U.S. Preventive Services Task Force Recommends Research Articles

Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement.

Falls are the leading cause of injury-related morbidity and mortality among older adults in the US. In 2018, 27.5% of community-dwelling adults 65 years or older reported at least 1 fall in the past year and 10.2% reported a fall-related injury. In 2021, an estimated 38 742 deaths resulted from fall-related injuries. The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling adults 65 years or older. Community-dwelling adults 65 years or older at increased risk of falls. The USPSTF concludes with moderate certainty that exercise interventions provide a moderate net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls. The USPSTF concludes with moderate certainty that multifactorial interventions provide a small net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls. The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians individualize the decision to offer multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation).

New USPSTF Breast Cancer Screening Recommendations: A Talk With Task Force Vice Chair Dr John Wong.

In this video article, Dr. John B. Wong, Vice Chair of the U.S. Preventive Services Task Force (USPSTF), discusses implications of the new USPSTF recommendation for biennial screening mammography for women 40-74 years old.

Absolute lung cancer risk increases among individuals with >15 quit-years: Analyses to inform the update of the American Cancer Society lung cancer screening guidelines.

This report quantifies counteracting effects of quit-years and concomitant aging on lung cancer risk, especially on exceeding 15 quit-years, when the US Preventive Services Task Force (USPSTF) recommends curtailing lung-cancer screening. Cox models were fitted to estimate absolute lung cancer risk among Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) and National Lung Screening Trial (NLST) participants who ever smoked. Absolute lung cancer risk and gainable years of life from screening for individuals aged 50 to 80 in the US-representative National Health Interview Survey (NHIS) 2015-2018 who ever smoked were projected. Relaxing USPSTF recommendations to 20/25/30 quit-years versus augmenting USPSTF criteria with individuals whose estimated gain in life expectancy from screening exceeded 16.2days according to the Life Years From Screening-CT (LYFS-CT) prediction model was compared. Absolute lung cancer risk increased by 8.7%/year (95% CI, 7.7%-9.7%; p<.001) as individuals aged beyond 15 quit-years in the PLCO, with similar results in NHIS and NLST. For example, mean 5-year lung cancer risk for those aged 65 years with 15 quit-years=1.47% (95% CI, 1.35%-1.59%) versus 1.76% (95% CI, 1.62%-1.90%) for those aged 70 years with 20 quit-years in the PLCO. Removing the quit-year criterion would make 4.9 million more people eligible and increase the proportion of preventable lung cancer deaths prevented (sensitivity) from 63.7% to 74.2%. Alternatively, augmentation using LYFS-CT would make 1.7million more people eligible while increasing the lung cancer death sensitivity to 74.0%. Because of aging, absolute lung cancer risk increases beyond 15 quit-years, which does not support exemption from screening or curtailing screening once it has been initiated. Compared with relaxing the USPSTF quit-year criterion, augmentation using LYFS-CT could prevent most of the deaths at substantially superior efficiency, while also preventing deaths among individuals who currently smoke with low intensity or long duration.

The aggregate value of cancer screenings in the United States: full potential value and value considering adherence

BackgroundAlthough cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence of the aggregate benefits of guideline-recommended single-site cancer screenings has been limited. This article assesses the benefits in terms of life-years gained and associated value from major cancer screening technologies in the United States.MethodsA mathematical model was built to estimate the aggregate benefits of screenings for breast, colorectal, cervical, and lung cancer over time since the start of US Preventive Services Task Force (USPSTF) recommendations. For each type, the full potential benefits under perfect adherence and the benefits considering reported adherence rates were estimated. The effectiveness of each screening technology was abstracted from published literature on the life-years gained per screened individual. The number of individuals eligible for screening per year was estimated using US Census data matched to the USPSTF recommendations, which changed over time. Adherence rates to screening protocols were based on the National Health Interview Survey results with extrapolation.ResultsSince initial USPSTF recommendations, up to 417 million people were eligible for cancer screening. Assuming perfect adherence to screening recommendations, the life-years gained from screenings are estimated to be 15.5–21.3 million (2.2–4.9, 1.4–3.6, 11.4–12.3, and 0.5 million for breast, colorectal, cervical, and lung cancer, respectively). At reported adherence rates, combined screening has saved 12.2–16.2 million life-years since the introduction of USPSTF recommendations, ~ 75% of potential with perfect adherence. These benefits translate into a value of $8.2-$11.3 trillion at full potential and $6.5-$8.6 trillion considering current adherence. Therefore, single-site screening could have saved an additional 3.2–5.1 million life-years, equating to $1.7-$2.7 trillion, with perfect adherence.ConclusionsAlthough gaps persist between the full potential benefit and benefits considering adherence, existing cancer screening technologies have offered significant value to the US population. Technologies and policy interventions that can improve adherence and/or expand the number of cancer types tested will provide significantly more value and save significantly more patient lives.

