Week 8: Screening for Diseases
What might happen to cancer rates if existing screening tests were no longer used? Consider, as an example, colorectal cancer. The American Cancer Society (ACS) identifies colorectal cancer as the third most common cancer in men and women, as well as the second leading cause of cancer-related death (2011). Colorectal cancer screening tests can detect abnormal cell growth before cancer even forms, allowing for early detection, more successful treatment, and—in some cases—the prevention of cancer altogether. The ACS recommends this screening for all men and women over the age of 50 and earlier for individuals with additional risk factors. Much to the credit of screening procedures, “the death rate from colorectal cancer has been dropping for more than 20 years” (ACS, 2011).
Scientists are continually seeking to develop new screening tests that can detect diseases earlier. Screening is an essential tool for the secondary prevention of disease. It is used when the earlier detection of disease is associated with an improved outcome, as is the case with colorectal cancer. This week, you will examine the process of screening for disease, the effectiveness of different screening tests, and the controversies that surround screening programs.
Learning Objectives
Students will:
· Analyze how epidemiologic data are used to argue for or against a screening program
· Analyze how epidemiologic data can be used to formulate policy for improving population health
· Evaluate the social impact of addressing a population health problem
· Develop an evaluation plan for a health intervention
Learning Resources
Required Readings
Friis, R. H., & Sellers, T. A. (2021). Epidemiology for public health practice (6th ed.). Jones & Bartlett.
- Chapter 10, “Data Interpretation Issues”
- Chapter 11, “Screening for Disease in the Community”
Chapter 11 examines aspects of screening for disease, including characteristics of a good screening test and how screening programs can be evaluated.
Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H. (2021). Accountability for outcomes. In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
Chapter 10 describes the purpose, methodology, and measures associated with accountability for outcomes. Scientific models for improvement, and the IHI Triple Aim Framework and the Quadruple Aim are explored. The chapter discusses the expanded role of social determinants of health and the need for expanded collaboration with stakeholders.
Nash, D. B., Skoufalos, A., Fabius, R. J. & Oglesby, W. H. (2021). Changing organizational vulture In Population health: Creating a culture of wellness (3rd ed.). Jones & Bartlett Learning.
Chapter 11 introduces components of change needed for success and three successful change theories: a) Switch, b) Psychology of Change, and c) Kotter eight-step change model. Important takeaways for change leaders are explored.
Note: You will need to review the following four articles to complete this week’s Discussion:
U.S. Preventive Services Task Force. (2009). Screening for breast cancer. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/evidence-summary-screening-for-breast-cancer/breast-cancer-screening1
This is a summary of the controversial USPSTF proposal regarding screening for breast cancer using mammography and breast self-examination. It includes the recommendations, rationale, and evidence supporting the proposal.
Alvarez, G. G., Gushulak, B., Rumman, K. A., Altpeter, E., Chemtob, D., Douglas, P., … & Ellis, E. (2011). A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates. BMC Public Health, 11(3). Retrieved from http://www.biomedcentral.com/1471-2334/11/3
This article examines tuberculosis screening practices among migrants from high-incidence countries to low-incidence countries. Consider the benefits and challenges of standardizing screening requirements at the global level.
Hugosson, J., Carlsson, S., Aus, G., Bergdahl, S., Khatami, A., Lodding, P., & … Lilja, H. (2010). Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Lancet Oncology, 11(8), 725–732.
Prostate cancer screening can result in the detection of other cancers that may “never present during the patient’s lifetime (over-diagnosis) and it results in unnecessary treatments that can damage men’s quality of life (over-treatment).” However, this research study also demonstrates how prostate cancer screening also can reduces mortality rates in some instances.
Kessler, T. A. (2017). Cervical cancer: Prevention and early detection. Seminars in Oncology Nursing, 33(2), 172–183. https://doi-org.ezp.waldenulibrary.org/10.1016/j.soncn.2017.02.005
HealthMap. (2007). Retrieved from http://www.healthmap.org/en
This website tracks, maps, and describes current disease outbreaks around the world, along with sources of information about them. It provides a valuable picture of global public health issues.
Centers for Disease Control and Prevention. (2011). A framework for program evaluation. Retrieved from http://www.cdc.gov/eval/framework/index.htm
The CDC provides this framework for program evaluation. Review the information presented as you prepare for Assignment 4.
Association for Community Health Improvement. (2006). Planning, assessment, outcomes & evaluation resources. Retrieved from
https://web.archive.org/web/20130709124030/http://www.communityhlth.org/communityhlth/resources/planning.html
Explore the many resources available for program evaluation. These resources may inform Assignment 4.
Required Media
Laureate Education (Producer). (2012). Epidemiology and population health: Screening [Video file]. Baltimore, MD: Author.
Note: The approximate length of this media piece is 8 minutes.
In this week’s program, Dr. LaPorte discusses screening as it relates to epidemiology.
Accessible player –Downloads– Download Video w/CC Download Audio Download Transcript VIDEO ATTACHED
Optional Resources
Fields, M. M., & Chevlen, E. (2006). Screening for disease: Making evidence-based choices. Clinical Journal of Oncology Nursing, 10(1), 73–76.
Strong, K., Wald, N., Miller, A., & Alwan, A. (2005). Current concepts in screening for noncommunicable disease: World Health Organization Consultation Group Report on methodology of noncommincable disease screening. Journal of Medical Screening, 12(1), 12–19.
Open the links
https://www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary-screening-for-breast-cancer/breast-cancer-screening
https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-11-3
https://www.cdc.gov/eval/framework/index.htm
https://www.healthmap.org/en/
https://web.archive.org/web/20130709124030/http://www.communityhlth.org/communityhlth/resources/planning.html
https://www.sciencedirect.com
https://www.healthmap.org/en/
https://www.cdc.gov/eval/framework/index.htm
https://web.archive.org/web/20130709124030/http://www.communityhlth.org/communityhlth/resources/planning.html
Discussion: Screening for Disease
Although many individuals and organizations may endorse the goal of screening programs, the details and implementation are often controversial. For some types of screening, it can be quite challenging to weigh the human and economic costs and benefits and determine a clear recommendation. For instance, in an article in the New England Journal of Medicine, Dr. Michael Barry (2009) indicates that “serial PSA [prostate-specific–antigen] screening has at best a modest effect on prostate-cancer mortality during the first decade of follow-up. This benefit comes at the cost of substantial over-diagnosis and overtreatment. It is important to remember that the key question is not whether PSA screening is effective but whether it does more good than harm.”
This week’s Learning Resources include articles about screening programs for four different diseases that contain potentially controversial recommendations. For this Discussion, you will select a disease and examine the epidemiological evidence to assess a recommendation for screening guidelines. In addition, you will consider possibilities for furthering policy to promote population health related to this disease.
To prepare:
· Review the four articles concerned with screening and public policy listed in this week’s Learning Resources. All four articles contain potentially controversial recommendations for screening and prevention.
· Select one article on which to focus for this Discussion.
· Analyze how the epidemiologic data could be used to formulate policy for improving population health.
By Day 3
Post a cohesive scholarly response that addresses the following:
· Summarize the recommendations of your selected article. Discuss ethical considerations and whether or not you believe the recommendations are justified.
· Describe the epidemiological evidence in support of your position.
· Identify whether the screening program you review is population-based or high-risk based and how that influences your assessment.
· How can the reported data be used to move policy forward for improving population health around this issue?
2 pages in APA and cite 4 to 5 of the given sources
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