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Screening for Preclinical Disease: Test and Disease Characteristics

Cheryl R. Herman1, Harmindar K. Gill, John Eng and Laurie L. Fajardo

1 All authors: The Russell Morgan Department of Radiology and Radiological Sciences, JHOC Rm. 4155, P. O. Box 0814, Johns Hopkins Medical Institutions, 601 N. Caroline St., Baltimore, MD 21287.



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  		Fig. 1. —Diagram shows natural history of disease. Progression from biologic onset of disease to death is divided into preclinical and clinical phases. Detectable preclinical phase of disease is period during which screening tests are applied to detect a condition early in its natural history, before onset of symptoms.

 


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  		Fig. 2. —Diagram of 2 x 2 matrix illustrates test outcomes and test accuracy for individuals with and without disease. Disease + = disease present, disease - = disease absent, a = number of true-positive results, b = number of false-positive results, c = number of false-negative results, and d = number of true-negative results.

 


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  		Fig. 3. —Diagram depicts how lead-time bias can result in apparent increase in survival attributable to screening. Shown are hypothetical case histories of two women with breast cancer. Screening appears to be beneficial when, in fact, it only pushed time of diagnosis forward.

 

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