日本総合健診医学会第38回大会―特別講演1―
疫学と健診の接点

抄録

 According to UK National Screening Committee, screening is a public health service in which members of a defined population, who do not necessarily perceive that they are at risk of, or are already affected by, a disease or its complications, are asked a question or offered a test to identify those who are more likely to be helped than harmed by further tests or treatment to reduce the risk of disease or its complications.
 In Japan, the screening program to detect and control risk factors for stroke and coronary heart disease are established.
 Sensitivity, specificity and ROC curves should be applied to a test with continuous variable and a detectable preclinical phase of cancer.
 The only design that effectively eliminates the effect of lead time, length time, overdiagnosis and selection biases is the randomized controlled trial, but only if person-years mortality is used as the endpoint. In Japan, practically, the case-control study is a second-best method.
 In screening, those who are approached to participate are not patients and most of them do not become patients. The screener must build up a core of ethical principles that govern the relationship between screenee and screener like that between patient and physician.