Guide to Clinical Preventive Services 2012 · impact the health of children, adolescents, adults,...
128
The Guide to Clinical Preventive Services 2012
Transcript of Guide to Clinical Preventive Services 2012 · impact the health of children, adolescents, adults,...
The Guide to Clinical Preventive Services2012
The clinical summaries in the Guide are abridged versions of recommendations from the U.S. Preventive Services Task Force (USPSTF). To view the full recommendation statements, supporting evidence, or recommendations published after March 2012, go to www.USPreventiveServicesTaskForce.org.
The USPSTF Electronic Preventive Services Selector (ePSS) allows users to download the USPSTF recommendations to PDA, mobile, or tablet devices; receive notifications of updates; and search and browse recommendations online. Users can search the ePSS for recommendations by patient age, sex, and pregnancy status. To download, subscribe, or search, go to www.epss.ahrq.gov.
Recommendations made by the USPSTF are independent of the U.S. Government. They should not be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
The Guide to Clinical Preventive Services2012
Recommendations of the U.S. Preventive Services Task Force
iii
Foreword
Since 1998, the Agency for Healthcare Research and Quality (AHRQ) has convened the U.S. Preventive Services Task Force (USPSTF)—an independent panel of non-Federal experts in prevention and primary care. AHRQ staff provide scientific, technical, and administrative support for the Task Force, and assist in disseminating its findings and recommendations to key audiences.
In that role, we are pleased to make The Guide to Clinical Preventive Services 2012 available to those who seek to ensure that their patients receive the highest quality clinical preventive services. Previous iterations of the USPSTF Guide to Clinical Preventive Services are used around the Nation to provide appropriate and effective preventive care.
This year’s Guide includes some changes that will make it more user-friendly for practicing clinicians. The Guide comprises 64 preventive services, which now are presented in an easy-to-use, one-page summary table format. In addition, the Guide provides information on resources that clinicians can use to educate their patients on appropriate preventive services, as well as brief descriptions of and links to tools that they can use to improve their practices, including the electronic Preventive Services Selector, MyHealthfinder, and the Guide to Community Preventive Services (for more details, see Appendixes D and E).
As more information becomes available to clinicians and patients alike, AHRQ’s goal is to help improve patients’ health and well being, and contribute to better health outcomes for the Nation overall.
Carolyn M. Clancy, M.D. Director Agency for Healthcare Research and Quality
v
Preface
Since being codified by Congress, the U.S. Preventive Services Task Force (USPSTF) has been fulfilling its charge to conduct rigorous reviews of scientific evidence to create evidence-based recommendations for preventive services that should be provided in the primary care setting.
Since its inception, the USPSTF has made and maintained recommendations on more than 100 clinical preventive services that are intended to prevent or reduce the risk for heart disease, cancer, infectious diseases, and other conditions and events that impact the health of children, adolescents, adults, and pregnant women. The Guide to Clinical Preventive Services 2012 includes new or updated recommendations on 64 clinical preventive services released from 2002-2012 in a brief, easily usable format meant for use at the point of patient care. Recommendations that were being updated while this edition of the Guide was being compiled, as well as the complete USPSTF recommendation statements, are available along with their supporting scientific evidence at www.USPreventiveServicesTaskForce.org.
Recommendations for preventive care have evolved over time. The suggestion that it is not beneficial to provide all of the services available for prevention was nearly a heretical concept in U.S. medical practice when the first USPSTF started its work. Over time, individual health care providers, professional organizations, integrated health systems, health plans and insurers, and public programs, including the Centers for Medicare & Medicaid Services as well as groups crafting health quality measures and national health objectives, have adopted the recommendations. The primary audience for the USPSTF’s work remains primary care clinicians, and the recommendations are now considered by many to provide definitive standards for preventive services.
The work of the USPSTF is central to the preventive benefits covered under the Patient Protection and Affordable Care Act. Under the new law, in new plans and policies preventive services with a Task Force grade of A or B will be covered with no cost sharing requirements. Even prior to national reform activities, the USPSTF had increased the transparency of its work, and these efforts have gained additional momentum in view of the enhanced importance of the recommendations under the new law. Public comments are welcomed at multiple points in the development of each recommendation to allow for additional input from experts and advocates and to assist us in better crafting messages for the public. However, the USPSTF remains committed to evaluating evidence free from the influence of politics, special interests, and advocacy.
vi
Our methods continue to evolve as well. Our Procedure Manual, which can be found at www.USPreventiveServicesTaskForce.org/uspstf08/methods/procmanual.htm, outlines our updated process for evaluating the quality and strength of the evidence for a service, determining the net health benefit (benefits minus harms) associated with the service, and judging the level of certainty that providing these services will be beneficial in primary care. We continue to explore the appropriate use of mathematical modeling to help fill research gaps regarding the ages at which to start and stop providing a service, and at what time intervals. In addition, we are committed to improving the communication of our recommendations to a broader audience, including patients and policymakers.
As before, the letter grade linked to each recommendation reflects the magnitude of net benefit and the strength and certainty of the evidence supporting the provision of a specific preventive service. These grades translate to practice guidance for clinicians:
■ Discuss services with “A” and “B” recommendations with eligible patients and offer them as a priority.
■ Discourage the use of services with “D” recommendations unless there are unusual additional considerations.
■ Give lower priority to services with “C” recommendations; they need not be provided unless there are individual considerations in favor of providing the service.
■ Help patients understand the uncertainty surrounding services when the evidence is insufficient to determine net benefit (I statement). Clinicians may read the Clinical Considerations section of the full recommendations for additional guidance.
As is true of all patient care, preventive services have become much more complex in view of ongoing research. The USPSTF realizes that clinical decisions about patients involve more complex considerations than the evidence alone; clinicians should always understand the evidence but individualize decisionmaking to the specific patient and situation. While providers and patients look for simple messages and actions, our recommendations reflect the advances in knowledge in this critical area of health services, and, in order to maximize the health benefits and decrease any health harms, we must consider the new complexity as we do for all medical services we provide. The Clinical Considerations section of each USPSTF recommendation statement helps clinicians by offering practical information so they can tailor these recommendations to individual patients.
vii
We strongly encourage clinicians to visit the USPSTF Web site and read the complete recommendation statements for those services they provide, as the additional information can help them deliver the highest quality preventive care. In addition, the USPSTF Electronic Preventive Services Selector (ePSS), available via PDA, smart phone, or on the Web at www.epss.ahrq.gov, allows users to search USPSTF recommendations by patient age and other clinical characteristics.
We hope you find the Guide to Clinical Preventive Services 2012 to be a useful tool as you care for patients. Based on the best medical evidence available, we are confident that by implementing these recommended services, you will help your patients live longer and healthier lives.
