Screening (medicine)

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A coal miner completes a screening survey for coalworker's pneumoconiosis. Colorado Coal Miner waiting on black lung screening (9256404966).jpg
A coal miner completes a screening survey for coalworker's pneumoconiosis.

Screening, in medicine, is a strategy used to look for as-yet-unrecognised conditions or risk markers. [1] [2] [3] This testing can be applied to individuals or to a whole population without symptoms or signs of the disease being screened.

Contents

Screening interventions are designed to identify conditions which could at some future point turn into disease, thus enabling earlier intervention and management in the hope to reduce mortality and suffering from a disease. Although screening may lead to an earlier diagnosis, not all screening tests have been shown to benefit the person being screened; overdiagnosis, misdiagnosis, and creating a false sense of security are some potential adverse effects of screening. Additionally, some screening tests can be inappropriately overused. [4] [5] For these reasons, a test used in a screening program, especially for a disease with low incidence, must have good sensitivity in addition to acceptable specificity. [6]

Several types of screening exist: universal screening involves screening of all individuals in a certain category (for example, all children of a certain age). Case finding involves screening a smaller group of people based on the presence of risk factors (for example, because a family member has been diagnosed with a hereditary disease). Screening interventions are not designed to be diagnostic, and often have significant rates of both false positive and false negative results.

Frequently updated recommendations for screening are provided by the independent panel of experts, the United States Preventive Services Task Force. [7]

Principles

In 1968, the World Health Organization published guidelines on the Principles and practice of screening for disease, which is often referred to as the Wilson and Jungner criteria. [8] The principles are still broadly applicable today:

  1. The condition should be an important health problem.
  2. There should be a treatment for the condition.
  3. Facilities for diagnosis and treatment should be available.
  4. There should be a latent stage of the disease.
  5. There should be a test or examination for the condition.
  6. The test should be acceptable to the population.
  7. The natural history of the disease should be adequately understood.
  8. There should be an agreed policy on whom to treat.
  9. The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole.
  10. Case-finding should be a continuous process, not just a "once and for all" project.

In 2008, with the emergence of new genomic technologies, the WHO synthesised and modified these with the new understanding as follows:

Synthesis of emerging screening criteria proposed over the past 40 years

In summation, "when it comes to the allocation of scarce resources, economic considerations must be considered alongside 'notions of justice, equity, personal freedom, political feasibility, and the constraints of current law'." [9]

Types

A mobile clinic used to screen coal miners at risk of black lung disease NIOSH Mobile Health Screenings (16027817612).jpg
A mobile clinic used to screen coal miners at risk of black lung disease

Examples

Common programs

In many countries there are population-based screening programmes. In some countries, such as the UK, policy is made nationally and programmes are delivered nationwide to uniform quality standards. Common screening programmes include:[ citation needed ]

School-based

Most public school systems in the United States screen students periodically for hearing and vision deficiencies and dental problems. Screening for spinal and posture issues such as scoliosis is sometimes carried out, but is controversial as scoliosis (unlike vision or dental issues) is found in only a very small segment of the general population and because students must remove their shirts for screening. Many states no longer mandate scoliosis screenings, or allow them to be waived with parental notification. There are currently bills being introduced in various U.S. states to mandate mental health screenings for students attending public schools in hopes to prevent self-harm as well as the harming of peers. Those proposing these bills hope to diagnose and treat mental illnesses such as depression and anxiety. [ citation needed ]

Screening for social determinants of health

The social determinants of health are the economic and social conditions that influence individual and group differences in health status. [12] Those conditions may have adverse effects on their health and well-being. To mitigate those adverse effects, certain health policies like the United States Affordable Care Act (2010) gave increased traction to preventive programs, such as those that routinely screen for social determinants of health. [13] Screening is believed to a valuable tool in identifying patients' basic needs in a social determinants of health framework so that they can be better served. [14] [15]

