United States Preventive Services Task Force: Difference between revisions

The methods of evidence synthesis used by the Task Force have been described in detail.<ref>{{cite web|title=Methods and Processes - |website=US Preventive Services Task Force|url=http://www.uspreventiveservicestaskforce.org/Page/Name/methods-and-processes|website=www.uspreventiveservicestaskforce.org|accessdateaccess-date = 2015-10-22}}</ref> In 2007, their methods were revised.<ref name=pmid17576998>{{cite journal|author=Guirguis-Blake J, Calonge N, Miller T, [[Albert Siu|Siu A]], Teutsch S, Whitlock E|title=Current processes of the U.S. Preventive Services Task Force: refining evidence-based recommendation development|journal=Ann. Intern. Med.|volume=147|issue=2|pages=117–22|year=2007|doi=10.7326/0003-4819-147-2-200707170-00170|pmid=17576998|citeseerx=10.1.1.670.8563|s2cid=19346342}}</ref><ref name=pmid17576997>{{cite journal|vauthors=Barton MB, Miller T, Wolff T, etal|title=How to read the new recommendation statement: methods update from the U.S. Preventive Services Task Force|journal=Ann. Intern. Med.|volume=147|issue=2|pages=123–7|year=2007|doi=10.7326/0003-4819-147-2-200707170-00171|pmid=17576997|doi-access=}}</ref>

The USPSTF explicitly does not consider cost as a factor in its recommendations, and it does not perform cost-effectiveness analyses.<ref name=":Branvani">{{cite journal|title=An Economic Framework For Preventive Care Advice|url=http://content.healthaffairs.org/content/33/11/2034|journal=Health Affairs|date=2014-11-01|issn=0278-2715|pages=2034–2040|volume=33|issue=11|firstfirst1=Mark V.|lastlast1=Pauly|first2=Frank A.|last2=Sloan|first3=Sean D.|last3=Sullivan|doi=10.1377/hlthaff.2013.0873|pmid=25368000|doi-access=}}</ref> 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.<ref name=":1">{{cite news|title = Forbidden Topic in Health Policy Debate: Cost Effectiveness|url=https://www.nytimes.com/2014/12/16/upshot/forbidden-topic-in-health-policy-debate-cost-effectiveness.html|newspaper = The New York Times|date=2014-12-15|access-date=2015-10-22|issn=0362-4331|first=Aaron E.|last=Carroll}}</ref>

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.<ref>{{cite web|url=http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm|title=U.S.Grade Definitions|website=US Preventive Services Task Force: Grade Definitions}}</ref>

The USPSTF has evaluated many interventions for prevention and found several have an expected net benefit in the general population.<ref>{{cite web|title = USPSTF A and B Recommendations by Date - US Preventive Services Task Force|url=http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations-by-date/|website=www.uspreventiveservicestaskforce.orgUS Preventive Services Task Force|accessdateaccess-date = 2015-10-21}}</ref>

|title=Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement|journal=Ann. Intern. Med.|volume=151|issue=10|pages=716–26, W–236|date=November 2009|doi=10.7326/0003-4819-151-10-200911170-00008|pmid=19920272|author1=US Preventive Services Task Force|url=httphttps://wwwcdr.annalslib.orgunc.edu/contentdownloads/151/10/716.full4t64gs692}}</ref> Screening mammograms, or routine mammograms, are X-rays given to apparently healthy women with no symptoms or evidence of [[breast cancer]] in the hope of detecting the disease in an early, easily treatable stage. The advice about using mammography in the presence of symptoms (such as a lump in the breast that can be felt) is unchanged.

The previous advice was for all women over the age of 40 to receive a mammogram every one to two years.<ref name=AHRQ2002>[{{cite web|url=http://www.ahrq.gov/clinic/3rduspstf/breastCancer/brcanrr.htm|website=Agency for Healthcare Research Quality|title=Screening for Breast Cancer: Recommendations and Rationale] |year=2002}}</ref> The new advice is more detailed. For women between the ages of 50 and 74, they have recommended routine mammograms once every two years in the absence of symptoms. Most American women who are diagnosed with breast cancer are diagnosed after age 60.<ref>[{{cite web|url=http://seer.cancer.gov/statfacts/html/breast.html|title= Stat Fact Sheets: Cancer of the breast], |website=[[SEER]]Surveillance, StatEpidemiology, Factand Sheets,End summarizingResults|SEER]]}}</ref><ref>{{cite report|last1=Horner |first1=MJ, |last2=Ries |first2=LAG, |last3=Krapcho |first3=M, |display-authors=et al. (eds). [|url=http://seer.cancer.gov/csr/1975_2006/ |title=SEER Cancer Statistics Review, 1975-2006], |publisher=[[National Cancer Institute]]. |location=Bethesda, MD|website=[[Surveillance, based on November 2008 SEER data submissionEpidemiology, postedand to theEnd Results|SEER web site, ]]|year=2009.}}</ref>

The Task Force made no recommendation about routine [[mammography]] to screen asymptomatic women aged 40 to 49 years for [[breast cancer]]. Patients in this age group should be educated about the risks and benefits of screening, and the decision whether to screen or not should be based on the individual situation and preferences.<ref>{{cite web|url=http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm|title=Final Update Summary: Breast Cancer: Screening|website=US Preventive Services Task Force}}</ref> The old advice was based on "weak" evidence for this age group.<ref name=AHRQ2002/> The new advice is based on improved scientific evidence about the benefits and harms associated with mammography and is consistent with recommendations by the [[World Health Organization]] and other major medical bodies. Their recommendation against routine, suspicion-less mammograms for younger women does not change the advice for screening women at above-average risk for developing breast cancer or for testing women who have a suspicious lump or any other symptoms that might be related to breast cancer.

