Prevention, Screening and Health Maintenance
Evidence-Based Screening Recommendation
Summaries for Counseling Patients
This work page allows you to reference the summarized recommendations of
the U. S. Preventive Services Task Force for the topics listed alphabetically below.
TOPIC (alphabetical order) |
REC |
RECOMMENDATION SUMMARY |
A |
B |
Recommend one-time screening for
abdominal aortic aneurysm (AAA) by ultrasonography in
men aged 65 to 75 who have ever smoked. |
B |
I |
Good studies, conflicting results. Many
studies showed benefit, largest did not. |
Bacteriuria |
A |
Good evidence that screening pregnant women for asymptomatic bacteriuria with urine culture significantly reduces symptomatic urinary tract infections, low birth weight, and preterm delivery. Not true for non-pregnant women or men. |
Bladder Cancer |
I |
The USPSTF concludes that
the current evidence is insufficient to assess the
balance of benefits and harms of screening for bladder
cancer in asymptomatic adults.
|
Blood Pressure |
A |
Good evidence that blood pressure measurement can identify adults at increased risk for cardiovascular disease due to high blood pressure, and good evidence that treatment of high blood pressure substantially decreases the incidence of cardiovascular disease and causes few major harms. |
Breast Cancer |
B, C |
Fair evidence that mammography screening every 12-33 months significantly reduces mortality from breast cancer. Evidence is strongest for women aged 50-69. For women aged 40-49, the evidence that screening mammography reduces mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller, than it is for older women. Most, but not all, studies indicate a mortality benefit for women undergoing mammography at ages 40-49, but the delay in observed benefit in women younger than 50 makes it difficult to determine the incremental benefit of beginning screening at age 40 rather than at age 50. |
Breastfeeding |
B |
Fair evidence that structured education and counseling programs can promote increased rates of breastfeeding. Insufficient evidence that brief counseling by primary care physician, peer counselors or written materials promote increase. |
C |
I |
Insufficient evidence to recommend for
or against screening asymptomatic persons for carotid
artery stenosis using physical examination or carotid
ultrasound. For selected high-risk patients, a
recommendation to discuss the potential benefits of
screening and carotid endarterectomy may be made on
other grounds. |
Cervical Cancer |
A |
Good evidence from multiple observational studies that screening with Pap smears reduces incidence of and mortality from cervical cancer. Evidence to determine the optimal starting and stopping age and interval for screening is limited. Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years. Consider stopping screening > 65 y/o if women has had adequate screening with 3 negative findings in past and no abnormal Pap tests in 10 yrs. Be alert to screen any women who has not had adequate screening in past. |
Chlamydial Infection |
A |
Good evidence that screening women at risk for chlamydial infection reduces the incidence of pelvic inflammatory disease and fair evidence that community-based screening reduces prevalence of chlamydial infection. Routinely screen all sexually active women aged 25 years and younger (including those pregnant), and other asymptomatic women at increased risk for chlamydial infection. |
Colorectal Cancer |
A |
Strongly recommends that clinicians
screen men and women 50 years of age or older for
colorectal cancer. |
Coronary Heart Disease |
D,I |
Recommends against routine screening
with resting ECG, exercise testing (ETT), or scanning
for coronary calcium for either the presence of severe
coronary artery stenosis (CAS) or the prediction of
coronary heart disease (CHD) events in adults at low
risk for CHD events. |
D
|
I |
Evidence is insufficient to recommend for or against routine screening for dementia in older adults. |
Dental Caries in Preschool Children |
I |
Evidence is insufficient to recommend
for or against routine risk assessment of preschool
children by primary care clinicians for the prevention
of dental disease. |
Depression |
B |
Good evidence that screening improves the accurate identification of depressed patients in primary care settings and that treatment of depressed adults identified in primary care settings decreases clinical morbidity. Insufficient evidence to recommend screening for adolescents and children. |
Diabetes Mellitus |
I, B |
The evidence is insufficient to
recommend for or against routinely screening
asymptomatic adults for type 2 diabetes, impaired
glucose tolerance, or impaired fasting glucose. |
Diet |
B,I |
Recommends intensive behavioral dietary
counseling for adult patients with hyperlipidemia and
other known risk factors for cardiovascular and
diet-related chronic disease. Intensive counseling can
be delivered by primary care clinicians or by referral
to other specialists, such as nutritionists or
dietitians. |
|
|
|
Drug Abuse |
I |
There is insufficient evidence to recommend for or against routine screening for drug abuse with standardized questionnaires or biologic assays. Including questions about drug use and drug-related problems when taking a history from all adolescent and adult patients may be recommended on other grounds.All pregnant women should be advised of the potential adverse effects of drug use on the development of the fetus.Clinicians should be alert to the signs and symptoms of drug abuse in patients and refer drug abusing patients to specialized treatment facilities where available. |
F |
B |
The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen women of childbearing age for intimate partner violence (IPV), such as domestic violence, and provide or refer women who screen positive to intervention services. This recommendation applies to women who do not have signs or symptoms of abuse.
