Test, episode, and programme sensitivities of screening for XXXX as a public health policy in Finland: experimental design.

@entity1 @entity204 @entity5 @entity14
OBJECTIVES: To report the sensitivities of the faecal occult blood test, screening episode, and screening programme for @entity14 and the benefits of applying a randomised design at the implementation phase of a new public health policy. DESIGN: Experimental design incorporated in public health evaluation using randomisation at individual level in the target population. SETTING: 161 of the 431 Finnish municipalities in 2004-6. @entity1 : 106 000 adults randomised to screening or control arms. In total, 52 998 adults aged 60-64 in the screening arm received faecal occult blood test kits. MAIN OUTCOME MEASURES: Test, episode, and programme sensitivities estimated by the incidence method and corrected for selective attendance and overdiagnosis. RESULTS: The response for screening was high overall (70.8%), and significantly better in @entity1 (78.1%) than in @entity1 (63.3%). The incidence of @entity5 in the controls was somewhat higher in @entity1 than in @entity1 (103 v 93 per 100 000 @entity1 years), which was not true for @entity5 (42 v 49 per 100 000 @entity1 years). The sensitivity of the faecal occult blood test was 54.6%. Only a few @entity5 were detected among those with positive test results, hence the episode sensitivity of 51.3% was close to the test sensitivity. At the population level the sensitivity of the programme was 37.5%. CONCLUSIONS: Although relatively low, the sensitivity of screening for @entity14 with the faecal occult blood test in Finland was adequate. An experimental design is a prerequisite for evaluation of such a screening programme because the effectiveness of preventing @entity204 is likely to be small and results may otherwise remain inconclusive. Thus, screening for @entity14 using any primary test modality should be launched in a public health programme with randomisation of the target population at the implementation phase.