Policy background in the United States

When established in the United States, the Affordable Care Act was able to bridge the gap between community-based health and healthcare as a medical treatment, leading to programs that screened for social determinants of health. [13] The Affordable Care Act established several services with an eye for social determinants or an openness to more diverse clientele, such as Community Transformation Grants, which were delegated to the community in order to establish "preventive community health activities" and "address health disparities". [16]

Clinical programs

Social determinants of health include social status, gender, ethnicity, economic status, education level, access to services, education, immigrant status, upbringing, and much, much more. [17] [18] Several clinics across the United States have employed a system in which they screen patients for certain risk factors related to social determinants of health. [19] In such cases, it is done as a preventive measure in order to mitigate any detrimental effects of prolonged exposure to certain risk factors, or to simply begin remedying the adverse effects already faced by certain individuals. [15] [20] They can be structured in different ways, for example, online or in person, and yield different outcomes based on the patient's responses. [15] Some programs, like the FIND Desk at UCSF Benioff Children's Hospital, employ screening for social determinants of health in order to connect their patients with social services and community resources that may provide patients greater autonomy and mobility. [21]

Medical equipment used

Medical equipment used in screening tests is usually different from equipment used in diagnostic tests as screening tests are used to indicate the likely presence or absence of a disease or condition in people not presenting symptoms; while diagnostic medical equipment is used to make quantitative physiological measurements to confirm and determine the progress of a suspected disease or condition. Medical screening equipment must be capable of fast processing of many cases, but may not need to be as precise as diagnostic equipment.[ citation needed ]

Limitations

Screening can detect medical conditions at an early stage before symptoms present while treatment is more effective than for later detection. [22] In the best of cases lives are saved. Like any medical test, the tests used in screening are not perfect. The test result may incorrectly show positive for those without disease (false positive), or negative for people who have the condition (false negative). Limitations of screening programmes can include:

Screening for dementia in the English NHS is controversial because it could cause undue anxiety in patients and support services would be stretched. A GP reported "The main issue really seems to be centred around what the consequences of a such a diagnosis is and what is actually available to help patients." [23]

Analysis

To many people, screening instinctively seems like an appropriate thing to do, because catching something earlier seems better. However, no screening test is perfect. There will always be the problems with incorrect results and other issues listed above. It is an ethical requirement for balanced and accurate information to be given to participants at the point when screening is offered, in order that they can make a fully informed choice about whether or not to accept.[ citation needed ]

Before a screening program is implemented, it should be looked at to ensure that putting it in place would do more good than harm. The best studies for assessing whether a screening test will increase a population's health are rigorous randomized controlled trials.When studying a screening program using case-control or, more usually, cohort studies, various factors can cause the screening test to appear more successful than it really is. A number of different biases, inherent in the study method, will skew results.[ citation needed ]

Overdiagnosis

Screening may identify abnormalities that would never cause a problem in a person's lifetime. An example of this is prostate cancer screening; it has been said that "more men die with prostate cancer than of it". [24] Autopsy studies have shown that between 14 and 77% of elderly men who have died of other causes are found to have had prostate cancer. [25]

Aside from issues with unnecessary treatment (prostate cancer treatment is by no means without risk), overdiagnosis makes a study look good at picking up abnormalities, even though they are sometimes harmless.[ citation needed ]

Overdiagnosis occurs when all of these people with harmless abnormalities are counted as "lives saved" by the screening, rather than as "healthy people needlessly harmed by overdiagnosis". So it might lead to an endless cycle: the greater the overdiagnosis, the more people will think screening is more effective than it is, which can reinforce people to do more screening tests, leading to even more overdiagnosis. [26] Raffle, Mackie and Gray call this the popularity paradox of screening: "The greater the harm through overdiagnosis and overtreatment from screening, the more people there are who believe they owe their health, or even their life, to the programme"(p56 Box 3.4) [27]

