Current Screening Recommendations Research Articles

Cancers associated with BRCA1 and BRCA2 mutations other than breast and ovarian.

Previous studies have reported additional cancers associated with BRCA mutations; however, the type, magnitude of risk, and sex differences remain to be clarified. The purpose of this study was to evaluate the incidence of cancers other than breast and ovarian cancer in known mutation carriers. An institutional review board-approved study identified 1072 patients who had genetic counseling at the authors' institution and tested positive for a deleterious BRCA mutation. The expected number of cancer cases was calculated from the number of individuals in the study sample multiplied by the cancer incidence rates for the general population. The expected and observed numbers of cases were calculated in 5-year intervals to accommodate different age-related incidence rates. Standardized incidence ratios (SIRs) for each cancer type were calculated. Among the 1072 mutation carriers, 1177 cancers of 30 different cancer types were identified. Individuals with a BRCA1 mutation did not have a significant increase in cancers other than breast and ovarian cancer; however, a trend in melanoma was observed. Individuals with a BRCA2 mutation had significantly higher numbers of observed cases versus expected cases for pancreatic cancer in both men and women (SIR, 21.7; 95% confidence interval [CI], 13.1-34.0; P < .001) and for prostate cancer in men (SIR, 4.9; 95% CI, 2.0-10.1; P = .002). The results of this study uphold the current recommendations for hereditary breast and ovarian cancer screening of cancers other than breast and ovarian cancer by the National Comprehensive Cancer Network. Larger cohorts and collaborations are needed to further verify these findings.

Going beyond the guidelines: a call for expanded carrier screen based on an analysis of 3,208 clinical samples

range from ancient-and-common polymorphisms with minimal effects to recent-and-rare mutations predicted to have larger effects on the phenotype. Applying NGS and IBD analysis using nuclear families, we were able to identify 5 candidate endometriosis regions that show excess genetic burden. A more complete picture of the genetics of endometriosis is likely to emerge as additional WGS data are analyzed. Supported by: Juneau Biosciences.

Bimanual Examinations in Asymptomatic Well Women: Interpreting Current Practice Guidelines

Rachel Wiebe Skouta, RN, NP, and Elsie Duff, NP, PhD(c) Bimanual examinations are not an effective assessment of gynecological health problems among asymptomatic well women. Annual bimanual exams do not increase the detection of adnexal masses, whether benign or malignant, and there is limited benefit in the use of these exams as part of regular screening for ovarian cysts or fibroids. There is also limited evidence to support the sensitivity and specificity of the pelvic exam; the effects of variables such as practitioner experience, client symptoms, client body shape, and client emotional experiences during the exam have not been well researched. As a result, the bimanual exam is not supported as a reproductive cancer screening tool. The purpose of this article is to address current guidelines and recommendations for routine health screening of well women. In symptomatic cases, pelvic ultrasounds and cancer antigen 125 (CA-125) tests are effective screening tools to detect ovarian cancer. Pap tests every 3 years is a standard screening for cervical cancer. Because premenopausal women are more likely to develop benign ovarian follicular cysts, excessive screening in these women may simply increase anxiety, promote repetitive screening, and lead to unnecessary surgery for a condition that may resolve spontaneously. More effective testing methods are available for gynecological pathology screening. Advances in screening technology have made the pelvic exam irrelevant when assessing for sexually transmitted infections (STIs). With improved technologies, such as nucleic-amplification tests, urine specimen collection, and vaginal selfswabs, bimanual exams have been rendered

Current Recommendations for Screening and Managing Lung Cancer

This article discusses updated recommendations for lung cancer screening, as well as the use of biomarkers in screening and guidelines for the management of nodules detected at screening.

Severe iron-deficiency anemia still an issue in toddlers.