The change in the recommendation for younger women has been criticized by some physicians and cancer advocacy groups, such as [[Otis Brawley]], the chief medical officer for the [[American Cancer Society]],<ref.[>{{cite web|url=http://www.cnn.com/2009/HEALTH/11/16/mammography.recommendation.changes/index.html "|title=Task force opposes routine mammograms for women age 40-49"] - |first=Danielle |last=Dellorto, |website=CNN Medical Producer}}</ref> and praised by physicians and medical organizations that support individualized and [[evidence-based medicine]], such as Donna Sweet, the former chair of the [[American College of Physicians]], who currently serves on its Clinical Efficacy Assessment Subcommittee.<ref name=ACP>{{cite web|url=http://www.acponline.org/pressroom/sweet_testimony.htm?hp|title=Role of evidence based medicine in clinical decision-making addressed by ACP in testimony|publisherwebsite=American College of Physicians|date=2 December 2009}}</ref>

|title=Senate Affirms Screening Mammography for 40-Year-Olds|author=Walker, Emily|date= 3 December 2009|publisher=ABC News|accessdateaccess-date=3 December 2009|url=httphttps://abcnews.go.com/Health/OnCallPlusBreastCancerNews/senate-affirms-screening-mammography-40-year-olds/story?id=9243563}}</ref> With a grade C recommendation, physicians are required to consider additional factors, such as the individual woman's personal risk of breast cancer. Pending health care legislation would require insurance companies to cover any and all preventive services that receive an "A" or "B" grade, but permit them to use discretion on preventive services that receive a worse grade.<ref name=Vitter-Mikulski/>

The Vitter amendment to the Mikulski amendment to pending legislation in the [[U.S. Senate]] instructs insurers to disregard the task force's recommendation against frequent routine mammograms in asymptomatic younger women, and requires them to provide free annual mammograms, even for low-risk women, based on the outdated 2002 report.<ref name=Vitter-Mikulski/> This proposal is not yet law and may change. {{update- inline|date=May 2018}} The efforts by politicians to reject the committee's scientific findings have been condemned as an example of unwarranted [[Politicization of science|political interference in scientific research]].<ref name=ACP2>{{cite web|title= Statement On the Politicization of Evidence-based Clinical Research|url= http://www.acponline.org/pressroom/pol_ebcr.htm|author= Stubbs, Joseph W.|publisherwebsite= American College of Physicians|date= 24 November 2009}}</ref>

In the current recommendation published in 20122018, the Task Force recommended againstthat [[prostate-specific antigen]] (PSA)-based screening for prostate cancer screenings be an individual decision for men between the ages of 55 to 69.<ref name=TaskForce2012/> TheIn 2018 the Task Force gave [[prostate cancer screening|PCa screening]] a DC recommendation.<ref name=TaskForce2012>{{cite web|url=httphttps://www.uspreventiveservicestaskforce.org/prostatecancerscreeninguspstf/prostatefinalrs.htmrecommendation/prostate-cancer-screening|title=Screening for Prostate Cancer: U.S.Recommendation Statement|website=US Preventive Services Task Force Recommendation Statement|date=MayOctober 20122022}}</ref>

A draftfinal statement published in 20172018 recommends basing to the decision to screen on shared decision making in those 55 to 69 years old.<ref name=TF2017DraftPC/> It continues to recommend against screening in those 70 and oldolder.<ref name=TF2017DraftPC>{{cite web|title=Draft Recommendation Statement: Prostate Cancer: Screening: - US Preventive Services Task ForceScreening|url=https://www.uspreventiveservicestaskforce.org/Pageuspstf/Document/RecommendationStatementDraftrecommendation/prostate-cancer-screening1screening|website=www.uspreventiveservicestaskforce.orgUS Preventive Services Task |accessdateaccess-date=1210 MarchOctober 20182022|language=en}}</ref>

FromThe 1984initial toUSPSTF 1989,was thecreated taskin force's1984 statedas purposea was5 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.<ref>{{Cite web |date=2020 |title=History Infographic EN |url=https://canadiantaskforce.ca/wp-content/uploads/2020/06/HistoryInfographicEN-20200612Final.pdf |website=canadiantaskforce.ca}}</ref> 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.<ref>{{cite web|url=http://odphp.osophs.dhhs.gov/pubs/guidecps/uspstf.htm |website=Office of Disease Prevention and Health Promotion|url-status=unfit|archive-url=https://web.archive.org/web/20040615012041/http://odphp.osophs.dhhs.gov/pubs/guidecps/uspstf.htm|archive-date=June 15, 2004|title=U.S. Preventive Services Task Force}}</ref>

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[[Category:Agencies of the United States Department ofPublic Health and Human Services agenciesService]]