The screening for neuroblastoma, the most common malignant solid tumor in children, in Japan is a very good example of why a screening program must be evaluated rigorously before it is implemented. In 1981, Japan started a program of screening for neuroblastoma by measuring homovanillic acid and vanilmandelic acid in urine samples of six-month-old infants. In 2003, a special committee was organized to evaluate the motivation for the neuroblastoma screening program. In the same year, the committee concluded that there was sufficient evidence that screening method used in the time led to overdiagnosis, but there was no enough evidence that the program reduced neuroblastoma deaths. As such, the committee recommended against screening and the Ministry of Health, Labor and Welfare decided to stop the screening program. [28]

Another example of overdiagnosis happened with thyroid cancer: its incidence tripled in United States between 1975 and 2009, while mortality was constant. [29] In South Korea, the situation was even worse with 15-fold increase in the incidence from 1993 to 2011 (the world's greatest increase of thyroid cancer incidence), while the mortality remained stable. [30] The increase in incidence was associated with the introduction of ultrasonography screening. [31]

The problem of overdiagnosis in cancer screening is that at the time of diagnosis it not possible to differentiate between a harmless lesion and lethal one, unless the patient is not treated and dies from other causes. [32] So almost all patients tend to be treated, leading to what is called overtreatment. As researchers Welch and Black put it, "Overdiagnosis—along with the subsequent unneeded treatment with its attendant risks—is arguably the most important harm associated with early cancer detection." [32]

Lead time bias

Lead time bias leads to longer perceived survival with screening, even if the course of the disease is not altered Lead time bias.svg
Lead time bias leads to longer perceived survival with screening, even if the course of the disease is not altered

If screening works, it must diagnose the target disease earlier than it would be without screening (when symptoms appear). Even if in both cases (with screening vs without screening) patients die at the same time, just because the disease was diagnosed earlier by screening, the survival time since diagnosis is longer in screened people than in persons who was not screened. This happens even when life span has not been prolonged. As the diagnosis was made earlier without life being prolonged, the patient might be more anxious as he must live with knowledge of his diagnosis for longer.[ citation needed ]

If screening works, it must introduce a lead time. So statistics of survival time since diagnosis tends to increase with screening because of the lead time introduced, even when screening offers no benefits. If we do not think about what survival time actually means in this context, we might attribute success to a screening test that does nothing but advance diagnosis. As survival statistics suffers from this and other biases, comparing the disease mortality (or even all-cause mortality) between screened and unscreened population gives more meaningful information.[ citation needed ]

Length time bias

Length time bias leads to better perceived survival with screening, even if the course of the disease is not altered. Length time bias.svg
Length time bias leads to better perceived survival with screening, even if the course of the disease is not altered.

Many screening tests involve the detection of cancers. Screening is more likely to detect slower-growing tumors (due to longer pre-clinical sojourn time) that are less likely to cause harm. Also, those aggressive cancers tend to produce symptoms in the gap between scheduled screening, being less likely to be detected by screening. [33] So, the cases screening often detects automatically have better prognosis than symptomatic cases. The consequence is those more slow progressive cases are now classified as cancers, which increases the incidence, and due to its better prognosis, the survival rates of screened people will be better than non-screened people even if screening makes no difference.[ citation needed ]

Selection bias

Not everyone will partake in a screening program. There are factors that differ between those willing to get tested and those who are not.[ citation needed ]

If people with a higher risk of a disease are more likely to be screened, for instance women with a family history of breast cancer are more likely than other women to join a mammography program, then a screening test will look worse than it really is: negative outcomes among the screened population will be higher than for a random sample.[ citation needed ]

Selection bias may also make a test look better than it really is. If a test is more available to young and healthy people (for instance if people have to travel a long distance to get checked) then fewer people in the screening population will have negative outcomes than for a random sample, and the test will seem to make a positive difference.[ citation needed ]