Chronic, severe iron-deficiency anemia (IDA) in the first years of life increases the risk of irreversibly compromised cognitive, affective, and motor development. While IDA in infants has decreased because of dietary changes (iron-fortified formula and delaying cow's milk), toddlers (13-36 months) are equally vulnerable to the adverse effects of IDA. We aimed to show that despite public health efforts, severe IDA remains a problem in toddlers and is associated with excess milk consumption. Retrospective chart review of children 6 to 36 months admitted to or evaluated by hematology at a children's hospital from January 1, 2005 to December 31, 2010 with a severe microcytic anemia (hemoglobin [Hb] <9 g/dL and mean corpuscular volume (MCV) <75 fL). We identified 68 infants and toddlers with severe IDA; most (84%) were 13 to 36 months old. The mean Hb and MCV were 6.0 g/dL (range = 2.2-8.9 g/dL) and 54.0 fL (range = 45.5-69.8 fL), respectively. Fatigue, poor appetite, and pica were the most common symptoms, found in 43%, 29%, and 22% of patients, respectively. Only 41% of parents reported pale skin while 77% of physicians recorded it on physical exam. Daily cow's milk consumption surpassed 24 ounces for 47 of 48 children with reported intake; 11 consumed more than 64 ounces per day. Despite current screening recommendations, severe IDA continues to be a problem in toddlers and strongly correlates with excess cow's milk consumption. This reiterates the importance of screening for IDA into routine toddler care.

Association between Cancer Literacy and Cancer-Related Behaviour: Evidence from Ticino, Switzerland.

BackgroundThis paper details the role of different dimensions of health literacy in the relationship between health literacy and cancer-related health behaviours. In particular, Cancer Literacy is studied as an exemplar of a dimension of health literacy beyond basic reading and writing skills. The link between functional health literacy, Cancer Literacy and cancer-related health behaviours is investigated in a sample of Ticino (Switzerland) residents (n=639).Design and methodsDetailed data is collected about respondents’ functional health literacy, Cancer Literacy, cancer information seeking behaviour, engagement in cancer preventive behaviours, participation to cancer screenings, and intention to adhere to current screening recommendations.ResultsResults confirm the added value of Cancer Literacy – compared to functional health literacy – in explaining people’s cancer information seeking behaviour, their participation to several cancer screenings and their screening intention, underscoring the need to take into account dimensions of health literacy beyond basic functional skills.ConclusionsFrom a public health perspective, findings provide further evidence on the importance of adapting informational and educational communication intervention designed to improve cancer prevention and screening to different audiences.Significance for public healthFrom a public health perspective, our findings underscore the importance of adapting informational and educational communication interventions designed to improve cancer prevention and screening to different audiences, which could differ not only in their functional health literacy, and in particular to put into place strategies to evaluate their success, including the actual transformation of information in relevant knowledge that can be used as a basis for health decision making. Moreover, the cancer literacy score is able to provide researchers and public health officials with detailed information on which are the main gaps in cancer knowledge and to identify the segments of the population that are more at risk. This information could be used to design and develop targeted informational campaigns for low health literate citizens.

Overview of Guideline Recommendations for Screening and Management of Lung Cancer

This article discusses current recommendations for lung cancer screening, as well as some of the similarities and differences between the clinical practice guidelines of the European Society for Medical Oncology (ESMO), American Society of Clinical Oncology (ASCO), and National Comprehensive Cancer Network (NCCN) for treatment of lung cancer. This article also compares these guidelines for early-stage and locally advanced non—small cell lung cancer (NSCLC), demonstrating that despite their similarities, there are often subtle differences in their recommendations.

English

Human papilloma-virus (HPV) infection confers 85-90% of the attributable risk for the development of cervical dysplasia. Worldwide and in particular in Nigeria, HPV 16 has been shown as the most prevalent HPV type and it also contributes more to the development of invasive squamous cell carcinoma. Studies have also shown that the prevalence of HPV is higher among HIV-positive women than among HIV-negative women of all age groups. HIV-positive women also have a higher incidence of squamous intra-epithelial lesion (SIL) and invasive cervical cancer. Progression to cervical cancer is also more rapid amongst these patients and often refractory to treatment with high incidence rates. Current screening recommendations for HIV-positive women are accessible and developed in rich countries. The best strategy for screening infected women in poorer nations where human immunodeficiency virus (HIV) is rampant remains uncertain and challenging. &nbsp; Key words: Human papilloma-virus (HPV), human immunodeficiency virus (HIV), cervical dysplasia, invasive squamous cell carcinoma.

Breast imaging in the transgender patient.

Limited information exists regarding breast health in the transgender population. In this article, we review transgender terminology, barriers faced by transgender patients, current breast care screening recommendations, and normal and abnormal imaging findings in this population. Health disparities in the transgender population continue. Educating physicians on the breast health care needs of transgender patients is important for improving their care.

