TAILIEUCHUNG - Chapter 004. Screening and Prevention of DiseaseExamples include tests that are biochemical (e.g.,

Chapter 004. Screening and Prevention of Disease Examples include tests that are biochemical (., cholesterol, glucose), physiologic (., blood pressure, growth curves), radiologic (., mammogram, bone densitometry), or tissue specimens (., Pap smear, fine-needle aspirations). In the future, it is anticipated that genetic testing will play an increasingly important role for predicting disease risk (Chap. 64). However, such tests are not widely used except for individuals at risk for high-penetrance genes based on family or ethnic history (., BRCA1, BRCA2). The identification of lowpenetrance but high-frequency genes that cause common disorders such as diabetes, hypertension, or macular degeneration offers the possibility. | Chapter 004. Screening and Prevention of Disease Examples include tests that are biochemical . cholesterol glucose physiologic . blood pressure growth curves radiologic . mammogram bone densitometry or tissue specimens . Pap smear fine-needle aspirations . In the future it is anticipated that genetic testing will play an increasingly important role for predicting disease risk Chap. 64 . However such tests are not widely used except for individuals at risk for high-penetrance genes based on family or ethnic history . BRCA1 BRCA2 . The identification of low-penetrance but high-frequency genes that cause common disorders such as diabetes hypertension or macular degeneration offers the possibility of new genetic tests. However any new screening test whether based on genetic or other methods must be subjected to rigorous evaluation of its sensitivity specificity impact on disease and cost-effectiveness. Physicians and patients are continuously introduced to new screening tests often in advance of complete evaluation. For example the use of whole-body CT imaging has been advocated as a means to screen for a variety of disorders. Though appealing in concept there is currently no evidence to justify this approach which is associated with high cost and a substantial risk of false-positive results. This chapter will review the basic principles of screening and prevention in the primary care setting. Recommendations for specific disorders such as cardiovascular disease diabetes or cancer are provided in the chapters dedicated to these topics. Basic Principles of Screening In general screening is most effective when applied to relatively common disorders that carry a large disease burden Table 4-1 . The five leading causes of mortality in the United States are heart diseases malignant neoplasms accidents cerebrovascular diseases and chronic obstructive pulmonary disease. Thus many prevention strategies are targeted at these conditions. From a global health .

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