USPSTF “Strong” Recommendations for Preventative Services.

This article is the second in a series on the USPSTF recommendations to health care providers and U.S. residents on recommendations for preventative care services.  The previous article listed 16 “D” recommendations, i.e. things you should not do in an attempt to prevent health problems.  In that article I selected the most relevant “D”: recommendations, and limited the list to 16 items.  In this article I list all 20 of the “A” level recommendations. These are recommendations the USPSTF feels warrant a strong recommendation to do based on the best data available. In their language, “The USPSTF recommends the service. There is high certainty that the net benefit is substantial.” Their recommendation is to, “Offer or provide this service.”

Remarkably there are only 20 of these strong recommendations, and 9 of them specifically relate only to pregnant women and neonatal screening This leaves just 11 for the non-pregnant and over 1 month old population.    Only 2 make positive recommendations about screening for cancer (Cevical and  Colon), breast cancer screening gets only a B grade recommendation.  Two are recommendations not to smoke, two each on screening for HIV, syphilis, and cholesterol.

USPSTF A Recommendations. Dr Pullen Comments
The USPSTF recommends the use of aspirin for men ages 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage.  March 2009 The devil is in the details here.  The details when the potential benefits outweigh the potential risks is detailed.
The USPSTF recommends the use of aspirin for women ages 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.  March 2009 See above. Note the age difference, >55 in women.
The USPSTF recommends screening for high blood pressure in adults age 18 years and older.  December 2007 Primary care physicians and most others do BP at every office visit.
The USPSTF recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years. March 2012 Note don’t start PAPs until age 21, and the relatively new addition of the HPV testing option after age 30. I am doing PAP and HPV after age 30 every 5 years when normal for most women.
The USPSTF strongly recommends screening men age 35 years and older for lipid disorders. June 2008 We probably do this more often than needed for most men who have normal levels.
The USPSTF strongly recommends screening women age 45 years and older for lipid disorders if they are at increased risk for coronary heart disease. June 2008 Note the language, for men all men >35, for women only if at increased risk of coronary heart disease, e.g. smokers, diabetes, hypertension, family history.
The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. October 2008 Note colonoscopy is not the only option.
The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid. May 2009 This is to prevent neural tube defects like spina bifida and anencephaly.  It is hard to find an off the shelf multiple vitamin without 0.4 mg of folic acid.
The USPSTF recommends prophylactic ocular topical medication for all newborns for the prevention of gonococcal ophthalmia neonatorum. July 2011 This is done routinely, though some mothers refuse feeling their child is not at risk.
The USPSTF recommends screening for sickle cell disease in newborns. September 2007 This is done routinely along with multiple other newborn screening tests.
The USPSTF recommends screening for congenital hypothyroidism in newborns. March 2008 See above.  This is a part of the same screening panel.
The USPSTF strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. February 2004
The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. April 2009 Just asking a patient to quit smoking doubles their chances of quitting.
The USPSTF recommends that clinicians ask all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling to those who smoke. April 2009 Super important for pregnant women to quit smoking. Many studies show higher incidence of preterm delivery, small babies in smoking women.
The USPSTF strongly recommends that clinicians screen persons at increased risk for syphilis infection. July 2004 Mostly sex workers and sexually active gay men.
The USPSTF recommends that clinicians screen all pregnant women for syphilis infection. May 2009 Congenital syphilis is a bad thing, though rare.
The USPSTF strongly recommends screening for hepatitis B virus infection in pregnant women at their first prenatal visit.  June 2009 Done routinely
The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults ages 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened. April 2013 Starting at age 15 a tough sell for many parents. No frequency for testing recommended.   This was changed from a “B” level recommendation to “A” in 2013.
The USPSTF recommends that clinicians screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown. April 2013 Again done routinely. More important than ever as treatments are so good now.
The USPSTF recommends screening for asymptomatic bacteriuria with urine culture in pregnant women at 12 to 16 weeks’ gestation or at the first prenatal visit, if later. July 2008 Done routinely.

This summary is a strong reminder of how little data there is to support preventative screening measures and how we need to allocate more resources to learn what we should and should not do to prevent disease.

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