Are current scoliosis school screening recommendations evidence-based and up to date? A best evidence synthesis umbrella review.

Recommendations addressing school screening for adolescents with idiopathic scoliosis are contradictory. Consequently a critical evaluation of the methodological quality of available systematic reviews, including those upon which these recommendations are based, was conducted. Articles meeting the minimal criteria to be considered a systematic review were included for a best evidence synthesis, umbrella review of secondary studies. The primary outcome measure was "any recommendation addressing the continuation, or not, of school screening programs". Multiple general bibliographic databases, guideline registries, as well as websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology of included reviews. Venn diagrams were created to examine potential overlaps across included papers within different reviews. Six reviews undertaken between 2002 and 2011, scored as moderate to low quality, were included. The 2012 US Preventive Services Task Force recommendation against screening was found to be based on an outdated (2004) low-quality review, whilst two higher quality and more recent (2009 and 2010) reviews support the continuation of school screening programs. As the existing recommendations supporting screening are based on moderate quality evidence whilst the recommendations against screening are based on low-quality evidence, the latter recommendations appear to be both unconvincing and methodologically invalid.

Chronic Kidney Disease and Cardiovascular Disease: A Focus on Primary Care

The prevalence of chronic kidney disease (CKD) in the United States has increased in the last 20 years. As CKD and cardiovascular disease (CVD) are interrelated, it is important to note that trends in the prevalence of CKD and common risk factors it shares with CVD, such as hypertension and diabetes, are likely to affect the burden of both diseases in the future. While preventing and treating CVD is of high priority in the primary care setting, a major reason why CKD continues to burden the US healthcare system is because it remains under-recognized by primary care physicians and specialists, partly due to a lack of uniform screening recommendations. This paper will review the public health implications of CKD, including its epidemiology and economic burden in the United States, its risk factor commonalities with CVD, current screening recommendations and possible prevention strategies for improvement in the future. Additionally, an emphasis will be made on encouraging primary care physicians to play a more prominent role in CKD screening and primary prevention.

PSA Screening: A Discussion Based on the USPSTF Recommendations and the AUA and EAU Guidelines

The role of prostate-specific antigen (PSA) screening in the adult male population is not clearly defined. Although PSA has been shown to be the single most significant predictive factor for identifying men at increased risk of developing prostate cancer (PCa), PSA screening may lead to an increase in unnecessary prostate biopsies, significant over-diagnoses of PCa, and overtreatment of the disease, each of which may contribute to untoward complications and/or side effects. We reviewed PubMed and MEDLINE for articles published between 1970 to December 2013 that discuss the clinical applications of PSA as a screening test, in addition to clinical trials, evidence-based recommendations and guidelines from major medical organizations both in the U.S. and worldwide regarding prostate cancer screening. We also reviewed the current PSA screening recommendations of the United States Preventive Services Task Force (USPSTF), the American Urological Association (AUA), and the European Association of Urology (EAU). A total of 110 publications were reviewed. Results from the European Randomized Study of Screening for Prostate Cancer (ERSPC), the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, and Göteborg trials regarding prostate screening are conflicting: The ERSPC and Göteborg trials show a reduction in prostate cancer mortality, but the PLCO trial shows no benefit. The USPSTF has assigned a grade D recommendation to PSA screening, that is, it has recommended against screening for men in the general U.S. population, regardless of age. The AUA updated its guideline in 2013 to reflect its belief that men under the age of 40 or over the age of 70 with less than a 10- to 15-year life expectancy should not be offered or subjected to PSA screening. Men between the ages of 40 and 54 with risk factors (positive family history or African American race), or men of average risk between the ages of 55 and 69 or older if life expectancy is greater than 10 years should be counseled on the risks and benefits of PSA screening and undergo PSA screening if desired. The EAU recommends obtaining a baseline PSA at age 40 to 45 and adapting subsequent screening intervals to that baseline. The diversity of methodology from randomized trials such as the PLCO, ERSPC, and Göteborg, allows for significant flexibility in interpretation, making it difficult to apply trial outcomes to substantiate universal recommendations. Clinical factors, such as age, race, family history, 10-year life expectancy, and patient preferences, should be taken into account. Variations on PSA-based screening, including age-adjusted PSA, PSA density (PSAD), PSA velocity (PSAV), and percentage of free PSA (%fPSA), may be used to improve the performance of the test. PSA testing may serve as the foundation for a more risk-based assessment. Finally, it should be noted that the decision to screen or not to screen using PSA testing is best made by the patient and his urologist after weighing its advantages and disadvantages.

