1/10/2014

United States Preventive Services Task Force - Wikipedia, the free encyclopedia

UnitedStatesPreventiveServicesTaskForce
FromWikipedia,thefreeencyclopedia

TheUnitedStatesPreventiveServicesTaskForce(USPSTF)is"anindependentpanelofexpertsin primarycareandpreventionthatsystematicallyreviewstheevidenceofeffectivenessanddevelops recommendationsforclinicalpreventiveservices."[1]Thetaskforce,apanelofprimarycarephysicians andepidemiologists,isfunded,staffed,andappointedbytheU.S.DepartmentofHealthandHuman Services'AgencyforHealthcareResearchandQuality.[2][3]

Contents
1Methods 2Gradedefinitions 3Mammographyrecommendations 4Prostatecancerscreening 5History 6References 7Externallinks

Methods
ThemethodsofevidencesynthesisusedbytheTaskForcehavebeendescribedindetail.[4]In2007,their methodswererevised.[5][6]TheUSPSTFexplicitlydoesnotconsidercostasafactorinits recommendations.

Gradedefinitions
TheTaskForceassignsthelettergradesA,B,C,D,orItoeachofitsrecommendations,andincludes "suggestionsforpractice"foreachgrade.TheTaskForcealsodefinedlevelsofcertaintyregardingnet benefit.[7] GradeA.Recommended.Thereishighcertaintythatthenetbenefitissubstantial. GradeB.Recommended.Thereishighcertaintythatthenetbenefitismoderateorthereismoderate certaintythatthenetbenefitismoderatetosubstantial. GradeC.Norecommendation.Cliniciansmayprovidetheservicetoselectedpatientsdependingon individualcircumstances.However,formostindividualswithoutsignsorsymptomsthereislikelyto beonlyasmallbenefit. GradeD.TheTaskForcerecommendsagainstthisservice.Thereismoderateorhighcertaintythat theservicehasnonetbenefitorthattheharmsoutweighthebenefits. Istatement.Thecurrentevidenceisinsufficienttoassessthebalanceofbenefitsandharms. Levelsofcertaintyvaryfromhightolowaccordingtotheevidence. High.Consistentresultsfromwelldesignedstudiesinrepresentativepopulationsthatassessthe effectoftheserviceonhealthoutcomes.
http://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force 1/4

1/10/2014

United States Preventive Services Task Force - Wikipedia, the free encyclopedia

Moderate.Theevidenceissufficienttodeterminetheeffectsoftheservice,butconfidenceislimited. Theconclusionmightchangeasmoreinformationbecomesavailable. Low.Theevidenceisinsufficienttoassesseffectsonhealthoutcome.

