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Screening in Chronic Disease
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Second edition. Alan S. Morrison. 254 pages. New York: Oxford University Press; 1992. $45.00.
Discussions, sometimes heated, abound on the value of various screening procedures in reducing mortality from disease. Whether it is the value of annual stool guiac testing, screening mammography in women aged 40 to 49 years, or various other screening procedures, little agreement seems to exist. Understanding why this is and knowing how to apply this understanding is Dr. Morrison's goal.
Screening in Chronic Disease is a thoughtful and logically constructed text devoted to the myriad of issues affecting the validity of studies aimed at evaluating the efficacy of screening. It is, in a sense, a general textbook on epidemiology, although one with a single-minded focus on screening for medical disease. Thus, it is a book that cannot help but interest its medical readers. However, it is not a book for the "casual" reader. Rather, it is primarily meant for medical and public health researchers (or potential researchers). However, nonresearchers interested in the issue of screening can benefit by carefully reading the first chapter (an overview), variably reading the middle chapters, and attentively reading the final three chapters (a review of screening for three specific medical conditions).
As noted above, the text starts with an excellent overview. This is followed by seven chapters that explore in depth topics such as the effect on screening efficacy of length of preclinical phase of a disease, how sensitivity of a test affects lead time, the use of experimental and nonexperimental designs in assessing the value of early treatment, how case fatality rates are affected by various forms of bias, and issues affecting the feasibility of screening programs and the formulation of screening policy. The book then concludes with three chapters that icritically and concisely review key studies that assess the efficacy of screening for breast cancer and cervical cancer and the risk factors for cardiovascular disease.
This is an excellent text for those interested in understanding how to do and evaluate studies on the efficacy of screening procedures. Even the nonresearcher should greatly appreciate the first and last three chapters of the text and, in fact, may even be stimulated enough by these chapters to delve enthusiastically into the remainder.
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