|
G |
I |
The optimal approach to screening and diagnosis is uncertain. Expert panels in the United States recommend a 50-g 1-hour glucose challenge test (GCT) at 24 to 28 weeks' gestation, followed by a 100-g 3-hour oral glucose tolerance test (OGTT) for women who screen positive on the GCT. |
Glaucoma |
I |
Good evidence that screening can detect increased intraocular pressure (IOP) and early primary open-angle glaucoma (POAG) in adults. The USPSTF also found good evidence that early treatment of adults with increased IOP detected by screening reduces the number of persons who develop small, visual field defects, and that early treatment of those with early, asymptomatic POAG decreases the number of those whose visual field defects progress. The evidence, however, is insufficient to determine the extent to which screening—leading to the earlier detection and treatment of people with IOP or POAG—would reduce impairment in vision-related function or quality of life |
Gonorrhea |
B |
Fair evidence that screening tests can
accurately detect gonorrhea infection and good evidence
that antibiotics can cure gonorrhea infection. There is
fair evidence that screening pregnant women at high risk
for gonorrhea, including women at high risk because of
younger age, may prevent other complications associated
with gonococcal infection during pregnancy, such as
preterm delivery and chorioamnionitis. |
|
|
|
H |
B |
Screening for older adults for hearing impairment is recommended through:
|
Hearing, Newborn |
I |
Good evidence that newborn hearing
screening leads to earlier identification and treatment
of infants with hearing loss. However, evidence to
determine whether earlier treatment resulting from
screening leads to clinically important improvement in
speech and language skills at age 3 years or beyond is
inconclusive because of the design limitations in
existing studies. |
Hemoglobinopathies |
B,I |
Neonatal screening for sickle hemoglobinopathies is recommended to identify infants
who may benefit from antibiotic prophylaxis to prevent
sepsis.
Offering screening for hemoglobinopathies to pregnant women at the first prenatal visit is recommended, especially for those at high risk. There is insufficient evidence to recommend for or against routine screening for hemoglobinopathies in high-risk adolescents and young adults, but recommendations to offer such testing may be made on other grounds. All screening efforts must be accompanied by comprehensive counseling and treatment services. |
Hepatitis B Virus Infection |
A,D |
Good evidence that universal prenatal
screening for HBV infection using HBsAg substantially
reduces prenatal transmission of HBV and the subsequent
development of chronic HBV infection. The current
practice of vaccinating all infants against HBV
infection and postexposure prophylaxis with hepatitis B
immune globulin administered at birth to infants of HBV-infected
mothers substantially reduces the risk for acquiring HBV
infection. |
Hepatitis C Virus Infection |
D,I |
Good evidence that screening with
available tests can detect HCV infection in the general
population. The prevalence of HCV infection in the
general population is low, and most who are infected do
not develop cirrhosis or other major negative health
outcomes. There is no evidence that screening for HCV
infection leads to improved long-term health outcomes,
such as decreased cirrhosis, hepatocellular cancer, or
mortality. |
Herpes Simplex, Genital |
D |
Fair evidence that screening
asymptomatic pregnant women using serological screening
tests for HSV antibody does not reduce transmission of
HSV to newborn infants. Women who develop primary HSV
infection during pregnancy have the highest risk for
transmitting HSV infection to their infants. Because
these women are initially seronegative, serological
screening tests for HSV (enzyme-linked immunosorbent
assay [ELISA], immunoblot, and western blot assay [WBA])
do not accurately detect those at highest risk. |
|
|
|
Hormone Replacement Therapy |
D |
