Screening tests in mass surveys and their use in heart disease case finding.

with illustrations by Ernest (Craige, M1.D. Wherein certatin principles governing screening tests for case finding in the general I)oulation .are (definedl and the heart disease case finding. studies in Boston atre eval-uatedl. HE comb)ined experience from mass surveys for such (liseases as tubherculosis, diabetes, syphilis, cancer and heart disease has madle it possible to define in a prelimi-iiary way certain principles which govern the use of screening tests in case fillding ill the general populatioll. rlThese principles are geineral and apply to the use of screening tests ill mass survevs for aiv disease. These will be discussed with particular reference to the practical use of the 70 mm. p)hotofluorographic film for heart, disease case finidinig by health departments, heart associations anld other interested agencies, blasecl on the (lata collecte(l in the Boston heart (lisease catse finding studies.0, '2No attempt will be made to outline the administrative (letails of the organization andl establishment of a mass survey, since these have been well summarizecl ill recent publications.3-" It might be assume(l that a health iniventory, consisting of a complete history alld physical examination, performed generally throughout the population at annual or other suitable intervals would (liscoverldisease at an early stage and assure maximum benefits of pie-venItion anld therapy. Ideally this may be true, but tactually it is impractical for many reasons, iincludiig the limited nuimber of practicing phy-While this paper was in preparation, t he aut hor Preventive Aspects. Certain portions of this paper were included by the author in the final report of that Committee, and he is deel)ly indebted to the members of the Committee for some of the ideas which appear inl this 1)apaer. 659 sicialls, lack of orientat ioI of undergraduate ail(l postgratluate medical education toward early diagnosis an(l the preservation of health, the traditional attitude of the average layman who seeks me(lical attention only during illness, and the enormous expense which must be borne by the individual or, failing that, by society. There is therefore a iieed for simple and ill-expensive screening tests to be use(l ill mass surveys.* Screening tests are not (liagnost i(utlt are proce(llures which sort out those who probably have abnormalities from those who probably (1o not. i\Lass sereeinng conisists of the application of screening tests rl pi(lly and ec(o-llomically to large population groups, to sort out those who probably have abnormal (coli-litions and refer them fol diaollosis allnd if i(lincated, for further …