Medical Nutrition Therapy in Adults with Chronic Kidney Disease: Integrating Evidence and Consensus into Practice for the Generalist Registered Dietitian Nutritionist

Chronic kidney disease is classified in stages 1 to 5 by the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative depending on the level of renal function by glomerular filtration rate and, more recently, using further categorization depending on the level of glomerular filtration rate and albuminuria by the Kidney Disease Improving Global Outcomes initiative. Registered dietitian nutritionists can be reimbursed for medical nutrition therapy in chronic kidney disease stages 3 to 4 for specific clients under Center for Medicare and Medicaid Services coverage. This predialysis medical nutrition therapy counseling has been shown to both potentially delay progression to stage 5 (renal replacement therapy) and decrease first-year mortality after initiation of hemodialysis. The Joint Standards Task Force of the American Dietetic Association (now the Academy of Nutrition and Dietetics), the Renal Nutrition Dietetic Practice Group, and the National Kidney Foundation Council on Renal Nutrition collaboratively published 2009 Standards of Practice and Standards of Professional Performance for generalist, specialty, and advanced practice registered dietitian nutritionists in nephrology care. The purpose of this article is to provide an update on current recommendations for screening, diagnosis, and treatment of adults with chronic kidney disease for application in clinical practice for the generalist registered dietitian nutritionist using the evidence-based library of the Academy of Nutrition and Dietetics, published clinical practice guidelines (ie, National Kidney Foundation Council on Renal Nutrition, Renal Nutrition Dietetic Practice Group, Kidney Disease Outcomes Quality Initiative, and Kidney Disease Improving Global Outcomes), the Nutrition Care Process model, and peer-reviewed literature.

Genomic era diagnosis and management of hereditary and sporadic colon cancer.

The morbidity and mortality attributable to heritable and sporadic carcinomas of the colon are substantial and affect children and adults alike. Despite current colonoscopy screening recommendations colorectal adenocarcinoma (CRC) still accounts for almost 140000 cancer cases yearly. Familial adenomatous polyposis (FAP) is a colon cancer predisposition due to alterations in the adenomatous polyposis coli gene, which is mutated in most CRC. Since the beginning of the genomic era next-generation sequencing analyses of CRC continue to improve our understanding of the genetics of tumorigenesis and promise to expand our ability to identify and treat this disease. Advances in genome sequence analysis have facilitated the molecular diagnosis of individuals with FAP, which enables initiation of appropriate monitoring and timely intervention. Genome sequencing also has potential clinical impact for individuals with sporadic forms of CRC, providing means for molecular diagnosis of CRC tumor type, data guiding selection of tumor targeted therapies, and pharmacogenomic profiles specifying patient specific drug tolerances. There is even a potential role for genomic sequencing in surveillance for recurrence, and early detection, of CRC. We review strategies for diagnostic assessment and management of FAP and sporadic CRC in the current genomic era, with emphasis on the current, and potential for future, impact of genome sequencing on the clinical care of these conditions.

Extra-renal manifestations of autosomal dominant polycystic kidney disease (ADPKD): considerations for routine screening and management

Autosomal-dominant polycystic kidney disease (ADPKD) is a systemic disease, marked by progressive increase of bilateral renal cysts, resulting in chronic kidney disease (CKD) and often leading to end-stage renal disease (ESRD). Apart from renal cysts, patients often have extra-renal disease, involving the liver, heart and vasculature. Other less common but equally important extra-renal manifestations of ADPKD include diverticular disease, hernias, male infertility and pain. Extra-renal disease burden is often asymptomatic, but may result in increased morbidity and mortality. If the disease burden is significant, screening may prove beneficial. We review the rationale for current screening recommendations and propose some guidelines for screening and management of ADPKD patients.