MP77-09 CHANGES IN PROSTATE SPECIFIC ANTIGEN UNITED STATES PREVENTIVE SERVICES TASK FORCE GUIDELINES AND THROUGH THE COVID-19 PANDEMIC

You have accessJournal of UrologyCME1 Apr 2023MP77-09 CHANGES IN PROSTATE SPECIFIC ANTIGEN SCREENING FOLLOWING THE 2018 UNITED STATES PREVENTIVE SERVICES TASK FORCE GUIDELINES AND THROUGH THE COVID-19 PANDEMIC Zhiyu (Jason) Qian, Xi Chen, Alexander P. Cole, Hari S. Iyer, Muhieddine Labban, Benjamin V. Stone, Dejan Fillipas, Edoardo Beatrici, Firas Abdollah, Adam S. Kibel, Stuart R. Lipsitz, and Quoc-Dien Trinh Zhiyu (Jason) QianZhiyu (Jason) Qian More articles by this author , Xi ChenXi Chen More articles by this author , Alexander P. ColeAlexander P. Cole More articles by this author , Hari S. IyerHari S. Iyer More articles by this author , Muhieddine LabbanMuhieddine Labban More articles by this author , Benjamin V. StoneBenjamin V. Stone More articles by this author , Dejan FillipasDejan Fillipas More articles by this author , Edoardo BeatriciEdoardo Beatrici More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Stuart R. LipsitzStuart R. Lipsitz More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In 2018, The US Preventive Services Task Force (USPSTF) changed its recommendations for prostate specific antigen (PSA) screening from “non-recommended” to “shared decision-making among men aged 55-69”. Thereafter, COVID-19 Pandemic disrupted cancer care with evidence suggesting overall reduced access to and utilization of health care services including preventive screening. We aim to examine the impacts of both events on PSA screening for men aged 55-69. METHODS: We analyzed 2013, 2015, 2018, 2019, and 2021 National Health Interview Survey data. Men >54 who reported PSA testing within 12 months preceding survey were considered to have undergone screening. Adjusted difference in differences (DID) analyses were performed to compare changes in screening in men aged 55-69 with reference to men >70 between 2015 and 2019 (pre- and post- 2018 USPSTF recommendation) and between 2019 and 2021 (pre- and post-Pandemic). RESULTS: A total of 24,308 men were included. PSA screening prevalence was 35.4% (95%CI: 33.7%, 37.1%), 32.1% (95%CI: 30.3%, 33.9%), 33.3% (95%CI: 31.6%, 34.9%), 37.2% (95%CI: 35.7%, 38.8%), and 34.9% (95%CI: 33.3%, 36.5%) respectively for included years. From 2015 to 2019, PSA screening increased 4.6% among men aged 55-69 (95%CI: 1.7, 7.5%) and increased 6.5% among men >70 (95%CI: 2.7, 10.4%). From 2019 to 2021, PSA screening decreased 3.1% among men aged 55-69 (95%CI: 0.58%, 5.8%); PSA screening also decreased 0.8% among older men but did not reach significance (95%CI: -2.6%, 4.2%). DID analysis did not show difference in changes between men aged 55-69 in reference to men >70 from both 2015 to 2019 (DID=-1.9%, 95%CI, -6.7%, 2.9%) and 2019 to 2021 (DID=-2.3%, 95%CI, -6.5%, 1.9%). CONCLUSIONS: We saw an increase in PSA screening after 2018 USPSTF recommendations among its target population – men aged 55-69 and also among older men >70. In contrast, the period from 2019 to 2021 saw a significant decrease in PSA screening in those aged 55-69. The lack of significant DID between groups as well as the downward trend of PSA screening in men >70 together suggest an overall trend of decrease in PSA screening post-Pandemic. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1105 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhiyu (Jason) Qian More articles by this author Xi Chen More articles by this author Alexander P. Cole More articles by this author Hari S. Iyer More articles by this author Muhieddine Labban More articles by this author Benjamin V. Stone More articles by this author Dejan Fillipas More articles by this author Edoardo Beatrici More articles by this author Firas Abdollah More articles by this author Adam S. Kibel More articles by this author Stuart R. Lipsitz More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement PDF downloadLoading ...