Virginia A. Moyer, M.D., M.P.H., Chair Michael L. LeFevre, M.D., M.S.P.H., Co-Vice Chair Albert L. Siu, M.D., M.S.P.H., Co-Vice Chair U.S. Preventive Services Task Force
ix
Contents
Foreword ........................................................................................................... iiiPreface ................................................................................................................vPreventive Services Recommended by the USPSTF ........................................... 1Recommendations for Adults (alphabetical list) ................................................ 5
Abdominal Aortic Aneurysm, Screening ..............................................................7Alcohol Misuse, Screening and Behavioral Counseling ........................................8Aspirin for the Prevention of Cardiovascular Disease, Preventive Medication ......9Aspirin or NSAIDS for Prevention of Colorectal Cancer, Preventive Medication ...................................................................................10Bacterial Vaginosis in Pregnancy, Screening .......................................................11Bacteriuria, Screening ........................................................................................12*Bladder Cancer, Screening ...............................................................................13Breast and Ovarian Cancer, BRCA Testing, Screening .......................................14Breast Cancer, Screening .............................................................................15, 16Breastfeeding, Counseling .................................................................................17Carotid Artery Stenosis, Screening ....................................................................18*Cervical Cancer, Screening ..............................................................................19Chlamydial Infection, Screening .......................................................................20Chronic Obstructive Pulmonary Disease, Screening ..........................................21Colorectal Cancer, Screening .............................................................................22Coronary Heart Disease (Risk Assessment, Nontraditional Risk Factors), Screening .......................................................................................................23Depression in Adults, Screening ........................................................................24Diabetes Mellitus, Screening .............................................................................25Folic Acid Supplementation, Preventive Medication ..........................................26Genital Herpes Simplex, Screening ....................................................................27Gestational Diabetes, Screening .........................................................................28Glaucoma, Screening .........................................................................................29Gonorrhea, Screening ........................................................................................30Hemochromatosis, Screening ............................................................................31Hepatitis B Virus Infection, Screening...............................................................32Hepatitis B Virus Infection (Pregnant Women), Screening ................................33Hepatitis C Virus Infection, Screening ..............................................................34High Blood Pressure in Adults, Screening ..........................................................35HIV Infection, Screening ..................................................................................36Hormone Replacement Therapy, Preventive Medication ...................................37Illicit Drug Use, Screening ................................................................................38Impaired Visual Acuity in Older Adults, Screening ...........................................39Lipid Disorders in Adults, Screening .................................................................40
x
Lung Cancer, Screening .....................................................................................41Motor Vehicle Occupant Restraints, Counseling ...............................................42Oral Cancer, Screening ......................................................................................43*Osteoporosis, Screening ...................................................................................44Ovarian Cancer, Screening ................................................................................45Pancreatic Cancer, Screening .............................................................................46Peripheral Arterial Disease, Screening ................................................................47Rh (D) Incompatibility, Screening.....................................................................48Sexually Transmitted Infections, Counseling .....................................................49Skin Cancer, Screening ......................................................................................50Suicide Risk, Screening ......................................................................................51Syphilis Infection, Screening .............................................................................52Syphilis (Pregnant Women), Screening ..............................................................53*Testicular Cancer, Screening ............................................................................54Thyroid Disease, Screening ................................................................................55Tobacco Use in Adults, Counseling and Intervention ........................................56
Recommendations for Children and Adolescents (alphabetical list) ................ 57Blood Lead Levels in Childhood and Pregnancy, Screening ...............................59Congenital Hypothyroidism, Screening .............................................................60Developmental Dysplasia of the Hip, Screening ................................................61*Gonococcal Ophthalmia Neonatorum, Preventive Medication ........................62Hearing Loss (Newborn), Screening ..................................................................63Hyperbilirubinemia in Infants, Screening ..........................................................64Iron Deficiency Anemia, Screening .............................................................65, 66Lipid Disorders in Children, Screening .............................................................67Major Depressive Disorder in Children and Adolescents, Screening ..................68Obesity in Children and Adolescents, Screening ................................................69Phenylketonuria, Screening ...............................................................................70Scoliosis in Adolescents (Idiopathic), Screening .................................................71Sickle Cell Disease, Screening ............................................................................72Speech and Language Delay, Screening ..............................................................73*Visual Impairment in Children Ages 1-5, Screening ........................................74
Immunizations ................................................................................................ 75Topics in Progress ............................................................................................ 79Appendixes and Index ...................................................................................... 83
Appendix A. How the U.S. Preventive Services Task Force Grades Its Recommendations .........................................................................................85Appendix B. Members of the U.S. Preventive Services Task Force 2002-2012 ....88Appendix C. Acknowledgements .......................................................................91Appendix D. About the U.S. Preventive Services Task Force ..............................94Appendix E. More Resources .............................................................................97
Index. Recommendations, Cross-Referenced ........................................................101*New recommendations released March 2010 to March 2012.
Preventive Services Recommended by the USPSTF
All clinical summaries in this Guide are abridged recommendations. To see the full recommendation statements and recommendations published after March 2012, go to www.USPreventiveServicesTaskForce.org.
1
Sect
ion
1: P
reve
ntiv
e Se
rvic
es R
ecom
men
ded
by th
e U
SPST
F
The
U.S
. Pre
vent
ive
Serv
ices
Tas
k Fo
rce
(USP
STF)
reco
mm
ends
that
clin
icia
ns d
iscu
ss th
ese
prev
entiv
e se
rvic
es w
ith e
ligib
le p
atie
nts
and
offe
r the
m a
s a
prio
rity.
All
thes
e se
rvic
es h
ave
rece
ived
an
“A” o
r a “B
” (re
com
men
ded)
gra
de fr
om th
e Ta
sk F
orce
. For
defi
nitio
ns o
f all
grad
es u
sed
by th
e U
SPST
F, s
ee
Appe
ndix
A (b
egin
ning
on
p. 8
5). C
linic
al s
umm
arie
s of
reco
mm
enda
tions
for a
dults
beg
in o
n p.
5. C
linic
al s
umm
arie
s of
reco
mm
enda
tions
for c
hild
ren
begi
n
on p
. 57.
Rec
omm
enda
tion
Adu
ltsSp
ecia
l Pop
ulat
ions
Men
Wom
enPr
egna
nt W
omen
Chi
ldre
n
Abdo
min
al A
ortic
Ane
urys
m, S
cree
ning
1P
Alco
hol M
isus
e Sc
reen
ing
and
Beha
vior
al C
ouns
elin
g In
terv
entio
nsP
PP
Aspi
rin fo
r Pre
vent
ion
of C
ardi
ovas
cula
r Dis
ease
2P
P
Asym
ptom
atic
Bac
teriu
ria in
Adu
lts, S
cree
ning
3P
Brea
st a
nd O
varia
n C
ance
r Sus
cept
ibilit
y, G
enet
ic R
isk
Asse
ssm
ent a
nd B
RC
A M
utat
ion
Test
ing4
P
Brea
st C
ance
r, Sc
reen
ing5
P
Brea
stfe
edin
g, P
rimar
y C
are
Inte
rven
tions
to P
rom
ote6
PP
Cer
vica
l Can
cer,
Scre
enin
g7P
Chl
amyd
ial I
nfec
tion,
Scr
eeni
ng8
PP
Col
orec
tal C
ance
r, Sc
reen
ing9
PP
Con
geni
tal H
ypot
hyro
idis
m, S
cree
ning
10P
Dep
ress
ion
in A
dults
, Scr
eeni
ng11
PP
Dia
bete
s M
ellit
us (T
ype
2) in
Adu
lts, S
cree
ning
12P
P
Folic
Aci
d to
Pre
vent
Neu
ral T
ube
Def
ects
13P
P
Gon
ococ
cal O
phth
alm
ia N
eona
toru
m, P
reve
ntiv
e M
edic
atio
n14P
2
Sect
ion
1: P
reve
ntiv
e Se
rvic
es R
ecom
men
ded
by th
e U
SPST
F (c
ontin
ued)
Rec
omm
enda
tion
Adu
ltsSp
ecia
l Pop
ulat
ions
Men
Wom
enPr
egna
nt W
omen
Chi
ldre
n
Gon
orrh
ea, S
cree
ning
15P
P
Hea
ring
Loss
in N
ewbo
rns,
Scr
eeni
ng16
P
Hep
atiti
s B
Viru
s in
Pre
gnan
t Wom
en, S
cree
ning
17P
Hig
h Bl
ood
Pres
sure
(Adu
lts),
Scre
enin
gP
P
HIV
, Scr
eeni
ng18
PP
PP
Iron
Defi
cien
cy A
nem
ia, P
reve
ntio
n19P
Iron
Defi
cien
cy A
nem
ia, S
cree
ning
20P
Lipi
d D
isor
ders
in A
dults
, Scr
eeni
ng21
PP
Maj
or D
epre
ssiv
e D
isor
der i
n C
hild
ren,
Scr
eeni
ng22
P
Obe
sity
in C
hild
ren
and
Adol
esce
nts,
Scr
eeni
ng23
P
Ost
eopo
rosi
s, S
cree
ning
24P
Phen
ylke
tonu
ria, S
cree
ning
25P
Rh
(D) I
ncom
patib
ility,
Scr
eeni
ng26
P
Sexu
ally
Tra
nsm
itted
Infe
ctio
ns, C
ouns
elin
g27P
PP
Sick
le C
ell D
isea
se, S
cree
ning
28P
Syph
ilis In
fect
ion,
Scr
eeni
ng29
PP
Syph
ilis In
fect
ion
in P
regn
ancy
, Scr
eeni
ngP
Toba
cco
Use
in A
dults
and
Pre
gnan
t Wom
en, C
ouns
elin
g30P
PP
Visu
al Im
pairm
ent i
n C
hild
ren
Ages
1 to
5, S
cree
ning
31P
3
1 One
-tim
e sc
reen
ing
by u
ltras
onog
raph
y in
men
age
d 65
to 7
5 w
ho h
ave
ever
sm
oked
.2 W
hen
the
pote
ntia
l har
m o
f an
incr
ease
in g
astro
inte
stin
al h
emor
rhag
e is
ou
twei
ghed
by
a po
tent
ial b
enefi
t of a
redu
ctio
n in
myo
card
ial i
nfar
ctio
ns (m
en
aged
45-
79 y
ears
) or i
n is
chem
ic s
troke
s (w
omen
age
d 55
-79
year
s).
3 Pre
gnan
t wom
en a
t 12-
16 w
eeks
ges
tatio
n or
at fi
rst p
rena
tal v
isit,
if la
ter.