Mammographyrecommendations
In2009,theUSPSTFupdateditsadviceforscreeningmammograms.[8]Screeningmammograms,or routinemammograms,areXraysgiventoapparentlyhealthywomenwithnosymptomsorevidenceof breastcancerinthehopeofdetectingthediseaseinanearly,easilytreatablestage.Theadviceaboutusing mammographyinthepresenceofsymptoms(suchasapalpablelumpinthebreast)isunchanged. Thepreviousadvicewasforallwomenovertheageof40toreceiveamammogrameveryonetotwo years.[9]Thenewadviceismoredetailed. Forwomenbetweentheagesof50and74,theyhaverecommendedroutinemammogramsonceeverytwo yearsintheabsenceofsymptoms.MostAmericanwomenwhoarediagnosedwithbreastcancerare diagnosedafterage60.[10] Norecommendationismadeaboutmammogramsinwomenovertheageof75,asverylittleresearchhas beenperformedinthisagegroup. TheTaskForcerecommendedagainstroutinemammographytoscreenasymptomaticwomenaged40to 49yearsforbreastcancer.Patientsinthisagegroupshouldbeeducatedabouttherisksandbenefitsof screening,andthedecisionwhethertoscreenornotshouldbebasedontheindividualsituationand preferences.[11]Theoldadvicewasbasedon"weak"evidenceforthisagegroup.[9]Thenewadviceis basedonimprovedscientificevidenceaboutthebenefitsandharmsassociatedwithmammographyandis consistentwithrecommendationsbytheWorldHealthOrganizationandothermajormedicalbodies.Their recommendationagainstroutine,suspicionlessmammogramsforyoungerwomendoesnotchangethe adviceforscreeningwomenataboveaverageriskfordevelopingbreastcancerorfortestingwomenwho haveasuspiciouslumporanyothersymptomsthatmightberelatedtobreastcancer. Thechangeintherecommendationforyoungerwomenhasbeencriticizedbysomephysiciansandcancer advocacygroups,suchasOtisBrawley,thechiefmedicalofficerfortheAmericanCancerSociety,[12]and praisedbyphysiciansandmedicalorganizationsthatsupportindividualizedandevidencebasedmedicine, suchasDonnaSweet,theformerchairoftheAmericanCollegeofPhysicians,whocurrentlyservesonits ClinicalEfficacyAssessmentSubcommittee.[13] TheUSPSTFrecommendation,whichfocusessolelyonclinicaleffectivenesswithoutregardtocost,[14] formallyreducesthegradegivenforevidencequalityfrom"B"to"C"(limitedevidencepreventsaone sizefitsallrecommendation)forroutinemammogramsinwomenundertheageof50.[15]WithagradeC recommendation,physiciansarerequiredtoconsideradditionalfactors,suchastheindividualwoman's personalriskofbreastcancer.Pendinghealthcarelegislationwouldrequireinsurancecompaniestocover anyandallpreventiveservicesthatreceivean"A"or"B"grade,butpermitthemtousediscretionon preventiveservicesthatreceiveaworsegrade.[15] TheVitteramendmenttopendinglegislationintheU.S.Senateinstructsinsurerstodisregardthetask force'srecommendationagainstfrequentroutinemammogramsinasymptomaticyoungerwomen,and requiresthemtoprovidefreeannualmammograms,evenforlowriskwomen,basedontheoutdated2002

http://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force

2/4

1/10/2014

United States Preventive Services Task Force - Wikipedia, the free encyclopedia

report.[15]Thisproposalisnotyetlawandmaychange.Theeffortsbypoliticianstorejectthecommittee's scientificfindingshavebeencondemnedasanexampleofunwarrantedpoliticalinterferenceinscientific research.[14]

Prostatecancerscreening
InMay2012,theTaskForcerecommendedagainstprostatespecificantigen(PSA)basedscreeningfor prostatecancer.ThetaskforcegavePSAscreeningaDrecommendation.[16]

History
From1984to1989,thetaskforce'sstatedpurposewasto"developrecommendationsforprimarycare cliniciansontheappropriatecontentofperiodichealthexaminations."[17]