Risk Model-Based Lung Cancer Screening : A Cost-Effectiveness Analysis.

In their 2021 lung cancer screening recommendation update, the U.S. Preventive Services Task Force (USPSTF) evaluated strategies that select people based on their personal lung cancer risk (risk model-based strategies), highlighting the need for further research on the benefits and harms of risk model-based screening. To evaluate and compare the cost-effectiveness of risk model-based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds. Comparative modeling analysis. National Lung Screening Trial; Surveillance, Epidemiology, and End Results program; U.S. Smoking History Generator. 1960 U.S. birth cohort. 45 years. U.S. health care sector. Annual low-dose computed tomography in risk model-based strategies that start screening at age 50 or 55 years, stop screening at age 80 years, with 6-year risk thresholds between 0.5% and 2.2% using the PLCOm2012 model. Incremental cost-effectiveness ratio (ICER) and cost-effectiveness efficiency frontier connecting strategies with the highest health benefit at a given cost. Risk model-based screening strategies were more cost-effective than the USPSTF recommendation and exclusively comprised the cost-effectiveness efficiency frontier. Among the strategies on the efficiency frontier, those with a 6-year risk threshold of 1.2% or greater were cost-effective with an ICER less than $100 000 per quality-adjusted life-year (QALY). Specifically, the strategy with a 1.2% risk threshold had an ICER of $94 659 (model range, $72 639 to $156 774), yielding more QALYs for less cost than the USPSTF recommendation, while having a similar level of screening coverage (person ever-screened 21.7% vs. USPSTF's 22.6%). Risk model-based strategies were robustly more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions. Risk models were restricted to age, sex, and smoking-related risk predictors. Risk model-based screening is more cost-effective than the USPSTF recommendation, thus warranting further consideration. National Cancer Institute (NCI).