4 Ref
er w
omen
who
se fa
mily
his
tory
is a
ssoc
iate
d w
ith a
n in
crea
sed
risk
for
dele
terio
us m
utat
ions
in B
RC
A1 o
r BR
CA
2 ge
nes
for g
enet
ic c
ouns
elin
g an
d ev
alua
tion
for B
RC
A te
stin
g.5 B
ienn
ial s
cree
ning
mam
mog
raph
y fo
r wom
en a
ged
50 to
74
year
s. N
ote:
Th
e D
epar
tmen
t of H
ealth
and
Hum
an S
ervi
ces,
in im
plem
entin
g th
e Af
ford
able
Car
e Ac
t, fo
llow
s th
e 20
02 U
SPST
F re
com
men
datio
n fo
r scr
eeni
ng
mam
mog
raph
y, w
ith o
r with
out c
linic
al b
reas
t exa
min
atio
n, e
very
1-2
yea
rs fo
r w
omen
age
d 40
and
old
er.
6 Inte
rven
tions
dur
ing
preg
nanc
y an
d af
ter b
irth
to p
rom
ote
and
supp
ort
brea
stfe
edin
g.7 S
cree
n w
ith c
ytol
ogy
ever
y 3
year
s (w
omen
age
s 21
to 6
5) o
r co-
test
(cyt
olog
y/H
PV te
stin
g) e
very
5 y
ears
(wom
en a
ges
30-6
5).
8 Sex
ually
act
ive
wom
en 2
4 an
d yo
unge
r and
oth
er a
sym
ptom
atic
wom
en a
t in
crea
sed
risk
for i
nfec
tion.
Asy
mpt
omat
ic p
regn
ant w
omen
24
and
youn
ger
and
othe
rs a
t inc
reas
ed ri
sk.
9 Adu
lts a
ged
50-7
5 us
ing
feca
l occ
ult b
lood
test
ing,
sig
moi
dosc
opy,
or
colo
nosc
opy.
10N
ewbo
rns.
11W
hen
staf
f-ass
iste
d de
pres
sion
car
e su
ppor
ts a
re in
pla
ce to
ass
ure
accu
rate
di
agno
sis,
effe
ctiv
e tre
atm
ent,
and
follo
wup
.12
Asym
ptom
atic
adu
lts w
ith s
usta
ined
blo
od p
ress
ure
grea
ter t
han
135/
80 m
g H
g.13
All w
omen
pla
nnin
g or
cap
able
of p
regn
ancy
take
a d
aily
sup
plem
ent
cont
aini
ng 0
.4 to
0.8
mg
(400
to 8
00 µ
g) o
f fol
ic a
cid.
14N
ewbo
rns.
15Se
xual
ly a
ctiv
e w
omen
, inc
ludi
ng p
regn
ant w
omen
25
and
youn
ger,
or a
t in
crea
sed
risk
for i
nfec
tion.
16N
ewbo
rns.
17Sc
reen
at fi
rst p
rena
tal v
isit.
18Al
l ado
lesc
ents
and
adu
lts a
nd in
crea
sed
risk
for H
IV in
fect
ion
and
all
preg
nant
wom
en.
19R
outin
e iro
n su
pple
men
tatio
n fo
r asy
mpt
omat
ic c
hild
ren
aged
6 to
12
mon
ths
who
are
at i
ncre
ased
risk
for i
ron
defic
ienc
y an
emia
.20
Rou
tine
scre
enin
g in
asy
mpt
omat
ic p
regn
ant w
omen
.21
Men
age
d 20
-35
and
wom
en o
ver a
ge 2
0 w
ho a
re a
t inc
reas
ed ri
sk fo
r co
rona
ry h
eart
dise
ase;
all
men
age
d 35
and
old
er.
22Ad
oles
cent
s (a
ge 1
2 to
18)
whe
n sy
stem
s ar
e in
pla
ce to
ens
ure
accu
rate
di
agno
sis,
psy
chot
hera
py, a
nd fo
llow
up.
23Sc
reen
chi
ldre
n ag
ed 6
yea
rs a
nd o
lder
; offe
r or r
efer
for i
nten
sive
cou
nsel
ing
and
beha
vior
al in
terv
entio
ns.
24W
omen
age
d 65
yea
rs a
nd o
lder
and
wom
en u
nder
age
65
who
se 1
0-ye
ar
fract
ure
risk
is e
qual
to o
r gre
ater
than
that
of a
65-
year
-old
whi
te w
oman
w
ithou
t add
ition
al ri
sk fa
ctor
s.
25N
ewbo
rns.
26Bl
ood
typi
ng a
nd a
ntib
ody
test
ing
at fi
rst p
regn
ancy
-rela
ted
visi
t. R
epea
ted
antib
ody
test
ing
for u
nsen
sitiz
ed R
h (D
)-neg
ativ
e w
omen
at 2
4-28
wee
ks
gest
atio
n un
less
bio
logi
cal f
athe
r is
know
n to
be
Rh
(D) n
egat
ive.
27Al
l sex
ually
act
ive
adol
esce
nts
and
adul
ts a
t inc
reas
ed ri
sk fo
r STI
s.28
New
born
s.29
Pers
ons
at in
crea
sed
risk.
30As
k al
l adu
lts a
bout
toba
cco
use
and
prov
ide
toba
cco
cess
atio
n in
terv
entio
ns
for t
hose
who
use
toba
cco;
pro
vide
aug
men
ted,
pre
gnan
cy-ta
ilore
d co
unse
ling
for t
hose
pre
gnan
t wom
en w
ho s
mok
e.31
Scre
en c
hild
ren
ages
3 to
5 y
ears
.
Recommendations for Adults
All clinical summaries in this Guide are abridged recommendations. To see the full recommendation statements and recommendations published after March 2012, go to www.USPreventiveServicesTaskForce.org.
7
SCR
EEN
ING
FO
R A
BD
OM
INA
L A
OR
TIC
AN
EURY
SM
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nM
en a
ges
65 to
75
year
s w
ho h
ave
ever
sm
oked
Men
age
s 65
to 7
5 ye
ars
who
hav
e ne
ver s
mok
edW
omen
age
s 65
to 7
5 ye
ars
Rec
omm
enda
tion
Scre
en o
nce
for a
bdom
inal
aor
tic
aneu
rysm
with
ultr
ason
ogra
phy.
G
rade
: B
No
reco
mm
enda
tion
for o
r aga
inst
sc
reen
ing.
G
rade
: C
Do
not s
cree
n fo
r abd
omin
al a
ortic
an
eury
sm.
Gra
de: D
Ris
k As
sess
men
tTh
e m
ajor
risk
fact
ors
for a
bdom
inal
aor
tic a
neur
ysm
incl
ude
mal
e se
x, a
his
tory
of e
ver s
mok
ing
(defi
ned
as 1
00 c
igar
ette
s in
a p
erso
n’s
lifet
ime)
, and
age
of 6
5 ye
ars
or o
lder
.
Scre
enin
g Te
sts
Scre
enin
g ab
dom
inal
ultr
ason
ogra
phy
is a
n ac
cura
te te
st w
hen
perfo
rmed
in a
set
ting
with
ade
quat
e qu
ality
ass
uran
ce (i
.e.,
in a
n ac
cred
ited
faci
lity
with
cre
dent
iale
d te
chno
logi
sts)
. Abd
omin
al p
alpa
tion
has
poor
acc
urac
y an
d is
not
an
adeq
uate
sc
reen
ing
test
.
Tim
ing
of S
cree
ning
One
-tim
e sc
reen
ing
to d
etec
t an
abdo
min
al a
ortic
ane
urys
m u
sing
ultr
ason
ogra
phy
is s
uffic
ient
. The
re is
neg
ligib
le h
ealth
be
nefit
in re
-scr
eeni
ng th
ose
who
hav
e no
rmal
aor
tic d
iam
eter
on
initi
al s
cree
ning
.
Inte
rven
tions
Ope
n su
rgic
al re
pair
of a
n an
eury
sm o
f at l
east
5.5
cm
lead
s to
dec
reas
ed a
bdom
inal
aor
tic a
neur
ysm
-rela
ted
mor
talit
y in
the
long
term
; how
ever
, the
re a
re m
ajor
har
ms
asso
ciat
ed w
ith th
is p
roce
dure
.
Bala
nce
of B
enefi
ts a
nd H
arm
s
In m
en a
ges
65 to
75
year
s w
ho h
ave
ever
sm
oked
, the
ben
efits
of s
cree
ning
fo
r abd
omin
al a
ortic
ane
urys
m o
utw
eigh
th
e ha
rms.