Radiation-Induced Cardiovascular Disease

Thoracic radiation remains an effective treatment for many types of neoplasms. The clinical benefit of radiation therapy on cancer mortality is counterbalanced by an increased risk of cardiovascular events in survivors. The long-term cardiovascular sequelae of thoracic radiation include premature coronary artery disease, valvular disease, pericardial disease, myocardial disease with systolic and especially diastolic dysfunction, and conduction system abnormalities. Radiation heart disease progresses over time and may manifest decades after the initial exposure. Since the risk of cardiac complications is significantly increased following chest irradiation, appropriate screening and long-term cardiac follow-up of these patients is essential. This article will summarize the pathophysiological features, clinical presentations, and current recommendations for screening and prevention of the wide spectrum of radiation induced cardiovascular disease.

Sexually Transmitted Infection Prevalence in a Population Seeking No-Cost Contraception

We used universal screening to determine the prevalence rates of Neisseria gonorrhoeae (GC), Chlamydia trachomatis (CT), and Trichomonas vaginalis (TV) in 9256 women enrolling into a contraceptive study. We offered screening using nucleic acid amplification or culture to all participants enrolling into the Contraceptive CHOICE Project. Demographic characteristics were collected through staff-administered questionnaires. Univariate and multivariable analyses were performed to assess the risk of sexually transmitted infection at baseline and to compare risk profiles of CT and TV. Results were available for 8347 consenting women with satisfactory results; 656 (7.9%) were tested positive for 1 or more infections. Approximately one third of participants were older than 26 years, and half were identified as African American. There were 35 cases of GC for a prevalence of 0.4% (95% confidence interval [CI], 0.3-0.6), 260 cases of CT for a prevalence of 3.1% (95% CI, 2.8-3.5), and 410 cases of TV for a prevalence of 4.9% (95% CI, 4.4-5.4). Black women were more likely to be tested positive (odds ratio, 3.95; 95% CI, 3.08-5.06) compared with white women and accounted for 81.3% of cases. T. vaginalis was more prevalent in black women (8.9%) compared with white women (0.9%). Older age was a risk factor for TV, whereas younger age was associated with CT. Of the 656 positive cases, 106 (16%) were diagnosed in women older than 25 years, falling outside traditional screening guidelines. We found GC, CT, and TV to be more prevalent than current national statistics, with TV being the most prevalent. Current screening recommendations would have missed 16% of infected women.

Real-world Experience in the Midst of an Exserohilum Meningitis Outbreak

THE OUTBREAK OF INVASIVE FUNGAL INFECTIONS AMONG patients who received injections of contaminated methylprednisolone acetate from the New England Compounding Center continues. New cases have been reported to the Centers for Disease Control and Prevention weekly and more than 740 patients in 20 states have been diagnosed with meningitis, spinal or paraspinal infections, or joint infections (ie, epidural abscess, phlegmon, diskitis, vertebral osteomyelitis, arachnoiditis, or other complications at or near the injection site). Spinal or paraspinal infections can present weeks to months after the initial injection. Current recommendations from the Centers for Disease Control and Prevention call for patients with new or worsening symptoms at or near the injection site to undergo magnetic resonance imaging (MRI) with contrast of the symptomatic areas. In this issue of JAMA, Malani et al provide important information detailing the possibility of paraspinal or spinal infections in those without a change from their baseline pain or neuropathic symptoms. These findings suggest that current screening recommendations may need reconsideration. Patients exposed to contaminated steroids can no longer be reassured that the lack of new or progressive symptoms equates to a lack of infection. In the report by Malani et al, 36 of 172 patients (21%) screened for evidence of paraspinal or spinal infection exhibited MRI abnormalities suggestive of infection. Although a review of symptoms was not available for all screened patients, among the 115 patients surveyed, 80 (70%) had no change in their symptoms. Of these 80 patients, 13 (16%) had an abnormal MRI. A total of 35 of 115 patients experienced an increase in their baseline pain or neuropathic symptoms, yet had not received an MRI (although one may have already been ordered). After diagnostic imaging was obtained, 22 of these 35 patients (63%) had imaging findings consistent with focal infection. These results suggest either reassurance at a prior clinical visit may have been offered, or patients were not aware of the need to seek care for worsening symptoms. Virtually all patients with abnormal MRI findings met criteria from the Centers for Disease Control and Prevention for probable or proven disease. Twenty-four of these 35 patients required operative intervention as a diagnostic or therapeutic maneuver, and all 35 received antifungal therapy. In light of these findings, it may seem reasonable to mandate MRI screening for all exposed patients. However, this recommendation may not be applicable to the entire exposed population. The lot (No. 06292012@26) of contaminated steroid responsible for cases in Michigan and the majority of those in Tennessee was associated with a higher attack rate than other steroid lots (Nos. 05212012@68 and 08102012@51) causally implicated in this outbreak. The reasons for differing attack rates by region and lot number remain obscure. However, storage conditions, age of the product, extent of exposure (ie, multiple exposures), and host factors, including immunogenetic differences in susceptibility, likely each play a large role. Other institution-related or region-specific factors may contribute to patient risk for fungal infection. For example, translaminar injection was an independent risk factor for fungal infection but transforminal injection was not. Geographicor region-specific practices for injection have not been reported. Furthermore, physician preference for procedure type may play a role in the variation of attack rates between locations and should be considered in the development of diagnostic and treatment recommendations. The report by Malani et al also raises the question of how infection develops in patients without worsening underlying back pain or neuropathic symptoms. Patients with preexisting chronic pain may pay less attention to the development of slightly more pain, or increases in pain frequency. It is not clear if a validated symptom questionnaire was used in the study by Malani et al to assess subtle changes from