Studies have shown that people who attend screening tend to be healthier than those who do not. This has been called the healthy screenee effect, [27] which is a form of selection bias. The reason seems to be that people who are healthy, affluent, physically fit, non-smokers with long-lived parents are more likely to come and get screened than those on low-income, who have existing health and social problems. [27] One example of selection bias occurred in Edinbourg trial of mammography screening, which used cluster randomisation. The trial found reduced cardiovascular mortality in those who were screened for breast cancer. That happened because baseline differences regarding socio-economic status in the groups: 26% of the women in the control group and 53% in the study group belonged to the highest socioeconomic level. [34]

Study Design for the Research of Screening Programs

The best way to minimize selection bias is to use a randomized controlled trial, though observational, naturalistic, or retrospective studies can be of some value and are typically easier to conduct. Any study must be sufficiently large (include many patients) and sufficiently long (follow patients for many years) to have the statistical power to assess the true value of a screening program. For rare diseases, hundreds of thousands of patients may be needed to realize the value of screening (find enough treatable disease), and to assess the effect of the screening program on mortality a study may have to follow the cohort for decades. Such studies take a long time and are expensive, but can provide the most useful data with which to evaluate the screening program and practice evidence-based medicine.[ citation needed ]

All-cause mortality vs disease-specific mortality

The main outcome of cancer screening studies is usually the number of deaths caused by the disease being screened for - this is called disease-specific mortality. To give an example: in trials of mammography screening for breast cancer, the main outcome reported is often breast cancer mortality. However, disease-specific mortality might be biased in favor of screening. In the example of breast cancer screening, women overdiagnosed with breast cancer might receive radiotherapy, which increases mortality due to lung cancer and heart disease. [35] The problem is those deaths are often classified as other causes and might even be larger than the number of breast cancer deaths avoided by screening. So the non-biased outcome is all-cause mortality. The problem is that much larger trials are needed to detect a significant reduction in all-cause mortality. In 2016, researcher Vinay Prasad and colleagues published an article in BMJ titled "Why cancer screening has never been shown to save lives", as cancer screening trials did not show all-cause mortality reduction. [36]

See also

Related Research Articles

<span class="mw-page-title-main">Cervical cancer</span> Cancer arising from the cervix

Cervical cancer is a cancer arising from the cervix or in the any layer of the wall of the cervix. It is due to the abnormal growth of cells that have the ability to invade or spread to other parts of the body. Early on, typically no symptoms are seen. Later symptoms may include abnormal vaginal bleeding, pelvic pain or pain during sexual intercourse. While bleeding after sex may not be serious, it may also indicate the presence of cervical cancer.

<span class="mw-page-title-main">Breast cancer</span> Cancer that originates in mammary glands

Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a red or scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.

<span class="mw-page-title-main">Mammography</span> Process of using low-energy X-rays to examine the human breast for diagnosis and screening

Mammography is the process of using low-energy X-rays to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses or microcalcifications.

<span class="mw-page-title-main">Physical examination</span> Process by which a medical professional investigates the body of a patient for signs of disease

In a physical examination, medical examination, clinical examination, or medical checkup, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the patient's medical history followed by an examination based on the reported symptoms. Together, the medical history and the physical examination help to determine a diagnosis and devise the treatment plan. These data then become part of the medical record.

Overdiagnosis is the diagnosis of disease that will never cause symptoms or death during a patient's ordinarily expected lifetime and thus presents no practical threat regardless of being pathologic. Overdiagnosis is a side effect of screening for early forms of disease. Although screening saves lives in some cases, in others it may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Given the tremendous variability that is normal in biology, it is inherent that the more one screens, the more incidental findings will generally be found. For a large percentage of them, the most appropriate medical response is to recognize them as something that does not require intervention; but determining which action a particular finding warrants can be very difficult, whether because the differential diagnosis is uncertain or because the risk ratio is uncertain.