APA’s Government, Policy, and Advocacy Update (December 2022)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (December 2022)Search for more papers by this authorPublished Online:27 Nov 2022https://doi.org/10.1176/appi.pn.2022.12.12.49APA Responds to Recommendations Related to Screening for Depression, Suicide Risk in AdultsEarlier this year, the U.S. Preventive Services Task Force (USPSTF) released draft recommendations around screening for depression and suicide risk in patients over age 18. In its draft, USPSTF recommended screening adults, including pregnant and postpartum adults, for depression. Further, they concluded that current evidence is insufficient to assess the balance of risks and benefits of screening for suicide in adults.APA provided comments, signed by APA CEO and Medical Director Saul Levin, M.D., M.P.A. APA strongly encouraged USPSTF to expand the depression screening recommendation to include screening with a brief evidence-based intervention and/or referral when indicated as opposed to screening alone.Further, APA urged USPSTF to recommend targeted suicide screening, such as for individuals who screen positive for depression. This would be “a more balanced and reasonable recommendation” than not screening for suicide risk at all. “This is especially important in groups at high risk for suicide, such as individuals over the age of 65,” the comments stated.Finally, APA raised concerns with USPSTF’s statements regarding pharmacologic agents taken by individuals who are pregnant or postpartum, suggesting that they could be interpreted as a recommendation against medications for depression in this population. “[I]t may reinforce the already reflexive tendency on the part of many clinicians to discontinue (or avoid) psychotropic medications during pregnancy for those individuals who might need and benefit from them,” the comments stated. APA attached a more detailed response to this aspect of the USPSTF recommendations in its comments, developed by APA’s Committee on Women’s Mental Health.APA’s comments on USPSTF Recommendation on Depression and Suicide Risk in Adults APA Joins Letter Urging Biden to Declare National Emergency on Children’s Mental HealthOctober marked the one-year anniversary of three organizations—the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association—declaring a national state of emergency on children’s mental health. APA joined the Sound the Alarm for Kids initiative last year, and this year, to commemorate the anniversary, APA and over 130 organizations sent a letter to President Joe Biden, urging him to declare a national emergency for the youth mental health crisis.“While much has been done by the federal government to address the crisis, the mental health of our nation’s youth continues to deteriorate,” the letter stated. It points to increasing rates of suicide among children (especially Black boys and girls under age 12), increasing number of emergency department visits for suspected youth suicide attempts and diagnoses of anxiety, depression, and behavioral or conduct issues. It also noted the challenges imposed by systemic inequities such as racism, homophobia, transphobia, economic inequality, and under-resourced schools.“Issuing a National Emergency Declaration would galvanize existing critical funding streams and support to help ensure that all children and adolescents can access the full continuum of mental and behavioral health care from promotion and prevention to early identification and treatment, especially in times of crisis,” the letter continued. “Of particular note, we need a robust and comprehensive mental health workforce strategy that prioritizes recruitment of underrepresented populations and ensures trained pediatric mental health and primary care professionals are adequately paid for the services they provide.” ■APA’s letter to President Biden ISSUES NewArchived

Abstract 13331: Low Statin Adherence Identified Across Diverse Populations in the All of Us Research Program

Introduction: Statins are a cornerstone of primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD), the leading cause of death in the US. Despite conclusive evidence to the efficacy and safety of statins, low adherence remains a public health challenge. Although patient, clinician, and health system barriers to statin adherence have been documented, the effect of national policies targeting prescription access remains largely understudied. This study sought to assess the effect of the 2016 US Preventive Services Task Force (USPSTF) recommendation of statins on racial/ethnic disparities in treatment adherence. Methods: Utilizing records of the novel All of Us Research Program, a dataset of historically underrepresented groups in health research, we compared statin use in adult ASCVD non-Hispanic White (NHW) patients before (2014-2016) and after (2017-2020) the USPSTF recommendation with Black and Hispanic patients. Statin use was measured as percent days covered (PDC). Trends were compared using a regression model with demographics and an indicator variable for the change in recommendation as covariates. Regression coefficients and p-values were analyzed to assess the effect of the policy. Results: The study included 94,883 unique statin prescription records belonging to a patient cohort of which 52% were female, 21% Black and 12% Hispanic, with a mean age of 61.93 years. There was poor statin adherence across all racial/ethinic subgroups (PDC &lt; 0.80). Following the policy, PDC increased 3.1% overall (p&lt;0.01), 12 percentage points in Black patients and no change in Hispanics with respect to NHW. Conclusion: Our results provide preliminary evidence that the 2016 USPSTF changes increased statin adherence, yet there were differential effects among racial/ethnic subgroups. To address population adherence disparities, more research is needed to inform policy that will facilitate access for underserved populations in the United States.

Modeling the impact of novel systemic treatments on lung cancer screening benefits.

