History of medical screening: from concepts to action

Abstract

The objective of medical screening is to identify disease in its preclinical, and therefore hopefully still curable, phase. This may have been an old quest in medicine but it became historically possible when at least four conditions were met: the availability of simple, valid and acceptable forms of tests, the discovery of effective treatments, the establishment of a theory of screening, and the wide access to health care. Five selected examples that illustrate the history of medical screening are reviewed: screening for psychiatric disorders in the United States army as it is one of the oldest screening programmes; screening for syphilis as it used one of the earliest screening tests; screening for diabetes as one of the first modern forms of mass screening; screening for cervical cancer using the Pap test as one of the greatest successes of screening; and screening for breast cancer by mammography as this offers a good opportunity to discuss the development of modern evaluation of screening programmes. The evaluation of the impact of screening on human health slowly progressed, from obvious changes in the vital statistics such as the decline in incidence of syphilis, to less obvious changes such as the decline in mortality of cancer of the uterus, to finally more subtle changes, such as the impact of mammographic screening on breast cancer mortality. Methods of evaluation had therefore to adapt, evolving from simple surveys to case-control studies and randomised trials. The history of screening is short, but very rich and mostly still to be written.

Principles of Screening for Chronic Kidney Disease

“…Screening programs became widespread after 1945 with the earliest modern and mass screening programs focusing on diabetes and cervical cancer (6). It is interesting that one of the first interventions that qualified as a "screening program" was implemented in 1917 by the US Army, in an attempt to prevent young men with psychologic disorders to join the military.…”

Problems in the implementation of the national programme of organized screening of malignant diseases

“…Za razumevanje procesa skrininga značajnim se čine i tumačenja koja je davne 1951. godine dala Američka komisija za hronične bolesti: 1) skriningom (testovima ili drugim dijagnostičkim procedurama za brzu primenu) jasno se odvajaju zdrave osobe od onih koje verovatno imaju određenu bolest; 2) skrining nije dijagnostička procedura, te osobe sa pozitivnim ili suspektnim nalazom moraju biti usmerene na dalje dijagnostičke i terapijske postupke (2). Ovo tumačenje skrininga navodi na razmišljanje o pitanjima dostupnosti dijagnostičkih procedura za identifikaciju pravih slučajeva bolesti među suspektnim PREGLED LITERATURE slučajevima, kao i o adekvatnim terapijskim modalitetima.…”

“…U većem delu svoje istorije ljudska populacija je bila više opterećena drugim zdravstvenim problemima, a ne malignitetima. Skrining na psihijatrijske poremećaje u vojsci SAD, uveden 1917. godine, i Vasermanov test na sifilis svakako su među prvim dostupnim skrining testovima, dok je ispitivanje nivoa glukoze u krvi i urinu jedan od prvih primera modernog skrininga, čija je primena počela još davne 1940. godine (2). Međutim, u savremenom dobu globalnu epidemiju i jedan od vodećih javnozdravstvenih problema predstavljaju maligne bolesti, pa su i pitanja organizovanih programa prevencije i ranog otkrivanja dospela u žižu interesovanja kako stručne javnosti, tako i kreatora zdravstvenih politika.…”

En etisk diskussion af screening for kræftsygdomme

“…Formålet med medicinsk screening er at helbrede eller forbedre prognosen for de personer, som ved screening får konstateret en abnorm tilstand (Morabia & Zhang 2004). Ordet «screening» betyder i denne kontekst en grovsortering eller en sigtning.…”