16 USPSTF “D” Recommendations: What Not to Do For Prevention

The USPSTF United States Preventative Services Task Force is the group tasked with making recommendations to the U.S. health care system and citizens concerning what to do and what not to do to prevent illness.  I’m going to post over the next few weeks a series of annotated lists highlighting selected USPSTF recommendations. We will start with some of their most important recommendations, what not to do.  These receive a category “D” recommendation, meaning, “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.”  The USPSTF recommendation to providers is to, “Discourage this service.”

USPSTF D Recommendation Dr. Pullen Comments
The USPSTF recommends against teaching breast self-examination (BSE). This does not mean women should not do self-breast exams, just the there is good evidence that recommending self-breast exams is not effective in improving outcomes in women regarding breast cancer.
The USPSTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population. This means you should not be tricked into paying for a “screening Ultrasound” evaluation like those offered by “Life Line Screen” and others.
The USPSTF recommends against routine screening for pancreatic cancer in asymptomatic adults using abdominal palpation, ultrasonography, or serologic markers. Ditto above.
The U.S. Preventive Services Task Force (USPSTF) recommends against the routine screening of asymptomatic adolescents for idiopathic scoliosis. A hard habit to break in adolescent physical exams.
The U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA)-based screening for prostate cancer. Just say no.
The USPSTF recommends against screening for testicular cancer in adolescent or adult men. It seems that treatment is so good that early diagnosis does not really improve outcomes.
The USPSTF recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years. Note that this recommendation does not even recommend aspirin in high risk younger persons.
The USPSTF recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes. Just because we can do genetic screening does not mean we should.
The U.S. Preventive Services Task Force (USPSTF) recommends against routine serological screening for HSV (herpes simplex virus) in asymptomatic adolescents and adults. I don’t know that this was ever common anyway.
The USPSTF recommends against the routine use of aspirin and nonsteroidal anit-inflammatory drugs (NSAIDS) to prevent colorectal cancer in individuals at average risk for colorectal cancer. I hear patients often tell me that they are using aspirin for these reasons. See a post Aspirin: Should You Take One-a-Day
The USPSTF recommends against screening for cervical cancer in women younger than age 21 years. At age 21 screening is now recommended much less often than in the past.  More frequent screening leads to more testing and treatment without improved outcomes.
The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer. I still hear from women that some OB-GYN specialists want them to have routine PAP testing “just to be safe.” Note that the ACOG recommendation is in agreement with the USPSTF on this.
The USPSTF recommends against routine screening of asymptomatic persons who are not at increased risk for syphilis infection. No states still require a syphilis blood test to get married.
The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years. My Dad, in poor health at age 84 became so weak during a prep for a screening colonoscopy that he ended up at the ER.  After that he was asked to “try again later.  When I discovered this I quickly gave him “permission” to refuse the test.
The USPSTF recommends against screening with resting or exercise electrocardiography (ECG) for the prediction of coronary heart disease (CHD) events in asymptomatic adults at low risk for CHD events. If you are not at high risk of coronary disease you don’t need a baseline or “screening” EKG


Note that the USPSTF recommendation are for screening, not for evaluation of symptomatic conditions.  These are great starting points for you to understand when you meet with your physician.

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