USPSTF Screening Recommendations:Implications for Adults at Higher Risk

NYFAHC Roundtable, June 18, 2013

Robert A. Smith, PhDSenior Director, Cancer Control Science

Cancer Control Sciences Department

Cancer Screening, the ACA, and the USPSTF

• Under the ACA, preventive services that are given an A or B rating by the USPSTF must be provided without any co-pays or deductibles

• USPSTF screening recommendations specifically are targeted to average risk adults

Cancer Screening, the ACA, and the USPSTF

• The need for a different screening regimen for adults at higher risk typically is acknowledged, but recommendations are not issued due to lack of adequate evidence

• The USPSTF commonly acknowledges that other organizations have issued different and specific recommendations for adults at higher risk

Colorectal Cancer Screening

Colorectal Screening in Average Risk Adults: Update 2008

Recommendation ACS, USMSTF, ACR USPSTF

Age to begin and end screening

Begin screening at age 50

End screening at a point where curative therapy would not be offered due to life-limiting co-morbidity

Begin screening at age 50

Routine screening in adults aged 76-85 is not recommended. There may be considerations that support screening in an individual patient.

Screening after age 85 is not recommended

CRC Screening in Average Risk Adults: Update 2008

Recommendation ACS, USMSTF, ACR USPSTF

CRC screening between ages 76-85

Adults in good health who would be candidates for treatment should continue screening

Recommend against routine screening in adults 76-85. There may be considerations that support screening in an individual patient.

CRC screening in adults over age 85

Screening not recommended in adults > 85 years

USPSTF Clinical Considerations• “These recommendations apply to adults 50 years of age

and older, excluding those with specific inherited syndromes (the Lynch syndrome or familial adenomatous polyposis) and those with inflammatory bowel disease. The recommendations do apply to those with first-degree relatives who have had colorectal adenomas or cancer, although for those with first-degree relatives who developed cancer at a younger age or those with multiple affected first-degree relatives, an earlier start to screening may be reasonable.”

USPSTF Clinical Considerations

• “When the screening test results in the diagnosis of clinically significant colorectal adenomas or cancer, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable. The USPSTF did not address evidence for the effectiveness of any particular surveillance regimen after diagnosis and/or removal of adenomatous polyps.”

INCREASED RISK

HIGHEST RISK

AVERAGE RISK

Breast Cancer Screening Guidelines

Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)

Recommendation ACS USPSTF

Mammography Age 40+ - Annual Screening

The USPSTF recommends biennial screening mammographyfor women between the ages of 50 and 74 years. (Grade B recommendation)

Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)

Recommendation ACS USPSTF

Mammography End screening at a point where curative therapy would not be offered due to life-limiting co-morbidity

The USPSTF concludes that the current evidence is insufficient toassess the additional benefits and harms of screening mammographyin women 75 years or older. (I statement)

Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)

Recommendation ACS USPSTF

Age to begin and end screening

Begin screening at age 50

End screening at a point where curative therapy would not be offered due to life-limiting co-morbidity

Begin screening at age 50

Routine screening in adults aged 76-85 is not recommended. There may be considerations that support screening in an individual patient.

Screening after age 85 is not recommended

USPSTF Clinical Considerations

• “This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.”

ACS Guidelines for Breast MR in High Risk Women

Cervical, Prostate, and Lung Screening

• ACS and USPSTF cervical cancer screening guidelines are similar

• USPSTF recommends against prostate cancer screening. ACS recommendations accommodate men at average and high risk

• Lung cancer screening recommendations are expected in 2013

Thank you