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The purpose of this task is to enable you to assess epidemiological information and integrate epidemiological concepts and methods to critically appraise a public health screening program.
This assignment comprises two parts. In Part A you will need to do some calculations, provide and interpret the results. Part B requires you to critically evaluate a breast cancer screening program. You are to answer both Part A and Part B.
Length and/or format: Part B: short answer questions; Part B: 1,200 words ± 10%
Learning outcomes assessed: LO1 – LO5
How to submit: Word document via the LEO AT3 Turnitin link
Return of assignment: Electronically via LEO, 3 weeks after the due date
Assessment criteria: Refer to AT3 instructions and marking rubric over the next few pages
The World Health Organization defines screening as the process of presumptive identification of unrecognised disease in an apparently healthy, asymptomatic population by means of tests, examinations or other procedures that can be applied rapidly and easily to the target population (WHO, 2020). A screening programme must include all the core components in the screening process from inviting the target population to accessing effective treatment for individuals diagnosed with disease. Screening mammography is developed to diagnose breast cancer in women at an early stage so that effective treatment can be implemented to reduce morbidity and mortality from this disease.
Part A of this assessment task requires you to calculate and interpret the results of a screening test in a hypothetical scenario, and then to justify the appropriateness and applicability of the test results.
The hypothetical scenario
Wakanda is a small but high-income country in Africa with a total population of about 50,000. The overall health of the population is generally very good, with a low prevalence of chronic non-communicable disease, including cancer.
Of the total population, 10,000 people are women over 40 years of age. The societal values and beliefs in this country is quite conservative. Women rarely seek care from male medical practitioners, however 90% of the medical practitioners in this country are men.
The government of this country is considering using mammography as a screening test at the population level. A validation study was conducted with the total population of women over the age of 40, to determine whether mammography could be used to detect early breast cancer. Of the 9,830 women who did not have cancer, 2,837 were tested positive. Seven women were incorrectly screened negative.
Part A questions
(a) Construct and complete a 2×2 table of the test results. Show your completed 2×2 table.
(b) Calculate the sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) for the mammography test. Show your calculations.
(c) Would you recommend using this test for breast cancer screening in this community? Why / why not? Justify your recommendation. Discuss the implications of implementing or not implementing this screening test.
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