Since low-dose computed tomography (LDCT) screening was shown to be effective in the National Lung Screening Trial (NLST), novel targeted therapies and immunotherapies for advanced lung cancer have become available. This study investigated the impact of these treatment advances on the expected benefits of LDCT screening. A microsimulation model of LDCT screening for high-risk individuals under standard systemic treatments (chemotherapy and radiation therapy) and novel treatments (immunotherapy and targeted therapy) was used. The model assumed a reduction in advanced-stage disease consistent with the NLST, and given the stage at diagnosis, it projected survival. The disease-specific relative mortality reduction (MR) due to LDCT screening was projected in the trial setting and in a population eligible for LDCT screening under the current US Preventive Services Task Force (USPSTF) recommendations. The availability of novel treatments reduced the MR in the LDCT arm of the NLST from 15% to 13.5% and the number of lung cancer deaths prevented from 310 to 224 per 100,000 persons screened. Over 10years, population LDCT screening based on USPSTF recommendations prevented 374 lung cancer deaths per 100,000 under standard treatments (13.3% MR) and 236 per 100,000 under fully adopted novel treatments (10.6% MR). The number needed to screen to avert one death over 10 years was 270 under standard treatments and 440 under novel treatments. The transition from standard systemic treatments to novel treatments is expected to reduce the relative and absolute mortality benefits of LDCT screening. Benefit-harm tradeoffs of LDCT screening are likely to change as novel treatments become widespread.

Association of disability with long-term noncompliance of breast cancer screening.

118 Background: Although the U.S. Preventive Services Task Force (USPSTF) recommends a biennial screening mammography for women aged 50 to 74 years at average risk for breast cancer, 24.6% of screening-eligible women do not follow the recommendation. Very little is known regarding the association between various types of disabilities and subsequent breast cancer screening behaviors following the initiation of screening mammography. This study examines the association of disability with short-term vs. long-term noncompliance of having a mammogram. Methods: Using data from 2016, 2018, and 2020 Behavioral Risk Factor Surveillance System annual surveys, we constructed the study cohort of women aged 55 to 74 years who did not have a cancer history and who received a mammogram at least once in the past. Outcomes are short-term (2 years) and long-term (5 years) noncompliance of USPSTF recommendations. Key independent variables are six binary variables of standard functional disability conditions (hearing, vision, cognition, ambulation, self-care, and independent living) in the first model and a categorized total number of disabilities (0, 1, 2, ≥3) in the second model. We employed a multivariable logistic regression model, adjusting individuals’ socio-demographics, general health status, chronic conditions, health risk factors, and metropolitan statistical areas (MSA), and accounting for complex survey design. Results: Among the study cohort (n = 232,143; weighted n = 29,358,431), 18.1% and 7.1% of women reported not having mammography in the past two and five years, respectively, representing short- vs. long-term noncompliance. Of the study cohort, 32.8% had any type of disability (ambulation 22.7%, cognition 11.0%, independent living 8.8%). Notably, the long-term noncompliance rate was highest among women with a disability and residing in non-MSA (10.2%). In multivariable analysis, while only disability in independent living was associated with short-term noncompliance (odds ratio [OR] 1.28; 95% confidence interval [CI] 1.15-1.42), disability in independent living (OR 1.34; 95% CI 1.18-1.52), vision (OR 1.15; 95% CI 1.01-1.32) and ambulation (OR 1.12; 95% CI 1.01-1.24) were all significantly associated with long-term noncompliance. Women with ≥3 disabilities were 1.64 times more likely to be non-compliant in the long term, and the association of disability with noncompliance was more pronounced in non-MSA. Conclusions: This study provides the first empirical evidence on the positive association between disability and screening noncompliance, especially in the long term. It suggests disability could aggravate disparities in timely access to cancer screening, particularly in non-MSA. Understanding how various types of disabilities affect screening behavior is a critical step for public health efforts in cancer prevention and control through identifying vulnerable subgroups for targeted interventions.

USPSTF: Taking vitamin, mineral, and multivitamin supplements doesn't prevent CVD and cancer

USPSTF: Taking vitamin, mineral, and multivitamin supplements doesn't prevent CVD and cancer

Assessing Information Available for Health Professionals and Potential Participants on Lung Cancer Screening Program Websites: Cross-sectional Study.