In m
en a
ges
65 to
75
year
s w
ho h
ave
neve
r sm
oked
, the
bal
ance
bet
wee
n th
e be
nefit
s an
d ha
rms
of s
cree
ning
fo
r abd
omin
al a
ortic
ane
urys
m
is to
o cl
ose
to m
ake
a ge
nera
l re
com
men
datio
n fo
r thi
s po
pula
tion.
The
pote
ntia
l ove
rall
bene
fit o
f scr
eeni
ng
for a
bdom
inal
aor
tic a
neur
ysm
am
ong
wom
en a
ges
65 to
75
year
s is
low
be
caus
e of
the
smal
l num
ber o
f ab
dom
inal
aor
tic a
neur
ysm
-rela
ted
deat
hs in
this
pop
ulat
ion
and
the
harm
s as
soci
ated
with
sur
gica
l rep
air.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
The
USP
STF
has
mad
e re
com
men
datio
ns o
n sc
reen
ing
for c
arot
id a
rtery
ste
nosi
s, c
oron
ary
hear
t dis
ease
, hig
h bl
ood
pres
sure
, lip
id d
isor
ders
, and
per
iphe
ral a
rteria
l dis
ease
. The
se re
com
men
datio
ns a
re a
vaila
ble
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
8
SCR
EEN
ING
AN
D B
EHAV
IOR
AL
CO
UN
SELI
NG
INTE
RVE
NTI
ON
S IN
PR
IMA
RY C
AR
E
TO R
EDU
CE
ALC
OH
OL
MIS
USE
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dults
, inc
ludi
ng p
regn
ant w
omen
Ado
lesc
ents
Rec
omm
enda
tion
Scre
en a
nd p
rovi
de b
ehav
iora
l cou
nsel
ing
inte
rven
tions
to
redu
ce a
lcoh
ol m
isus
e.
Gra
de: B
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
t
“Ris
ky” o
r “ha
zard
ous”
drin
king
has
bee
n de
fined
in th
e U
nite
d St
ates
as
mor
e th
an 7
drin
ks p
er w
eek
or m
ore
than
3 d
rinks
per
occ
asio
n fo
r w
omen
, and
mor
e th
an 1
4 dr
inks
per
wee
k or
mor
e th
an 4
drin
ks p
er o
ccas
ion
for m
en. “
Har
mfu
l drin
king
” des
crib
es p
erso
ns w
ho a
re c
urre
ntly
ex
perie
ncin
g ph
ysic
al, s
ocia
l, or
psy
chol
ogic
al h
arm
from
alc
ohol
use
but
do
not m
eet c
riter
ia fo
r dep
ende
nce.
Alc
ohol
abu
se a
nd d
epen
denc
e ar
e de
fined
by
spec
ific
crite
ria in
the
DSM
-IV.
Scre
enin
g Te
sts
The
Alco
hol U
se D
isor
ders
Iden
tifica
tion
Test
(AU
DIT
) is
the
mos
t stu
died
scr
eeni
ng to
ol fo
r det
ectin
g th
e fu
ll sp
ectru
m o
f alc
ohol
-rela
ted
prob
lem
s in
prim
ary
care
set
tings
. The
4-it
em C
AGE
is th
e m
ost p
opul
ar s
cree
ning
test
for d
etec
ting
alco
hol a
buse
or d
epen
denc
e.
TWEA
K, a
5-it
em s
cale
, and
the
T-AC
E ar
e de
sign
ed to
scr
een
preg
nant
wom
en fo
r alc
ohol
mis
use.
The
y de
tect
low
er le
vels
of a
lcoh
ol
cons
umpt
ion
that
may
pos
e ris
ks d
urin
g pr
egna
ncy.
Clin
icia
ns m
ay c
hoos
e sc
reen
ing
stra
tegi
es th
at a
re a
ppro
pria
te fo
r the
ir cl
inic
al p
opul
atio
n an
d se
tting
.
Tim
ing
of S
cree
ning
The
optim
al in
terv
al fo
r scr
eeni
ng a
nd in
terv
entio
n is
unk
now
n. P
atie
nts
with
pas
t alc
ohol
pro
blem
s, y
oung
adu
lts, a
nd o
ther
hig
h-ris
k gr
oups
(e
.g.,
smok
ers)
may
ben
efit m
ost f
rom
freq
uent
scr
eeni
ng.
Inte
rven
tions
Effe
ctiv
e be
havi
oral
inte
rven
tions
to re
duce
risk
y/ha
zard
ous
and
harm
ful d
rinki
ng in
clud
e an
initi
al c
ouns
elin
g se
ssio
n of
abo
ut 1
5 m
inut
es,
feed
back
, adv
ice,
and
goa
l-set
ting.
Mos
t als
o in
clud
e fu
rther
ass
ista
nce
and
follo
wup
. Res
ourc
es th
at h
elp
clin
icia
ns d
eliv
er e
ffect
ive
inte
rven
tions
incl
ude
brie
f pro
vide
r tra
inin
g or
acc
ess
to s
peci
ally
trai
ned
prim
ary
care
pra
ctiti
oner
s or
hea
lth e
duca
tors
, and
the
pres
ence
of
offic
e-le
vel s
yste
m s
uppo
rts (p
rom
pts,
rem
inde
rs, c
ouns
elin
g al
gorit
hms,
and
pat
ient
edu
catio
n m
ater
ials
).
All p
regn
ant w
omen
and
wom
en c
onte
mpl
atin
g pr
egna
ncy
shou
ld b
e in
form
ed o
f the
har
mfu
l effe
cts
of a
lcoh
ol o
n th
e fe
tus.
Ref
erra
l or s
peci
alty
trea
tmen
t is
reco
mm
ende
d fo
r ind
ivid
uals
mee
ting
the
diag
nost
ic c
riter
ia fo
r alc
ohol
dep
ende
nce.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Scre
enin
g in
prim
ary
care
set
tings
can
acc
urat
ely
iden
tify
patie
nts
who
se a
lcoh
ol c
onsu
mpt
ion
does
not
mee
t crit
eria
for a
lcoh
ol
depe
nden
ce, b
ut p
lace
s th
em a
t ris
k fo
r inc
reas
ed m
orbi
dity
and
m
orta
lity.
Brie
f beh
avio
ral c
ouns
elin
g in
terv
entio
ns w
ith fo
llow
up
prod
uce
smal
l to
mod
erat
e re
duct
ions
in a
lcoh
ol c
onsu
mpt
ion
that
are
su
stai
ned
over
6 to
12
mon
ths
or lo
nger
.
The
evid
ence
is in
suffi
cien
t to
asse
ss th
e po
tent
ial b
enefi
ts a
nd
harm
s of
scr
eeni
ng a
nd b
ehav
iora
l cou
nsel
ing
inte
rven
tions
in th
is
popu
latio
n.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r illic
it dr
ug u
se a
nd c
ouns
elin
g fo
r tob
acco
ces
satio
n in
ado
lesc
ents
, adu
lts, a
nd
preg
nant
wom
en. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/. Fo
r a s
umm
ary
of th
e ev
iden
ce s
yste
mat
ical
ly re
view
ed in
mak
ing
this
reco
mm
enda
tion,
the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
9
ASP
IRIN
FO
R T
HE
PREV
ENTI
ON
OF
CA
RD
IOVA
SCU
LAR
DIS
EASE
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nM
en a
ge 4
5-79
yea
rsW
omen
age
55-
79 y
ears
Men
age
<45
yea
rsW
omen
age
<55
yea
rsM
en &
Wom
en a
ge ≥
80 y
ears
Rec
omm
enda
tion
Enco
urag
e as
pirin
use
w
hen
pote
ntia
l CVD
ben
efit
(MIs
pre
vent
ed) o
utw
eigh
s po
tent
ial h
arm
of G
I he
mor
rhag
e.
Enco
urag
e as
pirin
use
w
hen
pote
ntia
l CVD
be
nefit
(str
okes
pre
vent
ed)
outw
eigh
s po
tent
ial h
arm
of
GI h
emor
rhag
e.
Do
not e
ncou
rage
asp
irin
use
for M
I pre
vent
ion.
Do
not e
ncou
rage
asp
irin
use
for s
trok
e pr
even
tion.
No
Rec
omm
enda
tion
Gra
de: A
Gra
de: D
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
How
to U
se T
his
Rec
omm
enda
tion
Shar
ed d
ecis
ionm
akin
g is
stro
ngly
enc
oura
ged
with
indi
vidu
als
who
se ri
sk is
clo
se to
(eith
er a
bove
or b
elow
) the
est
imat
es o
f 10-
year
risk
leve
ls in
dica
ted
belo
w. A
s th
e po
tent
ial C
VD b
enefi
t inc
reas
es a
bove
har
ms,
the
reco
mm
enda
tion
to ta
ke a
spiri
n sh
ould
bec
ome
stro
nger
.