Do current screening recommendations allow for early detection of lithium-induced hyperparathyroidism in patients with bipolar disorder?

BackgroundCurrent screening recommendations for early detection of lithium-associated hyperparathyroidism propose an exclusive measurement of serum albumin-adjusted calcium (Aac) concentration as a single first step. However, longitudinal data in patients with recurrent affective disorders suggest that increases in serum intact parathyroid hormone (iPTH) levels in lithium-treated patients may not necessarily be accompanied by a parallel increase in the concentration of Aac. If true, patients with an isolated increase in iPTH concentration above the reference range might be missed following current screening recommendations. Therefore, this study set out to examine key parameters of calcium metabolism, including iPTH and 25-hydroxycholecalciferol concentrations in patients with bipolar disorder that was or was not managed with lithium.MethodsSixty patients with bipolar disorder according to DSM-IV were enrolled, 30 of whom had received long-term lithium treatment (lithium group), whereas the other 30 patients were on psychopharmacological treatment not including lithium (non-lithium group) at the time of the study. Owing to exclusion criteria (e.g., lithium < 6 months, laboratory results indicative of secondary hyperparathyroidism), 23 bipolar patients composed the final lithium group, whereas 28 patients remained in the non-lithium group for statistical analyses.ResultsPatients in the lithium group showed a significantly higher concentration of iPTH compared to the non-lithium group (p < 0.05). Similarly, Aac concentrations were significantly increased in the lithium group compared to the non-lithium group (p < 0.05). However, in a multivariate linear regression model, group affiliation only predicted iPTH concentration (p < 0.05). In line with this, none of the four patients in the lithium group with an iPTH concentration above the reference range had an Aac concentration above the reference range.DiscussionThis study suggests that the biochemical characteristics between primary hyperparathyroidism and lithium-induced hyperparathyroidism differ substantially with regard to regulation of calcium homeostasis. As such, current screening practice does not reliably detect iPTH concentrations above the reference range. Therefore, further research is needed to elucidate the consequences of an isolated iPTH concentration above the reference range in order to develop the most appropriate screening tools for hyperparathyroidism in lithium-treated patients with bipolar disorder.

Indications for Testing Among Reported Cases of HCV Infection From Enhanced Hepatitis Surveillance Sites in the United States, 2004–2010

Centers for Disease Control and Prevention has recommended a 1-time HCV test for persons born from 1945 through 1965 to supplement current risk-based screening. We examined indications for testing by birth cohort (before 1945, 1945-1965, and after 1965) among persons with past or current HCV. Cases had positive HCV laboratory markers reported by 4 surveillance sites (Colorado, Connecticut, Minnesota, and New York) to health departments from 2004 to 2010. Health department staff abstracted demographics and indications for testing from cases' medical records and compiled this information into a surveillance database. Of 110, 223 cases of past or current HCV infection reported during 2004-2010, 74, 578 (68%) were among persons born during 1945-1965. Testing indications were abstracted for 45, 034 (41%) cases; of these, 29 ,544 (66%) identified at least 1 Centers for Disease Control and Prevention-recommended risk factor as a testing indication. Overall, 74% of reported cases were born from 1945 to 1965 or had an injection drug use history. These data support augmenting the current HCV risk-based screening recommendations by screening adults born from 1945 to 1965.