S2D: The Symptom to Diagnosis Podcast Screening Tests
Jan 19, 2022
A lively dive into screening tests, using a PSA role-play to explore risks, false positives, and treatment harms. They define screening goals and list five criteria for doing it well. Trials, biases, and overdiagnosis get close scrutiny. The conversation weighs real-world trade offs between lives saved and potential harms.
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Finding Disease Alone Is Not A Success
- The goal of screening is to reduce morbidity and mortality from the target disease, not merely to find disease.
- Detecting disease without improving outcomes converts healthy people into patients and may cause net harm.
Five Criteria For A Good Screening Test
- Five criteria make a good screening test: do no harm, sufficient disease burden, detect preclinical disease, good accuracy, and improved outcomes with early detection.
- Scott emphasized the first and last criteria as most important.
Don't Treat PSA As Harmless
- Remember PSA is not a harmless simple blood test because positive results often lead to biopsies and downstream harms.
- Most elevated PSAs (4 to 10) are false positives; biopsies and treatments cause real adverse effects.