To d
eter
min
e w
heth
er th
e po
tent
ial b
enefi
t of M
Is p
reve
nted
(men
) and
stro
kes
prev
ente
d (w
omen
) out
wei
ghs
the
pote
ntia
l har
m o
f inc
reas
ed G
I hem
orrh
age,
bot
h 10
-yea
r C
VD ri
sk a
nd a
ge m
ust b
e co
nsid
ered
.
Ris
k le
vel a
t whi
ch C
VD e
vent
s pr
even
ted
(ben
efit)
exce
eds
GI h
arm
s
Men
10
-yea
r CH
D ri
skW
omen
10
-yea
r str
oke
risk
Age
45-5
9 ye
ars
≥4%
Age
55-5
9 ye
ars
≥3%
Age
60-6
9 ye
ars
≥9%
Age
60-6
9 ye
ars
≥8%
Age
70-7
9 ye
ars
≥12%
Age
70-7
9 ye
ars
≥11%
The
tabl
e ab
ove
appl
ies
to a
dults
who
are
not
taki
ng N
SAID
s an
d w
ho d
o no
t hav
e up
per G
I pai
n or
a h
isto
ry o
f GI u
lcer
s.
NSA
ID u
se a
nd h
isto
ry o
f GI u
lcer
s ra
ise
the
risk
of s
erio
us G
I ble
edin
g co
nsid
erab
ly a
nd s
houl
d be
con
side
red
in d
eter
min
ing
the
bala
nce
of b
enefi
ts a
nd h
arm
s. N
SAID
us
e co
mbi
ned
with
asp
irin
use
appr
oxim
atel
y qu
adru
ples
the
risk
of s
erio
us G
I ble
edin
g co
mpa
red
to th
e ris
k w
ith a
spiri
n us
e al
one.
The
rate
of s
erio
us b
leed
ing
in a
spiri
n us
ers
is a
ppro
xim
atel
y 2-
3 tim
es h
ighe
r in
patie
nts
with
a h
isto
ry o
f GI u
lcer
s.
Ris
k As
sess
men
t
For m
en: R
isk
fact
ors
for C
HD
incl
ude
age,
dia
bete
s, to
tal c
hole
ster
ol le
vel,
HD
L le
vel,
bloo
d pr
essu
re, a
nd s
mok
ing.
C
HD
risk
est
imat
ion
tool
: http
://hp
2010
.nhl
bihi
n.ne
t/atp
iii/ca
lcul
ator
.asp
For w
omen
: Ris
k fa
ctor
s fo
r isc
hem
ic s
troke
incl
ude
age,
hig
h bl
ood
pres
sure
, dia
bete
s, s
mok
ing,
his
tory
of C
VD, a
trial
fibr
illatio
n, a
nd le
ft ve
ntric
ular
hyp
ertro
phy.
St
roke
risk
est
imat
ion
tool
: http
://w
ww.
wes
tern
stro
ke.o
rg/in
dex.
php?
head
er_n
ame=
stro
ke_t
ools
.gif&
mai
n=st
roke
_too
ls.p
hp
Oth
er R
elev
ant
USP
STF
Rec
omm
enda
tions
The
USP
STF
has
mad
e re
com
men
datio
ns o
n sc
reen
ing
for a
bdom
inal
aor
tic a
neur
ysm
, car
otid
arte
ry s
teno
sis,
cor
onar
y he
art d
isea
se, h
igh
bloo
d pr
essu
re, l
ipid
di
sord
ers,
and
per
iphe
ral a
rteria
l dis
ease
. The
se re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
Abb
revi
atio
ns: C
HD
= c
oron
ary
hear
t dis
ease
, CVD
= c
ardi
ovas
cula
r dis
ease
, GI =
gas
troin
test
inal
, HD
L =
high
-den
sity
lipo
prot
ein,
MI =
myo
card
ial i
nfar
ctio
n, N
SAID
s =
nons
tero
idal
ant
i-infl
amm
ator
y dr
ugs.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
10
RO
UTI
NE
ASP
IRIN
OR
NO
NST
ERO
IDA
L A
NTI
-INFL
AM
MAT
ORY
DR
UG
(NSA
ID) U
SE F
OR
TH
E PR
IMA
RY
PREV
ENTI
ON
OF
CO
LOR
ECTA
L C
AN
CER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts a
t ave
rage
risk
for c
olor
ecta
l can
cer
Rec
omm
enda
tion
Do
not u
se a
spiri
n or
NSA
IDs
for t
he p
reve
ntio
n of
col
orec
tal c
ance
r.G
rade
: D
Ris
k As
sess
men
tTh
e m
ajor
risk
fact
ors
for c
olor
ecta
l can
cer a
re o
lder
age
(old
er th
an a
ge 5
0 ye
ars)
, fam
ily h
isto
ry (h
avin
g tw
o or
mor
e fir
st-
or s
econ
d-de
gree
rela
tives
with
col
orec
tal c
ance
r), a
nd A
frica
n Am
eric
an ra
ce.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Aspi
rin a
nd N
SAID
s, ta
ken
in h
ighe
r dos
es fo
r lon
ger p
erio
ds, r
educ
e th
e in
cide
nce
of a
deno
mat
ous
poly
ps. H
owev
er,
ther
e is
poo
r evi
denc
e th
at a
spiri
n an
d N
SAID
use
lead
s to
a re
duct
ion
in c
olor
ecta
l can
cer-a
ssoc
iate
d m
orta
lity.
Aspi
rin in
crea
ses
the
inci
denc
e of
gas
troin
test
inal
ble
edin
g an
d he
mor
rhag
ic s
troke
; NSA
IDs
incr
ease
the
inci
denc
e of
ga
stro
inte
stin
al b
leed
ing
and
rena
l im
pairm
ent,
espe
cial
ly in
the
elde
rly.
The
USP
STF
conc
lude
d th
at th
e ha
rms
outw
eigh
the
bene
fits
of a
spiri
n an
d N
SAID
use
for t
he p
reve
ntio
n of
col
orec
tal
canc
er.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r col
orec
tal c
ance
r and
asp
irin
use
for t
he p
reve
ntio
n of
ca
rdio
vasc
ular
dis
ease
. The
se re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
11
SCR
EEN
ING
FO
R B
AC
TER
IAL
VAG
INO
SIS
IN P
REG
NA
NC
Y TO
PR
EVEN
T PR
ETER
M D
ELIV
ERY
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
pre
gnan
t wom
en w
ithou
t ris
k fa
ctor
s fo
r pre
term
del
iver
yA
sym
ptom
atic
pre
gnan
t wom
en w
ith ri
sk fa
ctor
s fo
r pr
eter
m d
eliv
ery
Rec
omm
enda
tion
Do
not s
cree
n.
Gra
de: D
N
o re
com
men
datio
n.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
t
Ris
k fa
ctor
s of
pre
term
del
iver
y in
clud
e:
●
Afric
an-A
mer
ican
wom
en.
●
Pelv
ic in
fect
ion.
●
Prev
ious
pre
term
del
iver
y.
Bact
eria
l vag
inos
is is
mor
e co
mm
on a
mon
g Af
rican
-Am
eric
an w
omen
, wom
en o
f low
soc
ioec
onom
ic s
tatu
s,
and
wom
en w
ho h
ave
prev
ious
ly d
eliv
ered
low
-birt
h-w
eigh
t inf
ants
.
Scre
enin
g Te
sts
Bact
eria
l vag
inos
is is
dia
gnos
ed u
sing
Am
sel’s
clin
ical
crit
eria
or G
ram
sta
in.
Whe
n us
ing
Amse
l’s c
riter
ia, 3
out
of 4
crit
eria
mus
t be
met
to m
ake
a cl
inic
al d
iagn
osis
:
1. V
agin
al p
H >
4.7.
2. T
he p
rese
nce
of c
lue
cells
on
wet
mou
nt.
3. T
hin
hom
ogen
eous
dis
char
ge.
4. A
min
e ‘fi
shy
odor
’ whe
n po
tass
ium
hyd
roxi
de is
add
ed to
the
disc
harg
e.
Scre
enin
g In
terv
als
Not
app
licab
le.
Trea
tmen
t
Trea
tmen
t is
appr
opria
te fo
r pre
gnan
t wom
en w
ith s
ympt
omat
ic b
acte
rial v
agin
osis
infe
ctio
n.
Ora
l met
roni
dazo
le a
nd o
ral c
linda
myc
in, a
s w
ell a
s va
gina
l met
roni
dazo
le g
el o
r clin
dam
ycin
cre
am, a
re u
sed
to tr
eat b
acte
rial v
agin
osis
.
