with the control of disease and the maintenance of health.

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