United States Preventive Services Task Force
{{Short description|US government medical review and recommendation panel}}
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".{{cite web|url=https://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/index.html|website=Agency for Healthcare Research Quality|title=Clinical Guidelines and Recommendations}} 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.{{cite web|url=http://www.ahrq.gov/clinic/uspstfab.htm |title=U.S. Preventive Services Task Force: About USPSTF|date=November 2014|website=Agency for Healthcare Research Quality}}{{cite web |last=Selyukh |first=Alina |date=December 18, 2011 |title=Factbox: How the U.S. Preventive Services Task Force works |url=https://www.reuters.com/article/us-factbox-how-the-us-preventive-service-idUKTRE7BH0CB20111218/ |website=Reuters |via=Reuters}}
Intent
The USPSTF evaluates scientific evidence to determine whether medical screenings, counseling, and preventive medications work for adults and children who have no symptoms.
Methods
The methods of evidence synthesis used by the Task Force have been described in detail.{{cite web|title=Methods and Processes|website=US Preventive Services Task Force|url=http://www.uspreventiveservicestaskforce.org/Page/Name/methods-and-processes|access-date = 2015-10-22}} In 2007, their methods were revised.{{cite journal|author=Guirguis-Blake J, Calonge N, Miller T, 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}}{{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=}}
= No weight given to cost-effectiveness =
The USPSTF explicitly does not consider cost as a factor in its recommendations, and it does not perform cost-effectiveness analyses.{{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|first1=Mark V.|last1=Pauly|first2=Frank A.|last2=Sloan|first3=Sean D.|last3=Sullivan|doi=10.1377/hlthaff.2013.0873|pmid=25368000|doi-access=|url-access=subscription}} 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.{{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}}
=Grade definitions=
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.{{cite web|url=http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm|title=Grade Definitions|website=US Preventive Services Task Force}}
| class="wikitable"
!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.
Recommended prevention
The USPSTF has evaluated many interventions for prevention and found several have an expected net benefit in the general population.{{cite web|title = USPSTF A and B Recommendations by Date|url=http://www.uspreventiveservicestaskforce.org/Page/Name/uspstf-a-and-b-recommendations-by-date/|website=US Preventive Services Task Force|access-date = 2015-10-21}}
- 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.{{Cite journal|url=https://jamanetwork.com/journals/jama/fullarticle/2779985|doi=10.1001/jama.2021.6238|title=Screening for Colorectal Cancer|year=2021|last1=Davidson|first1=Karina W.|last2=Barry|first2=Michael J.|last3=Mangione|first3=Carol M.|last4=Cabana|first4=Michael|last5=Caughey|first5=Aaron B.|last6=Davis|first6=Esa M.|last7=Donahue|first7=Katrina E.|last8=Doubeni|first8=Chyke A.|last9=Krist|first9=Alex H.|last10=Kubik|first10=Martha|last11=Li|first11=Li|last12=Ogedegbe|first12=Gbenga|last13=Owens|first13=Douglas K.|last14=Pbert|first14=Lori|last15=Silverstein|first15=Michael|last16=Stevermer|first16=James|last17=Tseng|first17=Chien-Wen|last18=Wong|first18=John B.|last19=Wong|first19=J. B.|journal=JAMA|volume=325|issue=19|pages=1965–1977|pmid=34003218|s2cid=234769050|doi-access=free|url-access=subscription}}
- 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
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.{{cite web
| title = Breast Cancer: Screening (2009)
| url = https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening-2009
| website = United States Preventive Services Task Force
| date = December 15, 2009
| access-date = October 19, 2024}} 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.{{cite news
|title=Senate Affirms Screening Mammography for 40-Year-Olds|author=Walker, Emily|date= 3 December 2009|publisher=ABC News|access-date=3 December 2009|url=https://abcnews.go.com/Health/OnCallPlusBreastCancerNews/senate-affirms-screening-mammography-40-year-olds/story?id=9243563}} The 2016 recommendations maintained 50 as the age when routine screening should begin.{{cite web
| title = Breast Cancer: Screening (2016)
| url = https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening-january-2016
| website = United States Preventive Services Task Force
| date = January 11, 2016
| access-date = October 19, 2024}}
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.
| last = US Preventive Services Task Force
| title = Screening for Breast Cancer: US Preventive Services Task Force Recommendation Statement
| journal = JAMA
| volume = 331
| issue = 22
| date = April 30, 2024
| url = https://jamanetwork.com/journals/jama/fullarticle/2818283
| doi = 10.1001/jama.2024.5534| url-access = subscription
| last = Johnson
| first = Carla
| title = Breast cancer is on the rise in women in their 40s. An earlier mammogram may help catch it sooner
| newspaper = Associated Press
| date = April 30, 2024
| url = https://apnews.com/article/mammogram-breast-cancer-screening-guidelines-2b4ebc0dcd0335fd08d17e2e03bc7b23}}{{cite web
| title = Breast Cancer: Screening (2024)
| url = https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening
| website = United States Preventive Services Task Force
| date = April 30, 2024
| access-date = October 19, 2024}}
Prostate cancer screening
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 and 69. In 2018 the Task Force gave PCa screening a C recommendation.{{cite web|url=https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening|title=Screening for Prostate Cancer Recommendation Statement|website=US Preventive Services Task Force|date=October 2022}}
A final statement published in 2018 recommends basing the decision to screen on shared decision making in those 55 to 69 years old. It continues to recommend against screening in those 70 and older.{{cite web|title=Prostate Cancer: Screening: Screening|url=https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening|website=US Preventive Services Task |access-date=10 October 2022|language=en}}
History
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.{{Cite web |date=2020 |title=History Infographic EN |url=https://canadiantaskforce.ca/wp-content/uploads/2020/06/HistoryInfographicEN-20200612Final.pdf |website=canadiantaskforce.ca}} 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.{{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}}
References
{{Reflist}}
External links
- [http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/uspstf/index.html USPSTF on Agency for Healthcare Research and Quality (AHRQ) website]
- [http://www.uspreventiveservicestaskforce.org USPSTF website]
{{Authority control}}
Preventive Services Task Force
Category:Agencies of the United States Public Health Service