The
optim
al tr
eatm
ent r
egim
en is
unc
lear
.1
1 The
Cen
ters
for D
isea
se C
ontro
l and
Pre
vent
ion
(CD
C) r
ecom
men
ds 2
50 m
g or
al m
etro
nida
zole
3 ti
mes
a d
ay fo
r 7 d
ays
as th
e tre
atm
ent f
or b
acte
rial v
agin
osis
in p
regn
ancy
.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
12
SCR
EEN
ING
FO
R A
SYM
PTO
MAT
IC B
AC
TER
IUR
IA IN
AD
ULT
S
CLI
NIC
AL
SUM
MA
RY O
F A
U.S
. PR
EVEN
TIVE
SER
VIC
ES T
ASK
FO
RC
E R
ECO
MM
END
ATIO
N S
TATE
MEN
T
Popu
latio
nA
ll pr
egna
nt w
omen
Men
and
non
preg
nant
wom
en
Rec
omm
enda
tion
Scre
en w
ith u
rine
cultu
re.
Gra
de: A
D
o no
t scr
een.
G
rade
: D
Det
ectio
n an
d Sc
reen
ing
Test
sAs
ympt
omat
ic b
acte
riuria
can
be
relia
bly
dete
cted
thro
ugh
urin
e cu
lture
.
The
pres
ence
of a
t lea
st 1
05 c
olon
y-fo
rmin
g un
its p
er m
L of
urin
e, o
f a s
ingl
e ur
opat
hoge
n, a
nd in
a m
idst
ream
cle
an-
catc
h sp
ecim
en is
con
side
red
a po
sitiv
e te
st re
sult.
Scre
enin
g In
terv
als
A cl
ean-
catc
h ur
ine
spec
imen
sho
uld
be c
olle
cted
for
scre
enin
g cu
lture
at 1
2-16
wee
ks’ g
esta
tion
or a
t the
firs
t pr
enat
al v
isit,
if la
ter.
The
optim
al fr
eque
ncy
of s
ubse
quen
t urin
e te
stin
g du
ring
preg
nanc
y is
unc
erta
in.
Do
not s
cree
n.
Bene
fits
of D
etec
tion
and
Early
Tr
eatm
ent
The
dete
ctio
n an
d tre
atm
ent o
f asy
mpt
omat
ic b
acte
riuria
w
ith a
ntib
iotic
s si
gnifi
cant
ly re
duce
s th
e in
cide
nce
of
sym
ptom
atic
mat
erna
l urin
ary
tract
infe
ctio
ns a
nd lo
w
birth
wei
ght.
Scre
enin
g m
en a
nd n
onpr
egna
nt w
omen
for a
sym
ptom
atic
ba
cter
iuria
is in
effe
ctiv
e in
impr
ovin
g cl
inic
al o
utco
mes
.
Har
ms
of D
etec
tion
and
Early
Tr
eatm
ent
Pote
ntia
l har
ms
asso
ciat
ed w
ith tr
eatm
ent o
f asy
mpt
omat
ic b
acte
riuria
incl
ude:
●
Adve
rse
effe
cts
from
ant
ibio
tics.
●
Dev
elop
men
t of b
acte
rial r
esis
tanc
e.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
Addi
tiona
l USP
STF
reco
mm
enda
tions
invo
lvin
g sc
reen
ing
for i
nfec
tious
con
ditio
ns d
urin
g pr
egna
ncy
can
be fo
und
at
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/re
com
men
datio
ns.h
tm#o
bste
tric
and
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/
reco
mm
enda
tions
.htm
#inf
ectio
us.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
13
SCR
EEN
ING
FO
R B
LAD
DER
CA
NC
ER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
t
Ris
k fa
ctor
s fo
r bla
dder
can
cer i
nclu
de:
●
Smok
ing
●
Occ
upat
iona
l exp
osur
e to
car
cino
gens
(e.g
., ru
bber
, che
mic
al, a
nd le
athe
r ind
ustri
es)
●
Mal
e se
x
●O
lder
age
●
Whi
te ra
ce
●In
fect
ions
cau
sed
by c
erta
in b
ladd
er p
aras
ites
●
Fam
ily o
r per
sona
l his
tory
of b
ladd
er c
ance
r
Scre
enin
g Te
sts
Scre
enin
g te
sts
for b
ladd
er c
ance
r inc
lude
:
●M
icro
scop
ic u
rinal
ysis
for h
emat
uria
●
Urin
e cy
tolo
gy
●U
rine
biom
arke
rs
Inte
rven
tions
The
prin
cipa
l tre
atm
ent f
or s
uper
ficia
l bla
dder
can
cer i
s tra
nsur
ethr
al re
sect
ion
of th
e bl
adde
r tum
or, w
hich
may
be
com
bine
d w
ith a
djuv
ant
radi
atio
n th
erap
y, c
hem
othe
rapy
, bio
logi
c th
erap
ies,
or p
hoto
dyna
mic
ther
apie
s.
Rad
ical
cys
tect
omy,
ofte
n w
ith a
djuv
ant c
hem
othe
rapy
, is
used
in c
ases
of s
urgi
cally
rese
ctab
le in
vasi
ve b
ladd
er c
ance
r.
Bala
nce
of B
enefi
ts a
nd H
arm
sTh
ere
is in
adeq
uate
evi
denc
e th
at tr
eatm
ent o
f scr
een-
dete
cted
bla
dder
can
cer l
eads
to im
prov
ed m
orbi
dity
or m
orta
lity.
Th
ere
is in
adeq
uate
evi
denc
e on
har
ms
of s
cree
ning
for b
ladd
er c
ance
r.
Sugg
estio
ns fo
r Pra
ctic
e
In d
ecid
ing
whe
ther
to s
cree
n fo
r bla
dder
can
cer,
clin
icia
ns s
houl
d co
nsid
er th
e fo
llow
ing:
●P
oten
tial p
reve
ntab
le b
urde
n: e
arly
det
ectio
n of
tum
ors
with
mal
igna
nt p
oten
tial c
ould
hav
e an
impo
rtant
impa
ct o
n th
e m
orta
lity
rate
of
blad
der c
ance
r.
●P
oten
tial h
arm
s: fa
lse-
posi
tive
resu
lts m
ay le
ad to
anx
iety
and
unn
eede
d ev
alua
tions
, dia
gnos
tic-re
late
d ha
rms
from
cys
tosc
opy
and
biop
sy, h
arm
s fro
m la
belin
g an
d un
nece
ssar
y tre
atm
ents
, and
ove
rdia
gnos
is.
●
Cur
rent
pra
ctic
e: s
cree
ning
test
s us
ed in
prim
ary
prac
tice
incl
ude
mic
rosc
opic
urin
alys
is fo
r hem
atur
ia a
nd u
rine
cyto
logy
; urin
e bi
omar
kers
are
not
com
mon
ly u
sed
in p
art b
ecau
se o
f cos
t. Pa
tient
s w
ith p
ositi
ve fi
ndin
gs a
re ty
pica
lly re
ferre
d to
a u
rolo
gist
for f
urth
er
eval
uatio
n.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsR
ecom
men
datio
ns o
n sc
reen
ing
for o
ther
type
s of
can
cer c
an b
e fo
und
at w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
. Fo
r a s
umm
ary
of th
e ev
iden
ce s
yste
mat
ical
ly re
view
ed in
mak
ing
thes
e re
com
men
datio
ns, t
he fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, ple
ase
go to
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
14
GEN
ETIC
RIS
K A
SSES
SMEN
T A
ND
BR
EAST
CA
NC
ER S
USC
EPTI
BIL
ITY
GEN
E (B
RC
A) M
UTA
TIO
N T
ESTI
NG
FO
R B
REA
ST A
ND
OVA
RIA
N C
AN
CER
SU
SCEP
TIB
ILIT
YC
LIN
ICA
L SU
MM
ARY
OF
U.S
. PR
EVEN
TIVE
SER
VIC
ES T
ASK
FO
RC
E R
ECO
MM
END
ATIO
N
Popu
latio
nW
omen
who
se fa
mily
his
tory
is n
ot a
ssoc
iate
d w
ith a
n in
crea
sed
risk
for d
elet
erio
us m
utat
ions
in th
e B
RC
A1
or B
RC
A2
gene
Wom
en w
hose
fam
ily h
isto
ry is
ass
ocia
ted
with
an
incr
ease
d ris
k fo
r de
lete
rious
mut
atio
ns in
the
BR
CA
1 or
BR
CA
2 ge
ne
Rec
omm
enda
tion
Do
not r
efer
pat
ient
s fo
r gen
etic
cou
nsel
ing
or B
RC
A te
stin
g.
