title: Contingent screening for Down syndrome is an efficient alternative to non-disclosure sequential screening.
abstract: OBJECTIVE
  To present a first and second trimester Down syndrome screening strategy, whereby second-trimester marker determination is contingent on the first-trimester results. Unlike non-disclosure sequential screening ('the Integrated test'), which requires all women to have markers in both trimesters, this allows a large proportion of the women to complete screening in the first trimester.
  
  
  METHODS
  Two first-trimester risk cut-offs defined three types of results: positive and referred for early diagnosis; negative with screening complete; and intermediate, needing second-trimester markers. Multivariate Gaussian modelling with Monte Carlo simulation was used to estimate the false-positive rate for a fixed 85% detection rate. The false-positive rate was evaluated for various early detection rates and early test completion rates. Model parameters were taken from the SURUSS trial.
  
  
  RESULTS
  Completion of screening in the first trimester for 75% of women resulted in a 30% early detection rate and a 55% second trimester detected rate (net 85%) with a false-positive rate only 0.1% above that achievable by the Integrated test. The screen-positive rate was 0.1% in the first trimester and 4.7% for those continuing to be tested in the second trimester. If the early detection rate were to be increased to 45% or the early completion rate were to be increased to 80%, there would be a further 0.1% increase in the false-positive rate.
  
  
  CONCLUSIONS
  Contingent screening can achieve results comparable with the Integrated test but with earlier completion of screening for most women. Both strategies need to be evaluated in large-scale prospective studies particularly in relation to psychological impact and practicability.
authors.affiliation: Department of Mathematics and Statistics, University of Plymouth, UK. d.wright@plymouth.ac.uk
authors.forename: Dave
authors.initials: D
authors.lastname: Wright
authors.forename: Ian
authors.initials: I
authors.lastname: Bradbury
authors.forename: Peter
authors.initials: P
authors.lastname: Benn
authors.forename: Howard
authors.initials: H
authors.lastname: Cuckle
authors.forename: Karen
authors.initials: K
authors.lastname: Ritchie
mesh_terms: D015415:Biomarkers / Q000032:analysis; D004314:Down Syndrome / Q000175:diagnosis* / Q000196:embryology; D005189:False Positive Reactions; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000196:embryology; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008954:Models, Biological; D009010:Monte Carlo Method; D016011:Normal Distribution; D011237:Predictive Value of Tests; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011296:Prenatal Diagnosis / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers