US Preventive Services Task Force Recommendations
GeneralThis 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
Each intervention receives an evidence-based grading set by the USPSTF. They are:
2005 TASK FORCE RATINGS
Strength of RecommendationsThe 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.
Grade Definitions After May 2007
What the Grades Mean and Suggestions for PracticeThe 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.
|Grade||Definition||Suggestions for Practice|
|A||The USPSTF recommends the service. There is high certainty that the net benefit is substantial.||Offer or provide this service.|
|B||The 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.|
|C||The 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.|
|D||The 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 Statement||The 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.|
|High||The 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.|
|Moderate||The 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: |
|Low||The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of: |
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