Gra
de: D
Ref
er p
atie
nts
for g
enet
ic c
ouns
elin
g an
d ev
alua
tion
for B
RC
A te
stin
g.
Gra
de: B
Ris
k As
sess
men
t
An in
crea
sed-
risk
fam
ily h
isto
ry is
defi
ned
as fo
llow
s:
For n
on-A
shke
nazi
Jew
ish
wom
en: 2
firs
t-deg
ree
rela
tives
with
bre
ast c
ance
r, 1
of w
hom
rece
ived
the
diag
nosi
s at
age
50
year
s or
you
nger
; a c
ombi
natio
n of
3 o
r mor
e fir
st- o
r sec
ond-
degr
ee re
lativ
es w
ith b
reas
t can
cer,
rega
rdle
ss o
f age
at d
iagn
osis
; a c
ombi
natio
n of
bot
h br
east
and
ova
rian
canc
er a
mon
g fir
st- a
nd s
econ
d-de
gree
rela
tives
; a fi
rst-d
egre
e re
lativ
e w
ith b
ilate
ral b
reas
t can
cer;
a co
mbi
natio
n of
2 o
r mor
e fir
st- o
r sec
ond-
degr
ee re
lativ
es w
ith o
varia
n ca
ncer
, reg
ardl
ess
of a
ge a
t dia
gnos
is; a
firs
t- or
sec
ond-
degr
ee re
lativ
e w
ith b
oth
brea
st a
nd o
varia
n ca
ncer
at a
ny a
ge; o
r a h
isto
ry o
f bre
ast c
ance
r in
a m
ale
rela
tive.
For w
omen
of A
shke
nazi
Jew
ish
herit
age:
an
incr
ease
d-ris
k fa
mily
his
tory
incl
udes
any
firs
t-deg
ree
rela
tive
(or 2
sec
ond-
degr
ee re
lativ
es o
n th
e sa
me
side
of
the
fam
ily) w
ith b
reas
t or o
varia
n ca
ncer
.
Abou
t 2%
of a
dult
wom
en in
the
gene
ral p
opul
atio
n ha
ve a
n in
crea
sed-
risk
fam
ily h
isto
ry a
s de
fined
her
e. T
here
are
tool
s av
aila
ble
to p
redi
ct th
e ris
k fo
r cl
inic
ally
impo
rtant
BR
CA
mut
atio
ns, b
ut th
ese
tool
s ha
ve n
ot b
een
verifi
ed in
the
gene
ral p
opul
atio
n. T
here
is n
o ev
iden
ce c
once
rnin
g th
e le
vel o
f ris
k fo
r a
BR
CA
mut
atio
n th
at m
erits
refe
rral f
or g
enet
ic c
ouns
elin
g.
Scre
enin
g Te
sts
Gen
etic
cou
nsel
ing
incl
udes
ele
men
ts o
f cou
nsel
ing,
risk
ass
essm
ent,
pedi
gree
ana
lysi
s, a
nd, i
n so
me
case
s, re
com
men
datio
ns fo
r tes
ting
for B
RC
A
mut
atio
ns in
affe
cted
fam
ily m
embe
rs, t
he p
atie
nt, o
r bot
h. A
BR
CA
test
is ty
pica
lly o
rder
ed b
y a
phys
icia
n. W
hen
done
toge
ther
with
gen
etic
cou
nsel
ing,
the
test
ass
ures
the
linka
ge o
f tes
ting
with
app
ropr
iate
man
agem
ent d
ecis
ions
.
Inte
rven
tions
The
inte
rven
tions
that
can
be
offe
red
to a
wom
an w
ith a
del
eter
ious
BR
CA
1 or
BR
CA
2 m
utat
ion
or o
ther
incr
ease
d ris
k fo
r her
edita
ry b
reas
t can
cer i
nclu
de
inte
nsiv
e sc
reen
ing,
che
mop
reve
ntio
n, p
roph
ylac
tic m
aste
ctom
y or
oop
hore
ctom
y, o
r a c
ombi
natio
n.
Bala
nce
of B
enefi
ts a
nd
Har
ms
Wom
en w
ithou
t an
incr
ease
d-ris
k fa
mily
his
tory
hav
e a
low
risk
for
deve
lopi
ng b
reas
t or o
varia
n ca
ncer
ass
ocia
ted
with
BR
CA
1 or
BR
CA
2 m
utat
ions
.
Ther
e ar
e im
porta
nt a
dver
se e
thic
al, l
egal
, and
soc
ial c
onse
quen
ces
that
can
re
sult
from
rout
ine
refe
rral a
nd te
stin
g of
thes
e w
omen
. Int
erve
ntio
ns s
uch
as
prop
hyla
ctic
sur
gery
, che
mop
reve
ntio
n, o
r int
ensi
ve s
cree
ning
hav
e kn
own
harm
s.
The
pote
ntia
l har
ms
of ro
utin
e re
ferra
l for
gen
etic
cou
nsel
ing
or B
RC
A
test
ing
in th
ese
wom
en o
utw
eigh
the
bene
fits.
Wom
en w
ith a
n in
crea
sed-
risk
fam
ily h
isto
ry h
ave
an in
crea
sed
risk
for
deve
lopi
ng b
reas
t or o
varia
n ca
ncer
ass
ocia
ted
with
BR
CA
1 or
BR
CA
2 m
utat
ions
.
The
pote
ntia
l ben
efits
of r
efer
ral a
nd d
iscu
ssio
n of
test
ing
and
prop
hyla
ctic
tre
atm
ent f
or th
ese
wom
en m
ay b
e su
bsta
ntia
l.
The
bene
fits
of re
ferri
ng w
omen
with
an
incr
ease
d-ris
k fa
mily
his
tory
to
suita
bly
train
ed h
ealth
car
e pr
ovid
ers
outw
eigh
the
harm
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
mam
mog
raph
y sc
reen
ing
for b
reas
t can
cer,
scre
enin
g fo
r ova
rian
canc
er, a
nd c
hem
opre
vent
ion
of b
reas
t ca
ncer
. The
se re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
15
SCR
EEN
ING
FO
R B
REA
ST C
AN
CER
PA
RT
I: U
SIN
G F
ILM
MA
MM
OG
RA
PHY
CLI
NIC
AL
SUM
MA
RY O
F 20
09 U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
1 Po
pula
tion
Wom
en a
ged
40-4
9 ye
ars
Wom
en a
ged
50-7
4 ye
ars
Wom
en a
ged
≥75
year
s
Rec
omm
enda
tion
Indi
vidu
aliz
e de
cisi
on to
beg
in b
ienn
ial
scre
enin
g ac
cord
ing
to th
e pa
tient
’s
circ
umst
ance
s an
d va
lues
.
Gra
de: C
Scre
en e
very
2 y
ears
.
Gra
de: B
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
tTh
is re
com
men
datio
n ap
plie
s to
wom
en a
ged
≥40
year
s w
ho a
re n
ot a
t inc
reas
ed ri
sk b
y vi
rtue
of a
kno
wn
gene
tic m
utat
ion
or h
isto
ry o
f che
st ra
diat
ion.
Incr
easi
ng a
ge is
the
mos
t im
porta
nt ri
sk fa
ctor
for m
ost w
omen
.
Scre
enin
g Te
sts
Stan
dard
izat
ion
of fi
lm m
amm
ogra
phy
has
led
to im
prov
ed q
ualit
y. R
efer
pat
ient
s to
faci
litie
s ce
rtifie
d un
der t
he M
amm
ogra
phy
Qua
lity
Stan
dard
s Ac
t (M
QSA
), lis
ted
at
http
://w
ww.
acce
ssda
ta.fd
a.go
v/sc
ripts
/cdr
h/cf
docs
/cfM
QSA
/mqs
a.cf
m
Tim
ing
of S
cree
ning
Evid
ence
indi
cate
s th
at b
ienn
ial s
cree
ning
is o
ptim
al. A
bie
nnia
l sch
edul
e pr
eser
ves
mos
t of
the
bene
fit o
f ann
ual s
cree
ning
and
cut
s th
e ha
rms
near
ly in
hal
f. A
long
er in
terv
al m
ay
redu
ce th
e be
nefit
.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Ther
e is
con
vinc
ing
evid
ence
that
scr
eeni
ng w
ith fi
lm m
amm
ogra
phy
redu
ces
brea
st c
ance
r m
orta
lity,
with
a g
reat
er a
bsol
ute
redu
ctio
n fo
r wom
en a
ged
50 to
74
year
s th
an fo
r you
nger
w
omen
.
