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PH 210: Epidemiology For Public Health Practice Dr. Grosskopf Post-Class Activity: ANSWERS To Screening

This document discusses the results of breast cancer screening tests and key metrics used to evaluate screening tests. It provides the sensitivity and specificity of the breast cancer screening test evaluated, which had a sensitivity of 85% and specificity of 98%. It also defines several types of biases that can occur in cancer screening like lead time bias and length bias, and how they can make screening appear more effective than it truly is.

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Melodic Dubz
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41 views

PH 210: Epidemiology For Public Health Practice Dr. Grosskopf Post-Class Activity: ANSWERS To Screening

This document discusses the results of breast cancer screening tests and key metrics used to evaluate screening tests. It provides the sensitivity and specificity of the breast cancer screening test evaluated, which had a sensitivity of 85% and specificity of 98%. It also defines several types of biases that can occur in cancer screening like lead time bias and length bias, and how they can make screening appear more effective than it truly is.

Uploaded by

Melodic Dubz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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PH 210: Epidemiology for Public Health Practice

Dr. Grosskopf
Post-Class Activity: ANSWERS to Screening

1.
Breast Cancer
Diagnosed Not Diagnosed Total
Screening Test + 136 996 1,132
Results - 24 48,844 48,868
Total 160 49,840 50,000

2. 160/50,000 or 3.2 per 1,000

3. Sensitivity = a/ (a+c) = 136/160 = 85%, Specificity = d/(b+d) = 48,844/49,840 = 98% The


test was very good at picking out women without breast cancer (specificity =98%); but it
missed 15% of the women with breast cancer (sensitivity=85%).

4. The criterion of positivity is the test value at which the screening test is considered positive.
If the criterion is set low (in this setting, this means that any small inkling of an abnormality on
the digital mammography is considered positive), then sensitivity improves but specificity
declines. If the criterion is set high (this means that the small inklings are ignored), then
specificity improves but sensitivity declines.

5. PVP+ = 136/1132 = 12% This means that only 12% of the women who test positive actually
have breast cancer.

6. She is probably screening a lower risk population.

7. It could be evaluated by using feasibility measures such as acceptability, cost, and


predictive value, and efficacy measures such as the severity of disease at diagnosis and the
cause-specific mortality rate.

8. “Lead time bias” is the amount of time by which the diagnosis is advanced due to screening.
This bias makes it erroneously appear that survival is better for screened versus non-screened
cases simply because the diagnosis was made earlier.

9. In cancer screening, “length bias” means that screening tends to pick up slow growing
tumors that have a more favorable prognosis than fast growing tumors. This bias also makes it
erroneously appear that survival is better for screened versus non-screened cases simply
because tumors with a longer detectable pre-clinical phase have a better prognosis. (FYI: You
can control for length bias by repeating the screening at frequent intervals.)

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