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Colorectal Cancer Title Screening for Colorectal Cancer Population 1 Adults age 50 to 75 years Adults age 76 to 85 years Adults older than 85 Recommendation Screen with high sensitivity fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy. Grade: A Do not automatically screen. Grade: C Do not screen. Grade: D For all populations, evidence is insufficient to assess the benefits and harms of screening with computerized tomography colonography (CTC) and fecal DNA testing. Grade: I (Insufficient Evidence) 24 Screening Tests Screening Test Intervals High sensitivity FOBT, sigmoidoscopy with FOBT, and colonoscopy are effective in decreasing colorectal cancer mortality. The risks and benefits of these screening methods vary. Colonoscopy and flexible sigmoidoscopy (to a lesser degree) entail possible serious complications. Intervals for recommended screening strategies: ●● ●● ●● Annual screening with high-sensitivity fecal occult blood testing Sigmoidoscopy every 5 years, with high-sensitivity fecal occult blood testing every 3 years Screening colonoscopy every 10 years Balance of Benefits and Harms The benefits of screening outweigh the potential harms for 50- to 75-year-olds. The likelihood that detection and early intervention will yield a mortality benefit declines after age 75 because of the long average time between adenoma development and cancer diagnosis. Implementation Other Relevant USPSTF Recommendations Focus on strategies that maximize the number of individuals who get screened. Practice shared decisionmaking; discussions with patients should incorporate information on test quality and availability. Individuals with a personal history of cancer or adenomatous polyps are followed by a surveillance regimen, and screening guidelines are not applicable. The USPSTF recommends against the use of aspirin or nonsteroidal anti-inflammatory drugs for the primary prevention of colorectal cancer. This recommendation is available at http://www.uspreventiveservicestaskforce.org. 1 These recommendations do not apply to individuals with specific inherited syndromes (Lynch Syndrome or Familial Adenomatous Polyposis) or those with inflammatory bowel disease. For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.
Coronary Heart Disease (Risk Assessment, Nontraditional Risk Factors) Title Population Recommendation Using Nontraditional Risk Factors In Coronary Heart Disease Risk Assessment Asymptomatic men and women with no history of coronary heart disease (CHD), diabetes, or any CHD risk equivalent No recommendation. Grade: I (Insufficient Evidence) Risk Assessment This recommendation applies to adult men and women classified at intermediate 10-year risk for CHD (10% to 20%) by traditional risk factors. 25 Importance Coronary heart disease (CHD) is the most common cause of death in adults in the United States. Treatment to prevent CHD events by modifying risk factors is currently based on the Framingham risk model. If the classification of individuals at intermediate risk could be improved by using additional risk factors, treatment to prevent CHD might be targeted more effectively. Risk factors not currently part of the Framingham model (nontraditional risk factors) include high sensitivity C-reactive protein (hs-CRP), ankle-brachial index (ABI), leukocyte count, fasting blood glucose level, periodontal disease, carotid intima-media thickness, electron beam computed tomography, homocysteine level, and lipoprotein(a) level. Balacne of Benefits and Harms Suggestions for practice Other Relevant USPSTF Recommendations There is insufficient evidence to determine the percentage of intermediate-risk individuals who would be reclassified by screening with nontraditional risk factors, other than hs-CRP and ABI. For individuals reclassified as high-risk on the basis of hs-CRP or ABI scores, data are not available to determine whether they benefit from additional treatments. Little evidence is available to determine the harms of using nontraditional risk factors in screening. Potential harms include lifelong use of medications without proven benefit and psychological and other harms from being misclassified in a higher risk category. Clinicians should continue to use the Framingham model to assess CHD risk and guide risk-based preventive therapy. Adding nontraditional risk factors to CHD assessment would require additional patient and clinical staff time and effort. Routinely screening with nontraditional risk factors could result in lost opportunities to provide other important health services of proven benefit. USPSTF recommendations on risk assessment for CHD, the use of aspirin to prevent cardiovascular disease, and screening for high blood pressure can be accessed at http://www.uspreventiveservicestaskforce.org. For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.
Page 1 and 2: The Guide to Clinical Preventive Se
Page 3: The Guide to Clinical Preventive Se
Page 7 and 8: Preface The U.S. Preventive Service
Page 9: Selector (ePSS), available via PDA,
Page 12 and 13: Hemochromatosis, Screening.........
Page 15: Preventive Services Recommended by
Page 18 and 19: Section 1: Preventive Services Reco
Page 20 and 21: 4 13 Asymptomatic adults with susta
Page 23 and 24: Abdominal Aortic Aneurysm Title Scr
Page 25 and 26: Aspirin for the Prevention of Cardi
Page 27 and 28: Bacterial Vaginosis in Pregnancy Ti
Page 29 and 30: Bladder Cancer Title Population Rec
Page 31 and 32: Breast Cancer (Preventive Medicatio
Page 33 and 34: Breastfeeding Title Primary Care In
Page 35 and 36: Cervical Cancer Title Screening for
Page 37 and 38: Chronic Kidney Disease Title Popula
Page 39: Cognitive Impairment Title Populati
Page 43 and 44: Depression in Adults Title Populati
Page 45 and 46: Falls in Older Adults Title Populat
Page 47 and 48: Genital Herpes Time Screening for G
Page 49 and 50: Glaucoma Title Population Recommend
Page 51 and 52: Healthful Diet and Physical Activit
Page 53 and 54: Hemochromatosis Title Population Re
Page 55 and 56: Hepatitis C Virus Infection Title S
Page 57 and 58: HIV Infection Title Population Reco
Page 59 and 60: Impaired Visual Acuity in Older Adu
Page 61 and 62: Lipid Disorders in Adults Title Scr
Page 63 and 64: Menopausal Hormone Therapy Title Me
Page 65 and 66: Obesity in Adults Title Population
Page 67 and 68: Osteoporosis Title Screening for Os
Page 69 and 70: Peripheral Artery Disease Title Pop
Page 71 and 72: Sexually Transmitted Infections Tit
Page 73 and 74: Skin Cancer (Screening) Title Scree
Page 75 and 76: Syphilis (Pregnant Women) Title Pop
Page 77 and 78: Tobacco Use in Adults Title Counsel
Page 79: Vitamin Supplementation to Prevent
Page 83 and 84: Blood Lead Levels in Children and P
Page 85 and 86: Congenital Hypothyroidism Title Scr
Page 87 and 88: Gonococcal Ophthalmia Neonatorum Ti
Page 89 and 90: High Blood Pressure (Children) Titl
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Illicit and Prescription Drug Use i
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Iron Deficiency Anemia (Supplementa
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Major Depressive Disorder in Childr
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Phenylketonuria (PKU) Title Populat
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Speech and Language Delay Title Pop
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Visual Impairment in Children Ages
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Immunizations for Adults and Childr
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Topics in Progress Each USPSTF reco
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Appendixes and Index
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Grade Definitions What the Grades M
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Grade Definitions Prior to May 2007
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David Grossman, M.D., M.P.H. Center
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Appendix C Acknowledgements AHRQ St
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Liaisons to the USPSTF Primary care
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The Task Force does not explicitly
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■■ ■■ Access the Electronic
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Appendix E More Resources AHRQ’s
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Healthy People 2020 Healthy People
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Index 2-hour postload plasma (see D
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Coronary Heart Disease (Risk Assess
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*Illicit and Prescription Drug Use
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Syphilis Infection (Pregnant Women)
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The U.S. Preventive Services Task F
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