BackgroundLung cancer is the leading cause of cancer death worldwide. The US Preventive Services Task Force (USPSTF) updated recommendations for lung cancer screening in 2021, adjusting the age of screening to 50 years (from 55 years) and reducing the number of pack-years used to estimate total firsthand cigarette smoke exposure to 20 (from 30). With many individuals using the internet to find health care information, it is important to understand what information is available for individuals contemplating lung cancer screening.ObjectiveThis study aimed to assess the eligibility criteria and information available on lung cancer screening program websites for both health professionals and potential screening participants.MethodsA descriptive cross-sectional analysis of 151 lung cancer screening program websites of academic (n=76) and community medical centers (n=75) in the United States with information for health professionals and potential screening participants was conducted in March 2021. Presentation of eligibility criteria for potential screening participants and presence of information available specific to health professionals about lung cancer screening were the primary outcomes. Secondary outcomes included presentation of information about cost and smoking cessation, inclusion of an online risk assessment tool, mention of any clinical guidelines, and use of multimedia to present information.ResultsEligibility criteria for lung cancer screening was included in nearly all 151 websites (n=142, 94%), as well as age range (n=139, 92.1%) and smoking history (n=141, 93.4%). Age was only consistent with the latest recommendations in 14.5% (n=22) of websites, and no websites had updated smoking history. Half the websites (n=76, 50.3%) mentioned screening costs as related to the type of insurance held. A total of 23 (15.2%) websites featured an online assessment tool to determine eligibility. The same proportion (n=23, 15.2%) hosted information specifically for health professionals. In total, 44 (29.1%) websites referred to smoking cessation, and 46 (30.5%) websites used multimedia to present information, such as short videos or podcasts.ConclusionsMost websites of US lung cancer screening programs provide information about eligibility criteria, but this is not consistent and has not been updated across all websites following the latest USPSTF recommendations. Online resources require updating to present standardized information that is accessible for all.

Statin Usage in Primary Prevention—Comparing the USPSTF Recommendations With the AHA/ACC/Multisociety Guidelines

This Editorial compares the US Preventive Services Task Force (USPSTF) recommendations with the American Heart Association/American College of Cardiology (AHA/ACC)/multisociety guidelines on statin usage in primary prevention.

USPSTF concludes daily aspirin may hurt more than help, especially for older adults

USPSTF concludes daily aspirin may hurt more than help, especially for older adults

Impact of U.S. Preventive Services Task Force lung cancer screening update on drivers of disparities in screening eligibility.

In 2021, the U.S. Preventive Services Task Force (USPSTF) updated its recommendation to expand lung cancer screening (LCS) eligibility and mitigate disparities. Although this increased the number of non-White individuals who are eligible for LCS, the update's impact on drivers of disparities is less clear. This analysis focuses on racial disparities among Black individuals because members of this group disproportionately share late-stage lung cancer diagnoses, despite typically having a lower intensity smoking history compared to non-Hispanic White individuals. We used data from the National Health Interview Survey to examine the impact of the 2021 eligibility criteria on racial disparities by factors such as education, poverty, employment history, and insurance status. We also examined preventive care use and reasons for delaying medical care. When comparing Black individuals and non-Hispanic White individuals, our analyses show significant differences in who would be eligible for LCS: Those who do not have a high school diploma (28.7% vs. 17.0%, p=0.002), are in poverty (26.2% vs. 14.9%, p < 0.001), and have not worked in the past 12 months (66.5% vs. 53.9%, p=0.009). Further, our analyses also show that more Black individuals delayed medical care due to not having transportation (11.1% vs. 3.6%, p < 0.001) compared to non-Hispanic White individuals. Our results suggest that despite increasing the number of Black individuals who are eligible for LCS, the 2021 USPSTF recommendation highlights ongoing socioeconomic disparities that need to be addressed to ensure equitable access.

