Disease prevention/screening

Specialties > General practice

Background knowledge 🧠

Definition

Disease prevention: Actions aimed at reducing the incidence, prevalence, and consequences of disease
Screening: Process of identifying unrecognized disease or risk factors in asymptomatic individuals
Aimed at early detection, reducing morbidity and mortality

Epidemiology

Disease prevention and screening have significantly reduced the burden of many diseases in the UK
Key diseases targeted: cancer, cardiovascular disease, diabetes, infectious diseases
The effectiveness of screening programs varies based on disease prevalence and risk factors in the population
Ongoing evaluation of screening programs ensures they remain effective and cost-efficient

Aetiology and Pathophysiology

Disease etiology varies widely (e.g., genetic, environmental, lifestyle factors)
Pathophysiology underpins screening decisions (e.g., pre-cancerous changes, atherosclerosis)
Understanding the natural history of disease is crucial for effective screening
Screening often targets early pathological changes before clinical symptoms appear

Types of Prevention

Primary prevention: Prevents disease occurrence (e.g., vaccination, lifestyle modification)
Secondary prevention: Early detection through screening (e.g., mammography, cervical smear)
Tertiary prevention: Reduces impact of established disease (e.g., rehabilitation, management of complications)
Quaternary prevention: Prevents over-medicalization or harm from unnecessary interventions

Clinical Features 🌡️

Symptoms

Most screening programs target asymptomatic individuals
Symptoms, when present, may indicate the need for diagnostic rather than screening tests
Increased awareness of symptoms in the population can aid in early diagnosis

Signs

Physical examination may reveal early signs that warrant further investigation
Significant findings often prompt referral for diagnostic testing rather than screening
Routine health checks (e.g., BP, BMI) can identify risk factors that lead to disease prevention strategies

Investigations 🧪

Tests

Common screening tests: mammography, cervical cytology, faecal occult blood test (FOBT)
Screening criteria include sensitivity, specificity, cost-effectiveness, and patient acceptability
Positive screening results typically require follow-up with diagnostic tests
Screening intervals and target populations vary based on disease risk and guidelines (e.g., age, gender)

Management 🥼

Management

Depends on screening outcomes; may include lifestyle modification, medical intervention, or referral
Close monitoring and follow-up essential for early-stage disease detected through screening
Management of false positives/negatives is important to avoid unnecessary harm
Patient education is critical to ensure understanding of screening results and next steps

Complications

Overdiagnosis: Identifying diseases that would not have caused harm
False positives: Leading to unnecessary anxiety and interventions
False negatives: Missed diagnosis with potential harm
Physical complications from procedures (e.g., biopsy, colonoscopy)

Prognosis

Screening aims to improve prognosis by detecting disease early
Prognosis varies depending on disease stage at detection and available treatment
Early intervention generally leads to better outcomes
Prognostic factors include disease type, patient health status, and treatment accessibility

Key Points

Effective screening programs are evidence-based and target high-risk populations
Patient involvement and informed consent are crucial for successful screening
Ethical considerations include balancing benefits and harms of screening
Continuous evaluation and adaptation of screening programs improve outcomes

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