On the formalism of the screening paradox.

Bayes' Theorem imposes inevitable limitations on the accuracy of screening tests by tying the test's predictive value to the disease prevalence. The aforementioned limitation is independent of the adequacy and make-up of the test and thus implies inherent Bayesian limitations to the screen...

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Autor principal:	Jacques Balayla
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/caef59f9aad34e33a7925b252e84d202
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spelling	oai:doaj.org-article:caef59f9aad34e33a7925b252e84d2022021-12-02T20:08:41ZOn the formalism of the screening paradox.1932-620310.1371/journal.pone.0256645https://doaj.org/article/caef59f9aad34e33a7925b252e84d2022021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0256645https://doaj.org/toc/1932-6203Bayes' Theorem imposes inevitable limitations on the accuracy of screening tests by tying the test's predictive value to the disease prevalence. The aforementioned limitation is independent of the adequacy and make-up of the test and thus implies inherent Bayesian limitations to the screening process itself. As per the WHO's Wilson - Jungner criteria, one of the prerequisite steps before undertaking screening is to ensure that a treatment for the condition screened for exists. However, when applying screening programs in closed systems, a paradox, henceforth termed the "screening paradox", ensues. If a disease process is screened for and subsequently treated, its prevalence would drop in the population, which as per Bayes' theorem, would make the tests' predictive value drop in return. Put another way, a very powerful screening test would, by performing and succeeding at the very task it was developed to do, paradoxically reduce its ability to correctly identify individuals with the disease it screens for in the future-over some time t. In this manuscript, we explore the mathematical model which formalizes said screening paradox and explore its implications for population level screening programs. In particular, we define the number of positive test iterations (PTI) needed to reverse the effects of the paradox. Given their theoretical nature, clinical application of the concepts herein reported need validation prior to implementation. Meanwhile, an understanding of how the dynamics of prevalence can affect the PPV over time can help inform clinicians as to the reliability of a screening test's results.Jacques BalaylaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0256645 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jacques Balayla On the formalism of the screening paradox.
description	Bayes' Theorem imposes inevitable limitations on the accuracy of screening tests by tying the test's predictive value to the disease prevalence. The aforementioned limitation is independent of the adequacy and make-up of the test and thus implies inherent Bayesian limitations to the screening process itself. As per the WHO's Wilson - Jungner criteria, one of the prerequisite steps before undertaking screening is to ensure that a treatment for the condition screened for exists. However, when applying screening programs in closed systems, a paradox, henceforth termed the "screening paradox", ensues. If a disease process is screened for and subsequently treated, its prevalence would drop in the population, which as per Bayes' theorem, would make the tests' predictive value drop in return. Put another way, a very powerful screening test would, by performing and succeeding at the very task it was developed to do, paradoxically reduce its ability to correctly identify individuals with the disease it screens for in the future-over some time t. In this manuscript, we explore the mathematical model which formalizes said screening paradox and explore its implications for population level screening programs. In particular, we define the number of positive test iterations (PTI) needed to reverse the effects of the paradox. Given their theoretical nature, clinical application of the concepts herein reported need validation prior to implementation. Meanwhile, an understanding of how the dynamics of prevalence can affect the PPV over time can help inform clinicians as to the reliability of a screening test's results.
format	article
author	Jacques Balayla
author_facet	Jacques Balayla
author_sort	Jacques Balayla
title	On the formalism of the screening paradox.
title_short	On the formalism of the screening paradox.
title_full	On the formalism of the screening paradox.
title_fullStr	On the formalism of the screening paradox.
title_full_unstemmed	On the formalism of the screening paradox.
title_sort	on the formalism of the screening paradox.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/caef59f9aad34e33a7925b252e84d202
work_keys_str_mv	AT jacquesbalayla ontheformalismofthescreeningparadox
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On the formalism of the screening paradox.

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