Good evidence that the use of combined estrogen and progestin results in both benefits and harms. Benefits include reduced risk for fracture (good evidence) and colorectal cancer (fair evidence). Combined estrogen and progestin has no beneficial effect on coronary heart disease and may even pose an increased risk (good evidence). Other harms include increased risk for breast cancer (good evidence), venous thromboembolism (good evidence), stroke (fair evidence), cholecystitis (fair evidence), dementia (fair evidence), and lower global cognitive function (fair evidence). |
|
|
|
Human Immunodeficiency Virus (HIV) Infection |
A |
Good evidence that rapid screening tests accurately detect HIV infection. The USPSTF also found good evidence that appropriately timed interventions, particularly highly active antiretroviral therapy (HAART), lead to improved health outcomes for many of those screened, including reduced risk for clinical progression and reduced mortality. Since false-positive test results are rare, harms associated with HIV screening are minimal. Potential harms of true-positive test results include increased anxiety, labeling, and effects on close relationships. Most adverse events associated with HAART, including metabolic disturbances associated with an increased risk for cardiovascular events, may be ameliorated by changes in regimen or appropriate treatment. The USPSTF concluded that the benefits of screening individuals at increased risk substantially outweigh potential harms. |
Hypothyroidism, Congenital |
A |
Screening for congenital hypothyroidism with thyroid function tests on dried-blood spot specimens is recommended for all newborns in the first week of life. |
I
|
|
|
L |
|
Screening for elevated lead levels by measuring blood lead at least once at age 12 months is recommended for:
|
Lipid Disorders |
A,B |
Good evidence that lipid measurement can
identify asymptomatic middle-aged people (men >
35, women > 45) at increased risk of coronary
heart disease and good evidence that lipid-lowering drug
therapy substantially decreases the incidence of
coronary heart disease in such people with abnormal
lipids and causes few major harms. |
Lung Cancer |
I |
Evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with either low dose computerized tomography (LDCT), chest x-ray (CXR), sputum cytology, or a combination of these tests |
Motor Vehicle Injuries |
|
The following counseling to all patients, and the parents of young patients, is recommended:
|
N
|
|
|
O |
I |
Approximately 15 percent of children and
adolescents aged 6 to 19 years are overweight and are at
risk for diabetes, elevated blood lipids, increased
blood pressure and their sequelae, as well as slipped
capital femoral epiphysis, steatohepatitis, sleep apnea,
and psychosocial problems. The USPSTF found fair
evidence that body mass index (BMI) is a reasonable
measure for identifying children and adolescents who are
overweight or are at risk for becoming overweight. There
is fair evidence that overweight adolescents and
children aged 8 years and older are at increased risk
for becoming obese adults. |
|
I |
Found good evidence that body mass index (BMI) is reliable and valid for identifying adults at increased risk for mortality and morbidity due to overweight and obesity. There is fair to good evidence that high-intensity counseling—about diet, exercise, or both—together with behavioral interventions aimed at skill development, motivation, and support strategies produces modest, sustained weight loss (typically 3-5 kg for 1 year or more) in adults who are obese (as defined by BMI > 30 kg/m2). Although the USPSTF did not find direct evidence that behavioral interventions lower mortality or morbidity from obesity, the USPSTF concluded that changes in intermediate outcomes, such as improved glucose metabolism, lipid levels, and blood pressure, from modest weight loss provide indirect evidence of health benefits |
Oral Cancer |
I |
No good-quality evidence that screening for oral cancer leads to improved health outcomes for either high-risk adults (i.e., those over the age of 50 who use tobacco) or for average-risk adults in the general population. |
Osteoporosis |
B |
The USPSTF recommends
screening for osteoporosis in women aged 65 years or
older and in younger women whose fracture risk is equal
to or greater than that of a 65-year-old white woman who
has no additional risk factors.
