Services Task Force Recommendation Statement Research Articles

Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement.

Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for hepatitis B virus (HBV) infection. The USPSTF reviewed the evidence on the benefits and harms of antiviral treatment, the benefits of education or behavior change counseling, and the association between improvements in intermediate and clinical outcomes after antiviral therapy. This recommendation applies to asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection (including those at high risk who were vaccinated before being screened for HBV infection). The USPSTF concludes that persons at high risk for infection should be screened for HBV infection. (B recommendation).

Summaries for patients. Screening for hepatitis B virus infection: U.S. Preventive Services Task Force recommendation statement.

Summaries for patients. Screening for hepatitis B virus infection: U.S. Preventive Services Task Force recommendation statement.

Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement

Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement

Screening for Cognitive Impairment in Older Adults: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for dementia. The USPSTF reviewed the evidence on the benefits, harms, and sensitivity and specificity of screening instruments for cognitive impairment in older adults and the benefits and harms of commonly used treatment and management options for older adults with mild cognitive impairment or early dementia and their caregivers. This recommendation applies to universal screening with formal screening instruments in community-dwelling adults in the general primary care population who are older than 65 years and have no signs or symptoms of cognitive impairment. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment. (I statement).

Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement.

Update of the 2004 US Preventive Services Task Force (USPSTF) recommendation on prevention of dental caries in preschool-aged children. The USPSTF reviewed the evidence on prevention of dental caries by primary care clinicians in children 5 years and younger, focusing on screening for caries, assessment of risk for future caries, and the effectiveness of various interventions that have possible benefits in preventing caries. This recommendation applies to children age 5 years and younger. The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (B recommendation) The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children from birth to age 5 years. (I Statement).

Screening for suicide risk in adolescents, adults, and older adults in primary care: U.S. Preventive Services Task Force recommendation statement.

Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for suicide risk. The USPSTF reviewed the evidence on the accuracy and reliability of instruments used to screen for increased suicide risk, benefits and harms of screening for increased suicide risk, and benefits and harms of treatments to prevent suicide. This recommendation applies to adolescents, adults, and older adults in the general population who do not have an identified psychiatric disorder. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for suicide risk in adolescents, adults, and older adults in a primary care setting. (I statement).

Primary Care Interventions to Reduce Drug Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Primary Care Interventions to Reduce Drug Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2008 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for illicit drug use. The USPSTF reviewed the evidence on interventions to help adolescents who have never used drugs to remain abstinent and interventions to help adolescents who are using drugs but do not meet criteria for a substance use disorder to reduce or stop their use. This recommendation applies to children and adolescents younger than age 18 years who have not been diagnosed with a substance use disorder. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents. (I statement).

Implementation of an Electronic Clinical Reminder to Improve Rates of Lung Cancer Screening

Lung cancer is a major public health problem in the United States. It is one of the most common malignancies, with an annual incidence of more than 228,000, and the leading cause of death from cancer, responsible for more than 159,000 deaths in 2013. 1 Siegel R. Naishadham D. Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013; 63: 11-30 Crossref PubMed Scopus (11432) Google Scholar Targeted screening with low-dose computed tomography (CT) of high-risk individuals, defined as those who are aged 55 to 74 years, who have a history of ≥30 pack-years of cigarette smoking, who are current smokers, or who quit smoking within the past 15 years, has been shown to decrease lung cancer mortality by 20% and all-cause mortality by approximately 7% when compared with chest radiography as part of the National Lung Screening Trial. 2 The National Lung Screening Trial Team Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011; 365: 395-409 Crossref PubMed Scopus (6615) Google Scholar Partly on the basis of these findings, the US Preventive Services Task Force recently issued a Grade B recommendation for annual low-dose CT for individuals between the ages of 55 and 80 years who are at high risk for lung cancer. 3 Moyer V.A. Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014; 160: 330-338 Crossref PubMed Google Scholar Furthermore, a recent systematic review concluded that there is “strong evidence” to demonstrate that low-dose CT screening can reduce both lung cancer–specific and all-cause mortality. 4 Humphrey L.L. Deffebach M. Pappas M. et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2013; 159: 411-420 Crossref PubMed Scopus (413) Google Scholar

Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on vitamin supplementation to prevent cardiovascular disease and cancer. The USPSTF reviewed the evidence on the efficacy of multivitamin or mineral supplements in the general adult population for the prevention of cardiovascular disease and cancer. This recommendation applies to healthy adults without special nutritional needs (typically aged 50 years or older). It does not apply to children, women who are pregnant or may become pregnant, or persons who are chronically ill or hospitalized or have a known nutritional deficiency. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of multivitamins for the prevention of cardiovascular disease or cancer. (I statement). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of single- or paired-nutrient supplements (except β-carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement). The USPSTF recommends against β-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation).

Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index in Adults: U.S. Preventive Services Task Force Recommendation Statement

The USPSTF concluded that the current evidence is insufficient to assess the balance of benefits and harms of PAD screening and does not recommend for or against screening with the ABI. This recomm...

Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for lung cancer. The USPSTF reviewed the evidence on the efficacy of low-dose computed tomography, chest radiography, and sputum cytologic evaluation for lung cancer screening in asymptomatic persons who are at average or high risk for lung cancer (current or former smokers) and the benefits and harms of these screening tests and of surgical resection of early-stage non-small cell lung cancer. The USPSTF also commissioned modeling studies to provide information about the optimum age at which to begin and end screening, the optimum screening interval, and the relative benefits and harms of different screening strategies. This recommendation applies to asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. (B recommendation).

Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation on genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility. The USPSTF reviewed the evidence on risk assessment,genetic counseling, and genetic testing for potentially harmful BRCA mutations in asymptomatic women with a family history of breast or ovarian cancer but no personal history of cancer or known potentially harmful BRCA mutations in the family. The USPSTF also reviewed interventions aimed at reducing the risk for BRCA-related cancer in women with potentially harmful BRCA mutations, including intensive cancer screening, medications, and risk-reducing surgery. This recommendation applies to asymptomatic women who have not been diagnosed with BRCA-related cancer. The USPSTF recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with 1 of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing. (B recommendation)The USPSTF recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes. (D recommendation).

Screening for Oral Cancer: U.S. Preventive Services Task Force Recommendation Statement

Screening for Oral Cancer: U.S. Preventive Services Task Force Recommendation Statement

Screening for Oral Cancer: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for oral cancer. The USPSTF reviewed the evidence on whether screening for oral cancer reduces morbidity or mortality and on the accuracy of the oral screening examination for identifying oral cancer or potentially malignant disorders that have a high likelihood of progression to oral cancer. This recommendation applies to asymptomatic adults aged 18 years or older who are seen by primary care providers. This recommendation focuses on screening of the oral cavity performed by primary care providers and not dental providers or otolaryngologists. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral cancer in asymptomatic adults.

Observational Studies May Be More Important Than Randomized Clinical Trials

On behalf of the Atherosclerosis, Hypertension, and Obesity in Youth committee of the American Heart Association (AHA), we appreciate the opportunity to comment on the recently published US Preventive Services Task Force (USPSTF) recommendation statement on Screening for Hypertension in Children and Adolescents (Table).1 View this table: Table. USPSTF Recommendations on Screening for Primary Hypertension (10 HTN) in Children and Adolescents* Since the 1970s, the National Heart, Lung, and Blood Institute has recommended measurement of blood pressure (BP) in healthy children as part of routine health maintenance.2,3 The American Academy of Pediatrics4 and the AHA also advocate this approach.5,6 Recently, the USPSTF concluded that the “current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease (CVD) in childhood or adulthood.”7 The USPSTF approach, which limits the allowable evidence, primarily to randomized controlled trials, and additionally fails to address important questions on pediatric BP, may lead to an undervaluing of pediatric BP measurement and may contribute to practitioner confusion. The USPSTF performed an evidenced-based review to address the use of BP screening in childhood. The task force developed 8 key questions and performed a literature review that netted 6435 potentially relevant articles. After abstract review, 1059 articles were selected as applicable to the key questions, and they underwent full text review. Only 35 articles (describing 34 studies) were included in the statement. The others were excluded as wrong population, intervention, outcome, study design, language, duration, no original data, inadequate duration, or inadequate reference standard. The search strategy, key questions, and references can be found at …

The Impact of Recent Screening Recommendations on Prostate Cancer Screening in a Large Health Care System

The United States Preventive Services Task Force recently recommended against routine prostate cancer screening, stating that the risks of screening outweigh the benefits. We determined the impact of this recommendation on prostate cancer screening in a large health system. We obtained data on all screening prostate specific antigen tests performed at University Hospitals Case Medical Center and affiliated hospitals in northeastern Ohio from January 2008 to December 2012. We examined the total number of prostate specific antigen tests ordered with time and adjusted for patient volume by fitting a regression line. The overall trend was examined and stratified by location (urban, suburban or rural), patient age and provider type (primary care or urology). A total of 43,498 screening prostate specific antigen tests were performed from January 2008 to December 2012. Most tests were ordered by specialists in internal medicine (64.9%), followed by family medicine (23.7%), urology (6.1%) and hematology/oncology (1.3%). Prostate specific antigen screening increased with time until March 2009, when initial screening trials were published. Prostate specific antigen testing then decreased significantly and continued to decrease after the task force recommendations. Similar patterns were noted in almost all subgroups. The greatest decrease in screening wasobserved by urologists and in patients in the intermediate age group (50 to 59 years). United States Preventive Services Task Force recommendations appeared to have decreased prostate cancer screening. The greatest impact was seen for urologists and patients in the intermediate age group. Further study is needed to determine the long-term effects of these recommendations on the screening, diagnosis, treatment and prognosis of this prevalent malignancy.

Screening for High Blood Pressure in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Screening for High Blood Pressure in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Screening for Primary Hypertension in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement*

Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for high blood pressure in children and adolescents. The USPSTF reviewed the evidence on screening and diagnostic accuracy of screening tests for blood pressure in children and adolescents, the effectiveness and harms of treatment of screen-detected primary childhood hypertension, and the association of hypertension with markers of cardiovascular disease in childhood and adulthood. This recommendation applies to children and adolescents who do not have symptoms of hypertension. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood.

Screening for Primary Hypertension in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for high blood pressure in children and adolescents. The USPSTF reviewed the evidence on screening and diagnostic accuracy of screening tests for blood pressure in children and adolescents, the effectiveness and harms of treatment of screen-detected primary childhood hypertension, and the association of hypertension with markers of cardiovascular disease in childhood and adulthood. This recommendation applies to children and adolescents who do not have symptoms of hypertension. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for primary hypertension in asymptomatic children and adolescents to prevent subsequent cardiovascular disease in childhood or adulthood.