Prostate cancer screening is the screening process used to detect undiagnosed prostate cancer in men without signs or symptoms. When abnormal prostate tissue or cancer is found early, it may be easier to treat and cure, but it is unclear if early detection reduces mortality rates.

Ductal carcinoma <i>in situ</i> Pre-cancerous breast lesion

Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast. DCIS is classified as Stage 0. It rarely produces symptoms or a breast lump that can be felt, typically being detected through screening mammography. It has been diagnosed in a significant percentage of men.

Predictive medicine is a field of medicine that entails predicting the probability of disease and instituting preventive measures in order to either prevent the disease altogether or significantly decrease its impact upon the patient.

<span class="mw-page-title-main">Fibrocystic breast changes</span> Medical condition

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<span class="mw-page-title-main">Lung cancer screening</span>

Lung cancer screening refers to cancer screening strategies used to identify early lung cancers before they cause symptoms, at a point where they are more likely to be curable. Lung cancer screening is critically important because of the incidence and prevalence of lung cancer. More than 235,000 new cases of lung cancer are expected in the United States in 2021 with approximately 130,000 deaths expected in 2021. In addition, at the time of diagnosis, 57% of lung cancers are discovered in advanced stages, meaning they are more widespread or aggressive cancers. Because there is a substantially higher probability of long-term survival following treatment of localized (60%) versus advanced stage (6%) lung cancer, lung cancer screening aims to diagnose the disease in the localized stage.

<span class="mw-page-title-main">Breast cancer screening</span> Medical screening of asymptomatic, healthy women for breast cancer

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<span class="mw-page-title-main">Epidemiology of cancer</span> The study of factors in cancer causes and treatments

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<span class="mw-page-title-main">Cancer screening</span> Method to detect cancer

The objective of cancer screening is to detect cancer before symptoms appear, involving various methods such as blood tests, urine tests, DNA tests, and medical imaging. The purpose of screening is early cancer detection, to make the cancer easier to treat and extending life expectancy. In 2019, cancer was the second leading cause of death globally; more recent data is pending due to the COVID-19 pandemic.

<span class="mw-page-title-main">Breast cancer awareness</span>

Breast cancer awareness is an effort to raise awareness and reduce the stigma of breast cancer through education about screening, symptoms, and treatment. Supporters hope that greater knowledge will lead to earlier detection of breast cancer, which is associated with higher long-term survival rates, and that money raised for breast cancer will produce a reliable, permanent cure.

<span class="mw-page-title-main">Cervical screening</span> Type of medical screening

Cervical cancer screening is a medical screening test designed to identify risk of cervical cancer. Cervical screening may involve looking for viral DNA, and/or to identify abnormal, potentially precancerous cells within the cervix as well as cells that have progressed to early stages of cervical cancer. One goal of cervical screening is to allow for intervention and treatment so abnormal lesions can be removed prior to progression to cancer. An additional goal is to decrease mortality from cervical cancer by identifying cancerous lesions in their early stages and providing treatment prior to progression to more invasive disease.

Dynamic angiothermography (DATG) is a technique for the diagnosis of breast cancer. This technique, though springing from the previous conception of thermography, is based on a completely different principle. DATG records the temperature variations linked to the vascular changes in the breast due to angiogenesis. The presence, change, and growth of tumors and lesions in breast tissue change the vascular network in the breast. Consequently, through measuring the vascular structure over time, DATG effectively monitors the change in breast tissue due to tumors and lesions. It is currently used in combination with other techniques for diagnosis of breast cancer. This diagnostic method is a low-cost one compared with other techniques.

Overscreening, also called unnecessary screening, is the performance of medical screening without a medical indication to do so. Screening is a medical test in a healthy person who is showing no symptoms of a disease and is intended to detect a disease so that a person may prepare to respond to it. Screening is indicated in people who have some threshold risk for getting a disease, but is not indicated in people who are unlikely to develop a disease. Overscreening is a type of unnecessary health care.

