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Special Article | ONLINE FIRST

Assessing Risk Factors as Potential Screening Tests:  A Simple Assessment Tool

Nicholas J. Wald, FRS, FRCP; Joan K. Morris, PhD
Arch Intern Med. 2011;171(4):286-291. doi:10.1001/archinternmed.2010.378.
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Many risk factors for disease are suggested as screening tests when there is little prospect that they could be useful in predicting disease. To avoid this, it is useful to know the relationship between the relative risk of a disease or disorder in people with high and low values of a risk factor, and the equivalent screening performance in terms of the detection rate (sensitivity) for a specified false-positive rate. We describe an interactive Risk-Screening Converter, accessible from the Internet (http://www.wolfson.qmul.ac.uk/rsc/http://www.wolfson.qmul.ac.uk/rsc/), that transforms an odds ratio into the equivalent estimates of detection and false-positive rates. The converter is intended for general clinicians, for people engaged in research into risk factors and disease, and for those who give advice on applying such research findings into medical practice. It should help to distinguish effective screening methods from ineffective ones, and so improve clinical guidelines relating to screening and the prediction and prevention of disease.

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Figure 1.

Illustration of Web page showing detection rate according to the false-positive rate for a specified odds ratio (OR) comparing lowest and highest groups of a risk factor. The Gaussian curves in the top left-hand corner indicate the relative distribution of the risk factor in affected and unaffected individuals. OAPR indicates odds of being affected given a positive result.

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Figure 2.

Illustration of Web page showing odds ratio (OR) comparing lowest and highest groups of a risk factor according to the false-positive rate for a specified detection rate.

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Place holder to copy figure label and caption
Figure 3.

Illustration of Web page showing odds ratio (OR) comparing lowest and highest groups of a risk factor according to the detection rate for a specified false-positive rate.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Illustration of Web page showing detection rate according to false-positive rate for a specified odds ratio per 1-SD difference in the value of a risk factor. The Gaussian curves in the top left-hand corner indicate the relative distributions of the risk factor in affected and unaffected individuals. OAPR indicates odds of being affected given a positive result.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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