|
Ovarian Cancer |
D |
Fair evidence that screening with serum CA-125 level or transvaginal ultrasound can detect ovarian cancer at an earlier stage than it can be detected in the absence of screening; however, the USPSTF found fair evidence that earlier detection would likely have a small effect, at best, on mortality from ovarian cancer. Because of the low prevale e of ovarian cancer and the invasive nature of diagnostic testing after a positive screening test, there is fair evidence that screening could likely lead to important harms. |
P |
D |
No evidence that screening for pancreatic cancer is effective in reducing mortality. There is a potential for significant harm due to the very low prevalence of pancreatic cancer, limited accuracy of available screening tests, the invasive nature of diagnostic tests, and the poor outcomes of treatment |
Peripheral Arterial Disease |
D |
Fair evidence that screening with ankle brachial index can detect adults with asymptomatic PAD. The evidence is also fair that screening for PAD among asymptomatic adults in the general population would have few or no benefits because the prevalence of PAD in this group is low and because there is little evidence that treatment of PAD at this asymptomatic stage of disease, beyond treatment based on standard cardiovascular risk assessment, improves health outcomes. |
Phenylketonuria |
A |
Screening for phenylketonuria (PKU) by measurment of phenylalanine level on a dried-blood spot specimen is recommended for all newborns prior to discharge from the nursery. Infants who are tested before 24 hours of age should receive a repeat screening test by 2 weeks of age. |
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Prostate Cancer |
D |
The
USPSTF recommends against prostate-specific antigen
(PSA)-based screening for prostate cancer. |
R |
A,B |
Good evidence that Rh (D) blood typing,
anti-Rh (D) antibody testing, and intervention with Rh
(D) immunoglobulin, as appropriate, prevents maternal
sensitization and improves outcomes for newborns. The
benefits substantially outweigh any potential harms. |
Rubella |
|
Routine screening for rubella susceptibility by history of vaccination or by serology is recommended for all women of childbearing age at their first clinical encounter. Susceptible non-pregnant women should be offered rubella vaccination; susceptible pregnant women should be vaccinated immediately after delivery. An equally acceptable alternative for non-pregnant women of childbearing age is to offer vaccination against rubella without screening. |
S |
I |
Evidence is insufficient to recommend
for or against routine screening for skin cancer using a
total-body skin examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell
skin cancer. |
Suicide Risk |
I |
No evidence that screening for suicide
risk reduces suicide attempts or mortality. There is
limited evidence on the accuracy of screening tools to
identify suicide risk in the primary care setting,
including tools to identify those at high risk. |
Syphilis |
A |
Strongly recommends that clinicians
screen persons at increased risk for syphilis infection. |
T |
D |
No new evidence that screening with clinical examination or testicular self-examination is effective in reducing mortality from testicular cancer. Even in the absence of screening, the current treatment interventions provide very favorable health outcomes. Given the low prevalence of testicular cancer, limited accuracy of screening tests, and no evidence for the incremental benefits of screening, the USPSTF concluded that the harms of screening exceed any potential benefits. |
Thyroid Disease |
I |
Fair evidence that the thyroid stimulating hormone (TSH) test can detect sub-clinical thyroid disease in people without symptoms of thyroid dysfunction, but poor evidence that treatment improves clinically important outcomes in adults with screen-detected thyroid disease. Although the yield of screening is greater in certain high-risk groups (e.g., postpartum women, people with Down syndrome, and the elderly), the USPSTF found poor evidence that screening these groups leads to clinically important benefits. |
Thyroid Cancer |
D, C |
Routine screening for thyroid cancer using neck palpation or ultrasonography is not recommended for asymptomatic children or adults. There is insufficient evidence to recommend for or against screening persons with a history of external head and neck irradiation in infancy or childhood, but recommendations for such screening may be made on other grounds. |
Tobacco Use |
A |
Good evidence that brief smoking
cessation interventions, including screening, brief
behavioral counseling (less than 3 minutes), and
pharmacotherapy delivered in primary care settings, are
effective in increasing the proportion of smokers who
successfully quit smoking and remain abstinent after 1
year. |
Tuberculous Infection |
A |
Screening for tuberculous infection with tuberculin skin testing is recommended for asymptomatic high-risk persons. Bacille Calmette-Guerin (BCG) vaccination should be considered only for selected high-risk individuals. |
U |
|
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V |
|
Vision screening to detect amblyopia and strabismus is recommended once for all children before entering school, preferably between the ages of 3 and 4. Clinicians should be alert for signs of ocular misalignment when examining infants and children. Screening for diminished visual acuity with the Snellen visual acuity chart is recommended for elderly persons. There is insufficient evidence to recommend for or against screening for diminished visual acuity among other asymptomatic persons, but recommendations against routine screening may be made on other grounds.
|
Visual Impairment in Children Ages 0-5 |
B |
The USPSTF found no direct evidence that screening for visual impairment in children leads to improved visual acuity. However, the USPSTF found fair evidence that screening tests have reasonable accuracy in identifying strabismus, amblyopia, and refractive error in children with these conditions; that more intensive screening compared with usual screening leads to improved visual acuity; and that treatment of strabismus and amblyopia can improve visual acuity and reduce long-term amblyopia. |
Vitamin Supplementation to Prevent Cancer and Coronary Heart Disease |
I |
Evidence is insufficient to recommend for
or against the use of supplements of vitamins A, C, or
E; multivitamins with folic acid; or antioxidant
combinations for the prevention of cancer or
cardiovascular disease. |
Y |
|
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Grade Definitions
(Below)