Cancer prevention is the practice of taking active measures to decrease the incidence of cancer and mortality. The practice of prevention is dependent upon both individual efforts to improve lifestyle and seek preventive screening, and socioeconomic or public policy related to cancer prevention. Globalized cancer prevention is regarded as a critical objective due to its applicability to large populations, reducing long term effects of cancer by promoting proactive health practices and behaviors, and its perceived cost-effectiveness and viability for all socioeconomic classes.

<span class="mw-page-title-main">H. Gilbert Welch</span> American doctor

H. Gilbert Welch is an American academic physician and cancer researcher. He was an internist at the Veterans Administration Medical Center in White River Junction, Vermont, as well as a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. In September 2018, Welch resigned from Dartmouth College after a 20-month long research misconduct investigation at Dartmouth concluded he had committed plagiarism.

The passing of the Cancer Act 1939 marked the political significance of cancer treatment. It envisaged a system of co-ordination of diagnosis and treatment under the control of County Councils and County Borough Councils which preceded the establishment of the National Health Service (NHS). The outbreak of war prevented most of its provisions from coming into effect.

References

  1. ↑ "To Screen or Not to Screen? - The Benefits and Harms of Screening Tests". NIH News in Health. National Institutes of Health. March 2017. Archived from the original on 22 December 2017. Retrieved 12 January 2020. Screening tests are given to people who seem healthy to try to find unnoticed problems. They're done before you have any signs or symptoms of the disease.
  2. ↑ O'Toole, Marie T., ed. (2013). Mosby's medical dictionary (9th ed.). St. Louis, Mo.: Elsevier/Mosby. Kindle loc. 145535. ISBN   978-0-323-08541-0. OCLC   788298656. screening, n., 1. a preliminary procedure, such as a test or examination, to detect the most characteristic sign or signs of a disorder that may require further investigation.
  3. ↑ "screening, n." . Oxford English Dictionary. March 2017. Archived from the original on 11 June 2017. Retrieved 12 January 2020. ... 8. a. Medical examination of a person or group to detect disease or abnormality, esp. as part of a broad survey rather than as a response to a request for treatment.
  4. ↑ O'Sullivan, Jack W; Albasri, Ali; Nicholson, Brian D; Perera, Rafael; Aronson, Jeffrey K; Roberts, Nia; Heneghan, Carl (11 February 2018). "Overtesting and undertesting in primary care: a systematic review and meta-analysis". BMJ Open. 8 (2): e018557. doi:10.1136/bmjopen-2017-018557. PMC   5829845 . PMID   29440142.
  5. ↑ O'Sullivan, Jack W.; Heneghan, Carl; Perera, Rafael; Oke, Jason; Aronson, Jeffrey K.; Shine, Brian; Goldacre, Ben (19 March 2018). "Variation in diagnostic test requests and outcomes: a preliminary metric for OpenPathology.net". Scientific Reports. 8 (1): 4752. Bibcode:2018NatSR...8.4752O. doi:10.1038/s41598-018-23263-z. PMC   5859290 . PMID   29556075.
  6. ↑ Screening and Diagnostic Tests at eMedicine
  7. ↑ Hall, Harriet (2019). "Too Many Medical Tests". Skeptical Inquirer . 43 (3): 25–27.