References
1. ^http://www.ahrq.gov/clinic/uspstfix.htmAgencyforHealthcareResearchQuality 2. ^"U.S.PreventiveServicesTaskForce:AboutUSPSTF"(http://www.ahrq.gov/clinic/uspstfab.htm). RetrievedNovember2009. 3. ^Factbox:theU.S.PreventiveServicesTaskForceworks(http://news.yahoo.com/factboxupreventive servicestaskforceworks131521046.htmlHow),ByAlinaSelyukh|ReutersviaYahooNewsSun,Dec18, 2011. 4. ^"U.S.PreventiveServicesTaskForce:MethodsandBackground" (http://www.ahrq.gov/clinic/uspstmeth.htm).Retrieved20070823. 5. ^GuirguisBlakeJ,CalongeN,MillerT,SiuA,TeutschS,WhitlockE(2007)."CurrentprocessesoftheU.S. PreventiveServicesTaskForce:refiningevidencebasedrecommendationdevelopment". Ann.Intern.Med. 147(2):11722.PMID17576998(//www.ncbi.nlm.nih.gov/pubmed/17576998). 6. ^BartonMB,MillerT,WolffT, etal. (2007)."Howtoreadthenewrecommendationstatement:methods updatefromtheU.S.PreventiveServicesTaskForce". Ann.Intern.Med. 147(2):1237.PMID17576997 (//www.ncbi.nlm.nih.gov/pubmed/17576997). 7. ^"U.S.PreventiveServicesTaskForce:GradeDefinitions" (http://www.uspreventiveservicestaskforce.org/uspstf/grades.htm). 8. ^"Screeningforbreastcancer:U.S.PreventiveServicesTaskForcerecommendationstatement" (http://www.annals.org/content/151/10/716.full). Ann.Intern.Med. 151(10):71626,W236.November 2009.doi:10.1059/000348191511020091117000008(http://dx.doi.org/10.1059%2F0003481915110 20091117000008).PMID19920272(//www.ncbi.nlm.nih.gov/pubmed/19920272). 9. ^ a bScreeningforBreastCancer:RecommendationsandRationale (http://www.ahrq.gov/clinic/3rduspstf/breastCancer/brcanrr.htm)2002 10. ^Cancerofthebreast(http://seer.cancer.gov/statfacts/html/breast.html),SEERStatFactSheets,summarizing HornerMJ,RiesLAG,KrapchoM,etal.(eds).SEERCancerStatisticsReview,19752006 (http://seer.cancer.gov/csr/1975_2006/),NationalCancerInstitute.Bethesda,MD,basedonNovember2008 SEERdatasubmission,postedtotheSEERwebsite,2009. 11. ^http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm 12. ^"Taskforceopposesroutinemammogramsforwomenage4049"DanielleDellorto,CNNMedical Producerhttp://www.cnn.com/2009/HEALTH/11/16/mammography.recommendation.changes/index.html 13. ^"RoleofevidencebasedmedicineinclinicaldecisionmakingaddressedbyACPintestimony" (http://www.acponline.org/pressroom/sweet_testimony.htm?hp).AmericanCollegeofPhysicians.2December 2009. 14. ^ a bStubbs,JosephW.(24November2009)."StatementOnthePoliticizationofEvidencebasedClinical Research"(http://www.acponline.org/pressroom/pol_ebcr.htm).AmericanCollegeofPhysicians. 15. ^ a b cWalker,Emily(3December2009)."SenateAffirmsScreeningMammographyfor40YearOlds" (http://abcnews.go.com/Health/OnCallPlusBreastCancerNews/senateaffirmsscreeningmammography40year
http://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force 3/4

1/10/2014

United States Preventive Services Task Force - Wikipedia, the free encyclopedia

olds/story?id=9243563).ABCNews.Retrieved3December2009. 16. ^"ScreeningforProstateCancer:U.S.PreventiveServicesTaskForceRecommendationStatement" (http://www.uspreventiveservicestaskforce.org/prostatecancerscreening/prostatefinalrs.htm).May2012. 17. ^http://odphp.osophs.dhhs.gov/pubs/guidecps/uspstf.htmOfficeofDiseasePreventionandHealthPromotion

Externallinks
USPSTFonAHRQwebsite(http://www.ahrq.gov/CLINIC/uspstfix.htm) USPSTFwebsite(http://www.uspreventiveservicestaskforce.org) Retrievedfrom"http://en.wikipedia.org/w/index.php? title=United_States_Preventive_Services_Task_Force&oldid=572079824" Categories: GovernmentoftheUnitedStates Taskforces UnitedStatesDepartmentofHealthandHumanServicesagencies UnitedStatesnationalcommissions HealthpolicyintheUnitedStates Thispagewaslastmodifiedon8September2013at17:30. TextisavailableundertheCreativeCommonsAttributionShareAlikeLicenseadditionaltermsmay apply.Byusingthissite,youagreetotheTermsofUseandPrivacyPolicy. WikipediaisaregisteredtrademarkoftheWikimediaFoundation,Inc.,anonprofitorganization.

http://en.wikipedia.org/wiki/United_States_Preventive_Services_Task_Force

4/4