Deep Learning to Optimize Candidate Selection for Lung Cancer CT Screening: Advancing the 2021 USPSTF Recommendations

Background A deep learning (DL) model to identify lung cancer screening candidates based on their chest radiographs requires external validation with a recent real-world non-U.S. sample. Purpose To validate the DL model and identify added benefits to the 2021 U.S. Preventive Services Task Force (USPSTF) recommendations in a health check-up sample. Materials and Methods This single-center retrospective study included consecutive current and former smokers aged 50-80 years who underwent chest radiography during a health check-up between January 2004 and June 2018. Discrimination performance, including receiver operating characteristic curve analysis and area under the receiver operating characteristic curve (AUC) calculation, of the model for incident lung cancers was evaluated. The added value of the model to the 2021 USPSTF recommendations was investigated for lung cancer inclusion rate, proportion of selected CT screening candidates, and positive predictive value (PPV). Results For model validation, a total of 19 488 individuals (mean age, 58 years ± 6 [SD]; 18 467 [95%] men) and the subset of USPSTF-eligible individuals (n = 7835; mean age, 57 years ± 6; 7699 [98%] men) were assessed, and the AUCs for incident lung cancers were 0.68 (95% CI: 0.62, 0.73) and 0.75 (95% CI: 0.68, 0.81), respectively. In individuals with pack-year information (n = 17 390), when excluding low- and indeterminate-risk categories from the USPSTF-eligible sample, the proportion of selected CT screening candidates was reduced to 35.8% (6233 of 17 390) from 45.1% (7835 of 17 390, P < .001), with three missed lung cancers (0.2%). The cancer inclusion rate (0.3% [53 of 17 390] vs 0.3% [56 of 17 390], P = .85) and PPV (0.9% [53 of 6233] vs 0.7% [56 of 7835], P = .42) remained unaffected. Conclusion An externally validated deep learning model showed the added value to the 2021 U.S. Preventive Services Task Force recommendations for low-dose CT lung cancer screening in reducing the number of screening candidates while maintaining the inclusion rate and positive predictive value for incident lung cancer. © RSNA, 2022 Online supplemental material is available for this article.

Cotesting for Human Immunodeficiency Virus and Sexually Transmitted Infections in the Emergency Department.

The Centers for Disease Control and Prevention (CDC) and US Preventive Services Task Force (USPSTF) guidelines recommend screening for human immunodeficiency virus (HIV) in patients aged 15 to 65 years, as well as those at increased risk. Patients screened in the emergency department (ED) for gonorrhea (GC) and/or chlamydia represent an increased-risk population. Our aim was to assess compliance with CDC and USPSTF guidelines for HIV testing in a national sample of EDs. We examined data from the 2010 to 2018 Nationwide Emergency Department Sample, which can be used to create national estimates of ED care to query tests for GC, chlamydia, HIV, and syphilis testing. Weighted proportions and 95% confidence intervals (CIs) were reported, and Rao-Scott χ 2 tests were used. We identified 13,443,831 (weighted n = 3,094,214) high-risk encounters in which GC/chlamydia testing was performed. HIV screening was performed in 3.9% (95% CI, 3.4-4.3) of such visits, and syphilis testing was performed in 2.9% (95% CI, 2.7-3.2). Only 1.5% of patients with increased risk encounters received both HIV and syphilis cotesting. Despite CDC and USPSTF recommendations for HIV and syphilis screening in patients undergoing STI evaluation, only a small proportion of patients are being tested. Further studies exploring the barriers to HIV screening in patients undergoing STI assessment in the ED may help inform future projects aimed at increasing guidance compliance.

Inclusion of the US Preventive Services Task Force Recommendation for Mammography in State Comprehensive Cancer Control Plans in the US