  8. ↑ Wilson, JMG; Jungner, G (1968). "Principles and practice of screening for disease" (PDF). WHO Chronicle. 22 (11): 281–393. PMID   4234760. Archived (PDF) from the original on 2016-04-17. Retrieved 2016-01-01Public Health Papers, #34.{{cite journal}}: CS1 maint: postscript (link)
  9. ↑ Anne Andermann, Ingeborg Blancquaert, Sylvie Beauchamp, Véronique Déry Revisiting Wilson and Jungner in the genomic age: a review of screening criteria over the past 40 years: Bulletin of the World Health Organization; 2008 Volume 86, Number 4, April 2008, 241-320
  10. ↑ Wald, N J; Hackshaw, A K; Frost, C D (1999). "When can a risk factor be used as a worthwhile screening test?". BMJ. 319 (7224): 1562–1565. doi:10.1136/bmj.319.7224.1562. ISSN   0959-8138. PMC   1117271 . PMID   10591726.
  11. ↑ AlGhalyini, Baraa; Shakir, Ismail; Wahed, Muaz; Babar, Sultan; Mohamed, Mohamed (30 June 2022). "Does SARI Score Predict COVID-19 Positivity? A Retrospective Analysis of Emergency Department Patients in a Tertiary Hospital" (PDF). Journal of Health and Allied Sciences. 13: 077–082. doi:10.1055/s-0042-1748806. S2CID   250189262. Archived (PDF) from the original on 4 July 2022. Retrieved 1 July 2022.
  12. ↑ Braveman, P. and Gottlieb, L., 2014. The social determinants of health: it's time to consider the causes of the causes. Public health reports, 129(1_suppl2), pp.19-31.
  13. 1 2 Heiman, Harry J., and Samantha Artiga. "Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity." Health 20.10 (2015): 1-10.
  14. ↑ Shekarchi, Amy, et al. "Social Determinant of Health Screening in a Safety Net Pediatric Primary Care Clinic." American Academy of Pediatrics, American Academy of Pediatrics, 1 May 2018, pediatrics.aappublications.org/content/142/1_MeetingAbstract/748.
  15. 1 2 3 Gottlieb, Laura; Hessler, Danielle; Long, Dayna; Amaya, Anais; Adler, Nancy (December 2014). "A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study". Pediatrics. 134 (6): e1611–e1618. doi:10.1542/peds.2014-1439. ISSN   0031-4005. PMID   25367545. S2CID   18189510.
  16. ↑ HHS action plan to reduce racial and ethnic health disparities : a nation free of disparities in health and health care. OCLC   872276544.
  17. ↑ Dasgupta, Rajib (2009). Cook, Harold J.; Bhattacharya, Sanjoy; Hardy, Anne (eds.). "Making Sense of Social Determinants". Economic and Political Weekly. 44 (23): 30–32. ISSN   0012-9976. JSTOR   40279083.
  18. ↑ Singh, Gopal; Daus, Gem; Allender, Michelle; Ramey, Christine; Martin, Elijah; Perry, Chrisp; Reyes, Andrew; Vedamuthu, Ivy (2017). "Social Determinants of Health in the United States: Addressing Major Health Inequality Trends for the Nation, 1935-2016". International Journal of Maternal and Child Health and AIDS. 6 (2): 139–164. doi: 10.21106/ijma.236 . ISSN   2161-8674. PMC   5777389 . PMID   29367890.
  19. ↑ Billioux, Alexander; Verlander, Katherine; Anthony, Susan; Alley, Dawn (2017-05-30). "Standardized Screening for Health-Related Social Needs in Clinical Settings: The Accountable Health Communities Screening Tool". NAM Perspectives. 7 (5). doi:10.31478/201705b. ISSN   2578-6865.
  20. ↑ Foy, Jane Meschan (June 2010). "Enhancing Pediatric Mental Health Care: Algorithms for Primary Care". Pediatrics. 125 (Supplement 3): S109–S125. doi: 10.1542/peds.2010-0788f . ISSN   0031-4005. PMID   20519563.
  21. ↑ "UCSF Benioff Children's Hospital Oakland". UCSF Benioff Children's Hospital Oakland. Archived from the original on 2013-07-28. Retrieved 2020-04-29.
