Screening for Ovarian Cancer: Recommendation Statement

This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on screening for ovarian cancer and the supporting evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, Second Edition: Periodic Updates.1 In 1996, the USPSTF recommended against routine screening for ovarian cancer (a “D” recommendation). Explanations of the ratings and of the strength of overall evidence are given in Appendix A and in Appendix B, respectively. The complete information on which this statement is based, including evidence tables and references, is available in the brief evidence update “Screening for Ovarian Cancer,”2 available through the USPSTF Web site at http://www.preventiveservices.ahrq.gov and through the National Guideline Clearinghouse™ (http://www.guideline.gov). The recommendation statement and brief evidence updates are also available from the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse in print through subscription to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates

Screening for Visual Impairment in Children Younger Than Age 5 Years: Recommendation Statement

This statement summarizes the U.S. Preventive Services Task Force recommendation on screening for visual impairment in children younger than age 5 years and the supporting evidence, and updates the 1996 recommendations contained in the Guide to Clinical Preventive Services, Second Edition: Periodic Updates. In updating its recommendations for children, the USPSTF limited its review to the most common causes of visual impairment: amblyopia (including amblyogenic risk factors), and refractive error not associated with amblyopia. Explanations of the ratings and of the strength of overall evidence are given in Appendix A and Appendix B, respectively. The complete information on which this statement is based, including evidence tables and references, is available in the systematic evidence review1 and the update of the evidence2 on this topic, available through the USPSTF Web site http://www.preventiveservices. ahrq.gov and through the National Guideline Clearinghouse™ (http://www.guideline.gov.) The recommendation statement and update of the evidence are also available from the Agency for Healthcare Research and Quality (AHRQ) Publications Clearinghouse in print through subscription to the Guide to Clinical Preventive Services, Third Edition: Periodic Updates

Partner Interference with Health Care: Do We Want One More Piece of a Complex Puzzle?

As I sit down to write, scattered images of former patients fill my mind: a well-educated, elderly woman presenting to the hospital 2 days after having a large myocardial infarction; a young diabetic woman with erratic blood glucose control; one of my colleague’s “frequent flyers” coming in to see me on a Friday afternoon, panicked, asking for yet another early refill of her hydrocodone; a very ill, middle-aged woman whose doting husband kept immaculate notes on her many medical issues and 12 medications. Each of these women has her own, complex story. Each had a partner who negatively interfered with her medical care

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

DESCRIPTION: Update of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for breast cancer. METHODS: The USPSTF reviewed the evidence on the following: effectiveness of breast cancer screening in reducing breast cancer-specific and all-cause mortality, as well as the incidence of advanced breast cancer and treatment-related morbidity; harms of breast cancer screening; test performance characteristics of digital breast tomosynthesis as a primary screening strategy; and adjunctive screening in women with increased breast density. In addition, the USPSTF reviewed comparative decision models on optimal starting and stopping ages and intervals for screening mammography; how breast density, breast cancer risk, and comorbidity level affect the balance of benefit and harms of screening mammography; and the number of radiation-induced breast cancer cases and deaths associated with different screening mammography strategies over the course of a woman's lifetime. POPULATION: This recommendation applies to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age. RECOMMENDATIONS: The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. (B recommendation) The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years. (C recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging (MRI), DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram. (I statement)

Counseling to prevent skin cancer : recommendations and rationale of the U.S. Preventive Services Task Force

