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United States Preventive Services Task Force

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The United States Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services".[1] The task force, a volunteer panel of primary care clinicians (including those from internal medicine, pediatrics, family medicine, obstetrics and gynecology, nursing, and psychology) with methodology experience including epidemiology, biostatistics, health services research, decision sciences, and health economics, is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality.[2][3]

Intent

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The USPSTF evaluates scientific evidence to determine whether medical screenings, counseling, and preventive medications work for adults and children who have no symptoms.

Methods

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The methods of evidence synthesis used by the Task Force have been described in detail.[4] In 2007, their methods were revised.[5][6]

No weight given to cost-effectiveness

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The USPSTF explicitly does not consider cost as a factor in its recommendations, and it does not perform cost-effectiveness analyses.[7] American health insurance groups are required to cover, at no charge to the patient, any service that the USPSTF recommends, regardless of how much it costs or how small the benefit is.[8]

Grade definitions

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The task force assigns the letter grades A, B, C, D, or I to each of its recommendations, and includes "suggestions for practice" for each grade. The Task Force also defined levels of certainty regarding net benefit.[9]

Grade Result Meaning
Grade A Recommended There is high certainty that the net benefit is substantial.
Grade B Recommended There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
Grade C No recommendation Clinicians may provide the service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit.
Grade D Recommended against The Task Force recommends against this service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
I statement Insufficient evidence The current evidence is insufficient to assess the balance of benefits and harms.

Levels of certainty vary from high to low according to the evidence.

  • High: Consistent results from well-designed studies in representative populations that assess the effect of the service on health outcomes.
  • Moderate: The evidence is sufficient to determine the effects of the service, but confidence is limited. The conclusion might change as more information becomes available.
  • Low: The evidence is insufficient to assess effects on health outcome.
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The USPSTF has evaluated many interventions for prevention and found several have an expected net benefit in the general population.[10]

  • Aspirin in men 45 to 79 and women 55 to 79 for cardiovascular disease
  • Colon cancer screening by colonoscopy, occult blood testing, or sigmoidoscopy in adults 45 to 75.[11]
  • Low-dose CT scans for adults 55 to 80 at increased risk of lung cancer
  • Osteoporosis screening via bone dual-energy X-ray absorptiometry (DEXA) in women over 65

Breast cancer screening

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The USPSTF has changed its breast cancer screening recommendations over the years, including at what age women should begin routine screening. In 2009, the task force recommended women at average risk for developing breast cancer should be screened with mammograms every two years beginning at age 50.[12] Previously, they had recommended beginning screening at age 40. The recommendation to begin screening at an older age received significant attention, including proposed congressional intervention.[13] The 2016 recommendations maintained 50 as the age when routine screening should begin.[14]

In April 2024, The USPSTF lowered the recommended age to begin breast cancer screening. Citing rising rates of breast cancer diagnosis and substantially higher rates among Black women in the United States, the task force recommends screening mammograms every two years beginning at age 40. This recommendation applies to all cisgender women and all other people assigned female at birth who are at average risk for breast cancer. [15][16][17]

Prostate cancer screening

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In the current recommendation published in 2018, the Task Force recommended that prostate-specific antigen (PSA)-based screening for prostate cancer screenings be an individual decision for men between the ages of 55 to 69.[18] In 2018 the Task Force gave PCa screening a C recommendation.[18]

A final statement published in 2018 recommends basing the decision to screen on shared decision making in those 55 to 69 years old.[19] It continues to recommend against screening in those 70 and older.[19]

History

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The initial USPSTF was created in 1984 as a 5 year appointment to "develop recommendations for primary care clinicians on the appropriate content of periodic health examinations" and was modelled on the Canadian Task Force on Preventive Health Care, established in 1976.[20] This initial 5 year project concluded in 1989 with the release of their report, the Guide to Clinical Preventive Services. In July 1990, the Department of Health and Human Services reconstituted the Task Force to continue and update these scientific assessments of preventive services.[21]