  22. ↑ "Benefits and risks of screening tests". InformedHealth.org. Institute for Quality and Efficiency in Health Care (IQWiG). 2006. Archived from the original on 2021-01-20. Retrieved 2020-09-23.
  23. ↑ "GPs hit by widespread complaints from patients 'unhappy' over dementia screening". Pulse. 22 November 2013. Archived from the original on 18 February 2017. Retrieved 22 November 2013.
  24. ↑ The Complete Book of Men's Health. Men's Health Books. Rodale Books. 2000. ISBN   9781579542986.[ page needed ]
  25. ↑ Sandhu GS, Adriole GL. Overdiagnosis of prostate cancer. Journal of the National Cancer Institute Monographs 2012 (45): 146–151.
  26. ↑ Brodersen, John; Kramer, Barnett S; Macdonald, Helen; Schwartz, Lisa M; Woloshin, Steven (17 August 2018). "Focusing on overdiagnosis as a driver of too much medicine". BMJ. 362: k3494. doi:10.1136/bmj.k3494. PMID   30120097. S2CID   52033494.
  27. 1 2 3 Raffle AE, Mackie A, Gray JAM. Screening: Evidence and Practice.2nd edition Oxford University Press. 2019
  28. ↑ Tsubono, Yoshitaka; Hisamichi, Shigeru (6 May 2004). "A Halt to Neuroblastoma Screening in Japan". New England Journal of Medicine. 350 (19): 2010–2011. doi: 10.1056/NEJM200405063501922 . PMID   15128908.
  29. ↑ Esserman, Laura J; Thompson, Ian M; Reid, Brian; Nelson, Peter; Ransohoff, David F; Welch, H Gilbert; Hwang, Shelley; Berry, Donald A; Kinzler, Kenneth W; Black, William C; Bissell, Mina; Parnes, Howard; Srivastava, Sudhir (May 2014). "Addressing overdiagnosis and overtreatment in cancer: a prescription for change". The Lancet Oncology. 15 (6): e234–e242. doi:10.1016/S1470-2045(13)70598-9. PMC   4322920 . PMID   24807866.
  30. ↑ Ahn, Hyeong Sik; Kim, Hyun Jung; Welch, H. Gilbert (6 November 2014). "Korea's Thyroid-Cancer "Epidemic" — Screening and Overdiagnosis". New England Journal of Medicine. 371 (19): 1765–1767. doi:10.1056/NEJMp1409841. PMID   25372084.
  31. ↑ Ahn, Hyeong Sik; Kim, Hyun Jung; Kim, Kyoung Hoon; Lee, Young Sung; Han, Seung Jin; Kim, Yuri; Ko, Min Ji; Brito, Juan P. (November 2016). "Thyroid Cancer Screening in South Korea Increases Detection of Papillary Cancers with No Impact on Other Subtypes or Thyroid Cancer Mortality". Thyroid. 26 (11): 1535–1540. doi:10.1089/thy.2016.0075. PMID   27627550.
  32. 1 2 Welch, H. G.; Black, W. C. (2010). "Overdiagnosis in Cancer". JNCI Journal of the National Cancer Institute. 102 (9): 605–613. doi: 10.1093/jnci/djq099 . PMID   20413742.
  33. ↑ Carter, Stacy; Barratt, Alexandra (2017). "What is overdiagnosis and why should we take it seriously in cancer screening?". Public Health Research & Practice. 27 (3). doi: 10.17061/phrp2731722 . hdl: 2123/17022 . PMID   28765855.
  34. ↑ Gøtzsche, P.C.; Jørgensen, K. J. (2013). "Screening for breast cancer with mammography". Cochrane Database of Systematic Reviews. 2013 (6): CD001877. doi:10.1002/14651858.CD001877.pub5. PMC   6464778 . PMID   23737396.
  35. ↑ Gøtzsche, P.C., Commentary: Screening: A seductive paradigm that has generally failed us., 2015, International Journal of Epidemiology, 244(1): 278-280 DOI, Archived 2019-01-29 at the Wayback Machine
  36. ↑ Prasad V., Lenzer J., Newman D.H., Why cancer screening has never been shown to "save lives"--and what we can do about it. British Medical Journal 2016; 352:h6080 DOI

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