Preventing skin cancer : findings of the Task Force on Community Preventive Services on Reducing Exposure to Ultraviolet Light. Rates of skin cancer, the most common cancer in the United States, are increasing. The most preventable risk factor for skin cancer is unprotected ultraviolet (UV) exposure. Seeking to identify effective approaches to reducing the incidence of skin cancer by improving individual and community efforts to reduce unprotected UV exposure, the Task Force on Community Preventive Services conducted systematic reviews of community interventions to reduce exposure to ultraviolet light and increase protective behaviors. The Task Force found sufficient evidence to recommend two interventions that are based on improvements in sun protective or "covering-up" behavior (wearing protective clothing including long-sleeved clothing or hats): educational and policy approaches in two settings--primary schools and recreational or tourism sites. They found insufficient evidence to determine the effectiveness of a range of other population-based interventions and recommended additional research in these areas: educational and policy approaches in child care centers, secondary schools and colleges, recreational or tourism sites for children, and workplaces; interventions conducted in health-care settings and targeted to both providers and children's parents or caregivers; media campaigns alone; and community wide multicomponent interventions. This report also presents additional information regarding the recommended community interventions, briefly describes how the reviews were conducted, provides resources for further information, and provides information that can help in applying the interventions locally. The U.S. Preventive Services Task Force conducted a systematic review of counseling by primary care clinicians to prevent skin cancer (CDC. Counseling to prevent skin cancer: recommendation and rationale of the U.S. Preventive Services Task Force. MMWR 2003;52[No. RR-15]:13-17), which is also included in this issue, the first jointly released findings from the Task Force on Community Preventive Services and the U.S. Preventive Services Task Force.Counseling to prevent skin cancer : recommendations and rationale of the U.S. Preventive Services Task Force. This statement summarizes the current U.S. Preventive Services Task Force (USPSTF) recommendation on counseling to prevent skin cancer and the supporting scientific evidence, and updates the 1996 recommendation contained in the Guide to Clinical Preventive Services, Second Edition (U.S. Preventive Services Task Force. Screening for skin cancer. In: Guide to clinical preventive services, 2nd ed. Washington DC: US Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 1996:141-52). The USPSTF finds insufficient evidence to recommend for or against routine counseling by primary care clinicians to prevent skin cancer. Although counseling parents may increase children's use of sunscreen, the USPSTF found little evidence to determine the effects of counseling on the sun protection behaviors of adults. These behaviors include wearing protective clothing, reducing excessive sun exposure, avoiding sun lamps and tanning beds, or practicing skin self-examination. The USPSTF, an independent panel of private sector experts in primary care and prevention, systematically reviews the evidence of effectiveness of a wide range of clinical preventive services, including screening tests, counseling, and chemoprevention. Members of the USPSTF represent the fields of family medicine, gerontology, obstetrics/gynecology, pediatrics, nursing, and prevention research.Preventing skin cancer : findings of the Task Force on Community Preventive Services on Reducing Exposure to Ultraviolet Light / prepared by Mona Saraiya, Karen Glanz, Peter Briss, Phyllis Nichols, Cornelia White, Debjani Das -- Counseling to prevent skin cancer : recommendations and rationale of the U.S. Preventive Services Task Force."October 17, 2003."Includes bibliographical references.Chronic DiseasePrevention and ControlRetirednot in validation spreadsheetnot in validation spreadshee

Randomized Controlled Trial on Effectiveness of Ultrasonography Screening for Breast Cancer in Women Aged 40–49 (J-START): Research Design

In cancer screening, it is essential to undertake effective screening with appropriate methodology, which should be supported by evidence of a reduced mortality rate. At present, mammography is the only method for breast cancer screening with such evidence. However, mammography does not achieve sufficient accuracy in breasts with high density at ages below 50. Although ultrasonography achieves better accuracy in Breast Cancer detection even in dense breasts, the effectiveness has not been verified. We have planned a randomized controlled trial to assess the effectiveness of ultrasonography in women aged 40–49, with a design to study 50 000 women with mammography and ultrasonography (intervention group), and 50 000 controls with mammography only (control group). The participants are scheduled to take second round screening with the same modality 2 years on. The primary endpoints are sensitivity and specificity, and the secondary endpoint is the rate of advanced breast cancers

Clinical Preventive Services: When Is the Juice Worth the Squeeze?

This paper provides an overview of clinical preventive services, including a definition of such services and the role of the U.S. Preventive Services Task Force in recommending which services should be routinely offered to patients. It also describes efforts to analyze the cost effectiveness of clinical preventive services and reviews the insurance coverage policies of private and public payers. Barriers to increased uptake of appropriate services are discussed and policy relevant issues are summarized

Targeted tuberculosis testing and interpreting tuberculin skin test results

The Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) recommend testing populations that are at increased risk for tuberculosis (TB) infection. Once TB disease has been ruled out, those who would benefit from treatment of latent TB infection (LTBI) should be offered this option regardless of their age. Treatment adherence and completion are important for those who initiate treatment.skintestresults_revised.pd

Screening for Otologic Functional Impairments in the Elderly: Whose Job is it Anyway?

Among the most prevalent of chronic conditions affecting older adults globally, hearing loss prevalence is increasing and its impact on society growing. Untreated hearing loss diminishes ones ability to communicate and its strong association with depression and cognitive decline adds further to the burden of hearing loss. Hearing health care is rarely included in the traditional medical exam for older adults, it is typically not considered a risk factor for cognitive decline or falls, and it is not a condition for which routine screening has been recommended by the U.S. Preventive Services Task Force. Yet in older adults, disability typically results from many small risks acting together with different people having a different pattern of multifactorial risk (U.S. Preventive Services Task Force, 2010). The importance of preventive hearing health care in primary care is discussed along with a screening strategy with targeted interventions designed to target older at risk adults

Screening for Gonorrhea: Recommendation Statement

The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk for infection (that is, if they are young or have other individual or population risk factors; see Clinical Considerations for further discussion of risk factors). B recommendation