References

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  1. ^ "Clinical Guidelines and Recommendations". Agency for Healthcare Research Quality.
  2. ^ "U.S. Preventive Services Task Force: About USPSTF". Agency for Healthcare Research Quality. November 2014.
  3. ^ Selyukh, Alina (December 18, 2011). "Factbox: How the U.S. Preventive Services Task Force works". Reuters – via Yahoo News.
  4. ^ "Methods and Processes". US Preventive Services Task Force. Retrieved 2015-10-22.
  5. ^ Guirguis-Blake J, Calonge N, Miller T, Siu A, Teutsch S, Whitlock E (2007). "Current processes of the U.S. Preventive Services Task Force: refining evidence-based recommendation development". Ann. Intern. Med. 147 (2): 117–22. CiteSeerX 10.1.1.670.8563. doi:10.7326/0003-4819-147-2-200707170-00170. PMID 17576998. S2CID 19346342.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ^ Barton MB, Miller T, Wolff T, et al. (2007). "How to read the new recommendation statement: methods update from the U.S. Preventive Services Task Force". Ann. Intern. Med. 147 (2): 123–7. doi:10.7326/0003-4819-147-2-200707170-00171. PMID 17576997.
  7. ^ Pauly, Mark V.; Sloan, Frank A.; Sullivan, Sean D. (2014-11-01). "An Economic Framework For Preventive Care Advice". Health Affairs. 33 (11): 2034–2040. doi:10.1377/hlthaff.2013.0873. ISSN 0278-2715. PMID 25368000.
  8. ^ Carroll, Aaron E. (2014-12-15). "Forbidden Topic in Health Policy Debate: Cost Effectiveness". The New York Times. ISSN 0362-4331. Retrieved 2015-10-22.
  9. ^ "Grade Definitions". US Preventive Services Task Force.
  10. ^ "USPSTF A and B Recommendations by Date". US Preventive Services Task Force. Retrieved 2015-10-21.
  11. ^ Davidson, Karina W.; Barry, Michael J.; Mangione, Carol M.; Cabana, Michael; Caughey, Aaron B.; Davis, Esa M.; Donahue, Katrina E.; Doubeni, Chyke A.; Krist, Alex H.; Kubik, Martha; Li, Li; Ogedegbe, Gbenga; Owens, Douglas K.; Pbert, Lori; Silverstein, Michael; Stevermer, James; Tseng, Chien-Wen; Wong, John B.; Wong, J. B. (2021). "Screening for Colorectal Cancer". JAMA. 325 (19): 1965–1977. doi:10.1001/jama.2021.6238. PMID 34003218. S2CID 234769050.
  12. ^ "Breast Cancer: Screening (2009)". United States Preventive Services Task Force. December 15, 2009. Retrieved October 19, 2024.
  13. ^ Walker, Emily (3 December 2009). "Senate Affirms Screening Mammography for 40-Year-Olds". ABC News. Retrieved 3 December 2009.
  14. ^ "Breast Cancer: Screening (2016)". United States Preventive Services Task Force. January 11, 2016. Retrieved October 19, 2024.
  15. ^ US Preventive Services Task Force (April 30, 2024), "Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement", JAMA, 331 (22), doi:10.1001/jama.2024.5534
  16. ^ Johnson, Carla (April 30, 2024), "Breast cancer is on the rise in women in their 40s. An earlier mammogram may help catch it sooner", Associated Press
  17. ^ "Breast Cancer: Screening (2024)". United States Preventive Services Task Force. April 30, 2024. Retrieved October 19, 2024.
  18. ^ a b "Screening for Prostate Cancer Recommendation Statement". US Preventive Services Task Force. October 2022.
  19. ^ a b "Prostate Cancer: Screening: Screening". US Preventive Services Task. Retrieved 10 October 2022.
  20. ^ "History Infographic EN" (PDF). canadiantaskforce.ca. 2020.
  21. ^ "U.S. Preventive Services Task Force". Office of Disease Prevention and Health Promotion. Archived from the original on June 15, 2004.{{cite web}}: CS1 maint: unfit URL (link)
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