Assignment: 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."

The 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 (See attached files for these articles).

• 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.

Write a minimum of 550 words in APA format with at least 3 scholarly references from the list of required readings below. Include the level one headings as numbered below:

Post a cohesive scholarly response that addresses the following:

1) Summarize the recommendations of your selected article. Discuss ethical considerations and whether or not you believe the recommendations are justified.

2) Describe the epidemiological evidence in support of your position.

3) Identify whether the screening program you review is population-based or high-risk based and how that influences your assessment.

4) How can the reported data be used to move policy forward for improving population health around this issue?

Required Readings

Friis, R. H., & Sellers, T. A. (2014). Epidemiology for public health practice (5th ed.). Sudbury, MA: 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., Fabius, R. J., Skoufalos, A., Clarke, J. L. & Horowitz, M. R. (2016). Population health: Creating a culture of wellness (2nd ed). Burlington, MA: Jones & Bartlett Learning.
Chapter 13, "Decision Support"

This chapter addresses measurement and analysis tools used to support decision making for improvement, accountability, and research related to population health. The three main purposes of measurement in population health (improvement, accountability, research) provide the framework for this chapter.

Note: You will need to review the following four articles to complete this week's Discussion: (See attached file for the articles)

U.S. Preventive Services Task Force. (2009). Screening for breast cancer.

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).

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.

Creighton, P., Lew, J.-B., Clements, M., Smith, M., Howard, K., Dyer, S., Lord, S., & Canfell, K. (2010). Cervical cancer screening in Australia: Modelled evaluation of the impact of changing the recommended interval from two to three years. BMC Public Health, 10, 734-747 (See attached File).

This article examines the cost benefits and health consequences of screening for cervical cancer every 3 years as opposed to every 2 years. Researchers summarize other studies that support this change as well.

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 (See attached File).

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.

HealthMap. (2007).

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.

Association for Community Health Improvement. (2006). Planning, assessment, outcomes & evaluation resources.

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.

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 noncommunicable disease screening. Journal of Medical Screening, 12(1), 12-19.