US Preventive Services Task Force Recommendations

General

This section is designed to be a quick reference to the best screening and prevention recommendations from the least biased sources. They are the US Preventive Services Task Force (USPSTF), the US Centers for Disease Control (CDC), the American Academy of Pediatrics, and the American Academy of Family Physicians.
The recommendations below should be tailored to patients' preferences. For example, “The USPSTF recommends biennial screening mammography for women aged 50 to 74 years” recommendation is just that, a recommendation; screening every year or starting earlier is a decision to be made between you and the patient. An Informed Consent discussion for screening empowers the patient and the clinician to use these recommendations in a patient-centered manner.
Absent in these recommendations are “vested interests.” Many disease-specific groups (the American Cancer Society, the American Heart Association, the National Osteoporosis Foundation, etc.) suggest interventions that serve their goals but do not always have a strong evidence base. The USPSTF provides the most unbiased, evidence-based recommendations.
—Frank J. Domino, MD
Editor-in-Chief
Each intervention receives an evidence-based grading set by the USPSTF. They are:

2005 TASK FORCE RATINGS

Strength of Recommendations

The USPSTF grades its recommendations according to 1 of 5 classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).

  • A: The USPSTF strongly recommends clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
  • B: The USPSTF recommends clinicians provide [this service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
  • C: The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence [the service] can improve health outcomes but concludes the balance of benefits and harms is too close to justify a general recommendation.
  • D: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
  • I: The USPSTF concludes the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence the [service] is effective is lacking, of poor quality, or conflicting and the net benefit cannot be determined.
In 2008, the USPSTF updated their rating system for all new recommendations; they are:

Grade Definitions After May 2007

What the Grades Mean and Suggestions for Practice

The USPSTF has updated its definitions of the grades it assigns to recommendations and now includes “suggestions for practice” associated with each grade. The USPSTF has also defined levels of certainty regarding net benefit. These definitions apply to USPSTF recommendations voted on after May 2007.
GradeDefinitionSuggestions for Practice
AThe USPSTF recommends the service. There is high certainty that the net benefit is substantial.Offer or provide this service.
BThe USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.Offer or provide this service.
CThe USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.
DThe USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.Discourage the use of this service.
I StatementThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.Read the clinical considerations section of the USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.
Levels of Certainty Regarding Net Benefit
Level of 
Certainty*Description
HighThe available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is, therefore, unlikely to be strongly affected by the results of future studies.
ModerateThe available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by such factors as:
  • The number, size, or quality of individual studies.
  • Inconsistency of findings across individual studies.
  • Limited generalizability of findings to routine primary care practice.
  • Lack of coherence in the chain of evidence.
As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.
LowThe available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of:
  • The limited number or size of studies.
  • Important flaws in study design or methods.
  • Inconsistency of findings across individual studies.
  • Gaps in the chain of evidence.
  • Findings not generalizable to routine primary care practice.
  • Lack of information on important health outcomes.
More information may allow estimation of effects on health outcomes.
*The USPSTF defines certainty as “likelihood that the USPSTF assessment of the net benefit of a preventive service is correct.” The net benefit is defined as benefit minus harm of the preventive service as implemented in a general, primary care population. The USPSTF assigns a certainty level based on the nature of the overall evidence available to assess the net benefit of a preventive service.



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TY - ELEC T1 - US Preventive Services Task Force Recommendations ID - 117265 Y1 - 2019 PB - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/117265/all/US_Preventive_Services_Task_Force_Recommendations ER -