Guide to Clinical Preventive Services 2012 - Agency for Healthcare ...

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SCREENING FOR BREAST CANCER PART II: USING METHODS OTHER THAN FILM MAMMOGRAPHYCLINICAL SUMMARY OF 2009 U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATION 1Population Women aged ≥40 yearsScreening Method Digital mammographyMagnetic resonanceimaging (MRI)Recommendation Grade: I (Insufficient Evidence)Clinical breast examination (CBE) Breast self-examination (BSE)Grade: DRationale for NoRecommendation orNegative RecommendationEvidence is lacking for benefits of digital mammographyand MRI of the breast as substitutes for filmmammography.Evidence of CBE’s additional benefit, beyondmammography, is inadequate.Adequate evidence suggests thatBSE does not reduce breast cancermortality.Considerations for PracticePotential PreventableBurdenFor younger women andwomen with dense breasttissue, overall detectionis somewhat better withdigital mammography.Contrast-enhanced MRIhas been shown to detectmore cases of cancer invery high-risk populationsthan does mammography.Indirect evidence suggests that when CBEis the only test available, it may detect asignificant proportion of cancer cases.Potential HarmsIt is not certain whetheroverdiagnosis occurs moreoften with digital than withfilm mammography.Contrast-enhanced MRIrequires injection ofcontrast material.MRI yields many morefalse-positive resultsand potentially moreoverdiagnosis thanmammography.Harms of CBE include false-positive results,which lead to anxiety, unnecessary visits,imaging, and biopsies.Harms of BSE include the samepotential harms as for CBE and may belarger in magnitude.CostsDigital mammography ismore expensive than film.MRI is much moreexpensive thanmammography.Costs of CBE are primarily opportunity coststo clinicians.Costs of BSE are primarily opportunitycosts to clinicians.Current PracticeSome clinical practices arenow switching to digitalequipment.MRI is not currently used toscreen women of averagerisk.No standard approach or reporting standardsare in place.The number of clinicians who teachBSE to patients is unknown; it is likelythat few clinicians teach BSE to allwomen.1 The U.S. Department of Health and Human Services, in implementing the Affordable Care Act under the standard it sets out in revised Section 2713(a)(5) of the Public Health Service Act, utilizes the 2002 recommendation on breast cancer screening of the U.S.Preventive Services Task Force. For clinical summary of 2002 Recommendation, see Appendix F.For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go tohttp://www.uspreventiveservicestaskforce.org.16
PRIMARY CARE INTERVENTIONS TO PROMOTE BREASTFEEDINGCLINICAL SUMMARY OF U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONPopulation Pregnant women New mothersThe mother’s partner, otherfamily members, and friendsInfants and young childrenRecommendationPromote and support breastfeeding.Grade: BBenefits of BreastfeedingMothersLess likelihood of breast and ovariancancerInfantsFewer ear infections, lower-respiratorytractinfections, and gastrointestinalinfectionsYoung childrenLess likelihood of asthma, type 2diabetes, and obesityInterventions to promote and support breastfeeding have been found to increase the rates of initiation, duration, and exclusivityof breastfeeding. Consider multiple strategies, including:● ● Formal breastfeeding education for mothers and familiesInterventions to PromoteBreastfeeding● ● Direct support of mothers during breastfeeding● ● Training of primary care staff about breastfeeding and techniques for breastfeeding support● ● Peer supportInterventions that include both prenatal and postnatal components may be most effective at increasing breastfeeding duration.In rare circumstances, for example for mothers with HIV and infants with galactosemia, breastfeeding is not recommended.Interventions to promote breastfeeding should empower individuals to make informed choices supported by the best availableevidence.Implementation System-level interventions with senior leadership support may be more likely to be sustained over time.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.17
Page 2 and 3: The clinical summaries in the Guide
Page 5: ForewordSince 1998, the Agency for
Page 8 and 9: Our methods continue to evolve as w
Page 11 and 12: ContentsForeword...................
Page 13: Preventive ServicesRecommended byth
Page 17: 1 One-time screening by ultrasonogr
Page 21 and 22: SCREENING FOR ABDOMINAL AORTIC ANEU
Page 23 and 24: ASPIRIN FOR THE PREVENTION OF CARDI
Page 25 and 26: SCREENING FOR BACTERIAL VAGINOSIS I
Page 27 and 28: SCREENING FOR BLADDER CANCERCLINICA
Page 29: SCREENING FOR BREAST CANCER PART I:
Page 33 and 34: SCREENING FOR CERVICAL CANCERCLINIC
Page 35 and 36: SCREENING FOR CHRONIC OBSTRUCTIVE P
Page 37 and 38: USING NONTRADITIONAL RISK FACTORS I
Page 39 and 40: SCREENING FOR TYPE 2 DIABETES MELLI
Page 41 and 42: SCREENING FOR GENITAL HERPESCLINICA
Page 43 and 44: SCREENING FOR GLAUCOMACLINICAL SUMM
Page 45 and 46: SCREENING FOR HEMOCHROMATOSISCLINIC
Page 47 and 48: SCREENING FOR HEPATITIS B VIRUS INF
Page 49 and 50: SCREENING FOR HIGH BLOOD PRESSURE I
Page 51 and 52: HORMONE REPLACEMENT THERAPY FOR THE
Page 53 and 54: SCREENING FOR IMPAIRED VISUAL ACUIT
Page 55 and 56: SCREENING FOR LUNG CANCERCLINICAL S
Page 57 and 58: SCREENING FOR ORAL CANCERCLINICAL S
Page 59 and 60: SCREENING FOR OVARIAN CANCERCLINICA
Page 61 and 62: SCREENING FOR PERIPHERAL ARTERIAL D
Page 63 and 64: BEHAVIORAL COUNSELING TO PREVENT SE
Page 65 and 66: SCREENING FOR SUICIDE RISKCLINICAL
Page 67 and 68: SCREENING FOR SYPHILIS INFECTION IN
Page 69 and 70: SCREENING FOR THYROID DISEASECLINIC
Page 71: Recommendationsfor Children andAdol
Page 74 and 75: SCREENING FOR CONGENITAL HYPOTHYROI
Page 76 and 77: OCULAR PROPHYLAXIS FOR GONOCOCCAL O
Page 78 and 79: SCREENING OF INFANTS FOR HYPERBILIR
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PART II: IRON SUPPLEMENTATION FOR C
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SCREENING AND TREATMENT FOR MAJOR D
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SCREENING FOR PHENYLKETONURIACLINIC
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SCREENING FOR SICKLE CELL DISEASE I
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SCREENING FOR VISUAL IMPAIRMENT IN
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Immunizations for Adults and Childr
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Topics in ProgressEach USPSTF recom
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Appendixesand Index
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Grade Definition Suggestions for Pr
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Grade Definitions Prior to May 2007
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Jessica Herzstein, M.D., M.P.H.Air
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Evidence-Based Practice Centers Sup
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Liaisons to the USPSTFPrimary care
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of a service. The Task Force assign
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Appendix EMore ResourcesAHRQ’s Pr
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Canadian Task Force on Preventive H
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Index5-A Approach (see Alcohol Misu
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Cover-Uncover Test (see Visual Impa
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Non-Steroidal Anti-Inflammatories [
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AHRQ’s Electronic Preventive Serv
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U.S. Department of Health and Human
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