The recommendations for the age and frequency that women at average risk for breast cancer should undergo breast cancer mammography screening have been a matter of emotional, political, and scientific debate over the past decades. Multiple national organizations provide recommendations for breast cancer screening age and frequency. US Centers for Disease Control and Prevention (CDC) funding for state comprehensive cancer control (CCC) planning requires compliance with stated objectives for attaining goals. US Preventive Services Task Force (USPSTF) recommendations on cancer prevention and control are currently used to require coverage of prevention services. To evaluate the consistency of state CCC plan objectives compared with the most current (2016) USPSTF recommendations for the age and frequency that individuals should undergo mammography screening and to make recommendations for improvement of state CCC plans. This cross-sectional study used a descriptive, point-in-time evaluation and was conducted from November 1, 2019, to June 30, 2021. In November 2019, the most recent CCC plans from 50 US states and the District of Columbia were downloaded from the CDC website. The recommended ages at which to begin and end mammography examinations and the frequency of mammography examinations were extracted from plan objectives. The recommendations found in CCC plan objectives regarding the ages at which to begin and end mammography examinations and the frequency of mammography examinations for women with average risk for breast cancer were compared with USPSTF recommendations. Of the 51 CCC plans, 16 (31%) were consistent with all USPSTF recommendations for age and frequency that women at average risk should undergo mammography. Twenty-six plans (51%) were partially consistent with recommendations, and 9 plans (18%) were not consistent with any of the 3 guideline components. Compared with the USPSTF recommendation, state CCC plans are not homogenous regarding the age and frequency that women at average risk for breast cancer should undergo mammography. This variation is partially due to differences in state-specific planning considerations and discretion, variations in recommendations among national organizations, and publication of plans prior to the most current USPSTF recommendation (2016). Specifying the concept that high-risk populations need different age and frequency of screening recommendations than the general population may reduce heterogeneity among plans.

USPSTF recommends anxiety screening for ages 8 to 18

Observing adequate evidence that treatment of anxiety with psychotherapy is associated with a moderate magnitude of benefit (e.g., treatment response, disease remission or resolution) for children and adolescents ages 8 to 18, the U.S. Preventive Services Task Force (USPSTF) on April 12 posted draft recommendation statements on screening for depression and suicide risk in children and adolescents. The task force recommends screening children 12 and older for depression and, for the first time, is recommending screening children ages 8 and older for anxiety.

Trends in Incidence of Metastatic Prostate Cancer in the US

The US Preventive Services Task Force (USPSTF) has recommended against routine prostate-specific antigen (PSA)-based prostate cancer (PCa) screening, initially for men older than 75 years in 2008, and then for all men in 2012. Concern has been raised that, by recommending against screening, and thus early detection, the USPSTF recommendations may be associated with an increase in the incidence of metastatic PCa (mPCa). To explore the incidence of mPCa before and after the USPSTF recommendations against routine PCa screening. This population-based cohort study used the recently released Surveillance, Epidemiology, and End Results (SEER) 18 registry incidence data to identify men aged 45 years and older with a diagnosis of invasive PCa from 2004 through 2018. Data were analyzed from January 1, 2004 to December 31, 2018. Outcomes were assessed before vs after the USPSTF recommendations against routine screening. Annual age-adjusted incidence rates per 100 000 population of mPCa (defined using SEER Summary Stage and American Joint Committee on Cancer [AJCC] staging systems), with adjustments for age structure and reporting delay from 2004 to 2011, according to race and age were examined. Annual percentage changes (APCs) were calculated to quantify changes in the annual incidence rates. From 2004 to 2018, a total of 836 282 patients with PCa were recorded in the SEER database; 26 642 (56.5%) distant mPCa cases were reported in men aged 45 to 74 years, and 20 507 (43.5%) cases were reported in men aged 75 years or older. Among men aged 45 to 74 years, the incidence rate of distant mPCa (SEER Summary staging) remained stable during 2004 to 2010 (APC, -0.4%; 95% CI, -1.7% to 1.1%; P = .60), then increased significantly during 2010 to 2018 (APC, 5.3%; 95% CI, 4.5% to 6.0%; P < .001). In men aged 75 years or older, the incidence rate of distant mPCa decreased from 2004 to 2011 (APC, -1.5%; 95% CI, -3.0% to 0%; P = .046), and then increased from 2011 to 2018 (APC, 6.5%; 95% CI, 5.1% to 7.8%; P < .001). Similar trends were also seen for M1 mPCa defined per the AJCC staging system. These increased trends in mPCa incidence were particularly significant in non-Hispanic White men (2010-2018 APC, 6.9%; 95% CI, 5.4% to 8.4%; P < .001). Analysis of the emerging trends from the most recently released SEER data set (2004-2018) suggests that the incidence rates of mPCa have increased significantly and coincide temporally with the USPSTF recommendations against PCa screening across races and age groups. These mPCa trends are associated with reported changes in screening practices following the USPSTF recommendations.