Har
ms
of s
cree
ning
incl
ude
psyc
holo
gica
l har
ms,
add
ition
al m
edic
al v
isits
, im
agin
g, a
nd
biop
sies
in w
omen
with
out c
ance
r, in
conv
enie
nce
due
to fa
lse-
posi
tive
scre
enin
g re
sults
, ha
rms
of u
nnec
essa
ry tr
eatm
ent,
and
radi
atio
n ex
posu
re. H
arm
s se
em m
oder
ate
for e
ach
age
grou
p.
Fals
e-po
sitiv
e re
sults
are
a g
reat
er c
once
rn fo
r you
nger
wom
en; t
reat
men
t of c
ance
r tha
t w
ould
not
bec
ome
clin
ical
ly a
ppar
ent d
urin
g a
wom
an’s
life
(ove
rdia
gnos
is) i
s an
incr
easi
ng
prob
lem
as
wom
en a
ge.
Rat
iona
le fo
r No
Rec
omm
enda
tion
(I
Stat
emen
t)
Amon
g w
omen
75
year
s or
old
er, e
vide
nce
of b
enefi
t is
lack
ing.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsU
SPST
F re
com
men
datio
ns o
n sc
reen
ing
for g
enet
ic s
usce
ptib
ility
for b
reas
t can
cer a
nd c
hem
opre
vent
ion
of b
reas
t can
cer a
re a
vaila
ble
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
. 1 T
he U
.S. D
epar
tmen
t of H
ealth
and
Hum
an S
ervi
ces,
in im
plem
entin
g th
e Af
ford
able
Car
e Ac
t und
er th
e st
anda
rd it
set
s ou
t in
revi
sed
Sect
ion
2713
(a)(5
) of t
he P
ublic
Hea
lth S
ervi
ce A
ct, u
tiliz
es th
e 20
02 re
com
men
datio
n on
bre
ast c
ance
r scr
eeni
ng o
f the
U.S
. Pr
even
tive
Serv
ices
Tas
k Fo
rce.
For
clin
ical
sum
mar
y of
200
2 R
ecom
men
datio
n, s
ee A
ppen
dix
F.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
16
SCR
EEN
ING
FO
R B
REA
ST C
AN
CER
PA
RT
II: U
SIN
G M
ETH
OD
S O
THER
TH
AN
FIL
M M
AM
MO
GR
APH
Y
CLI
NIC
AL
SUM
MA
RY O
F 20
09 U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
1
Popu
latio
nW
omen
age
d ≥4
0 ye
ars
Scre
enin
g M
etho
d D
igita
l mam
mog
raph
y M
agne
tic re
sona
nce
imag
ing
(MR
I) C
linic
al b
reas
t exa
min
atio
n (C
BE)
B
reas
t sel
f-exa
min
atio
n (B
SE)
Gra
de: D
R
ecom
men
datio
nG
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Rat
iona
le fo
r No
Rec
omm
enda
tion
or
Neg
ativ
e R
ecom
men
datio
n
Evid
ence
is la
ckin
g fo
r ben
efits
of d
igita
l mam
mog
raph
y an
d M
RI o
f the
bre
ast a
s su
bstit
utes
for fi
lm
mam
mog
raph
y.
Evid
ence
of C
BE’s
add
ition
al b
enefi
t, be
yond
m
amm
ogra
phy,
is in
adeq
uate
.
Adeq
uate
evi
denc
e su
gges
ts th
at
BSE
does
not
redu
ce b
reas
t can
cer
mor
talit
y.
Con
side
ratio
ns fo
r Pra
ctic
e
Pote
ntia
l Pre
vent
able
Bu
rden
For y
oung
er w
omen
and
w
omen
with
den
se b
reas
t tis
sue,
ove
rall
dete
ctio
n is
som
ewha
t bet
ter w
ith
digi
tal m
amm
ogra
phy.
Con
trast
-enh
ance
d M
RI
has
been
sho
wn
to d
etec
t m
ore
case
s of
can
cer i
n ve
ry h
igh-
risk
popu
latio
ns
than
doe
s m
amm
ogra
phy.
Indi
rect
evi
denc
e su
gges
ts th
at w
hen
CBE
is
the
only
test
ava
ilabl
e, it
may
det
ect a
si
gnifi
cant
pro
porti
on o
f can
cer c
ases
.
Pote
ntia
l Har
ms
It is
not
cer
tain
whe
ther
ov
erdi
agno
sis
occu
rs m
ore
ofte
n w
ith d
igita
l tha
n w
ith
film
mam
mog
raph
y.
Con
trast
-enh
ance
d M
RI
requ
ires
inje
ctio
n of
co
ntra
st m
ater
ial.
MR
I yie
lds
man
y m
ore
fals
e-po
sitiv
e re
sults
an
d po
tent
ially
mor
e ov
erdi
agno
sis
than
m
amm
ogra
phy.
Har
ms
of C
BE in
clud
e fa
lse-
posi
tive
resu
lts,
whi
ch le
ad to
anx
iety
, unn
eces
sary
vis
its,
imag
ing,
and
bio
psie
s.
Har
ms
of B
SE in
clud
e th
e sa
me
pote
ntia
l har
ms
as fo
r CBE
and
may
be
larg
er in
mag
nitu
de.
Cos
tsD
igita
l mam
mog
raph
y is
m
ore
expe
nsiv
e th
an fi
lm.
MR
I is
muc
h m
ore
expe
nsiv
e th
an
mam
mog
raph
y.
Cos
ts o
f CBE
are
prim
arily
opp
ortu
nity
cos
ts
to c
linic
ians
.C
osts
of B
SE a
re p
rimar
ily o
ppor
tuni
ty
cost
s to
clin
icia
ns.
Cur
rent
Pra
ctic
eSo
me
clin
ical
pra
ctic
es a
re
now
sw
itchi
ng to
dig
ital
equi
pmen
t.
MR
I is
not c
urre
ntly
use
d to
sc
reen
wom
en o
f ave
rage
ris
k.
No
stan
dard
app
roac
h or
repo
rting
sta
ndar
ds
are
in p
lace
.
The
num
ber o
f clin
icia
ns w
ho te
ach
BSE
to p
atie
nts
is u
nkno
wn;
it is
like
ly
that
few
clin
icia
ns te
ach
BSE
to a
ll w
omen
.
1 The
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
s, in
impl
emen
ting
the
Affo
rdab
le C
are
Act u
nder
the
stan
dard
it s
ets
out i
n re
vise
d Se
ctio
n 27
13(a
)(5) o
f the
Pub
lic H
ealth
Ser
vice
Act
, util
izes
the
2002
reco
mm
enda
tion
on b
reas
t can
cer s
cree
ning
of t
he U
.S.
Prev
entiv
e Se
rvic
es T
ask
Forc
e. F
or c
linic
al s
umm
ary
of 2
002
Rec
omm
enda
tion,
see
App
endi
x F.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
17
PRIM
ARY
CA
RE
INTE
RVE
NTI
ON
S TO
PR
OM
OTE
BR
EAST
FEED
ING
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nPr
egna
nt w
omen
New
mot
hers
The
mot
her’s
par
tner
, oth
er
fam
ily m
embe
rs, a
nd fr
iend
sIn
fant
s an
d yo
ung
child
ren
Rec
omm
enda
tion
Prom
ote
and
supp
ort b
reas
tfeed
ing.
Gra
de: B
Bene
fits
of B
reas
tfeed
ing
Mot
hers
Less
like
lihoo
d of
bre
ast a
nd o
varia
n ca
ncer
Infa
nts
Few
er e
ar in
fect
ions
, low
er-re
spira
tory
-tra
ct in
fect
ions
, and
gas
troin
test
inal
in
fect
ions
Youn
g ch
ildre
n
Less
like
lihoo
d of
ast
hma,
type
2
diab
etes
, and
obe
sity
Inte
rven
tions
to P
rom
ote
Brea
stfe
edin
g
Inte
rven
tions
to p
rom
ote
and
supp
ort b
reas
tfeed
ing
have
bee
n fo
und
to in
crea
se th
e ra
tes
of in
itiat
ion,
dur
atio
n, a
nd e
xclu
sivi
ty
of b
reas
tfeed
ing.
Con
side
r mul
tiple
stra
tegi
es, i
nclu
ding
:
●
Form
al b
reas
tfeed
ing
educ
atio
n fo
r mot
hers
and
fam
ilies
●
Dire
ct s
uppo
rt of
mot
hers
dur
ing
brea
stfe
edin
g
●
Trai
ning
of p
rimar
y ca
re s
taff
abou
t bre
astfe
edin
g an
d te
chni
ques
for b
reas
tfeed
ing
supp
ort
●
Peer
sup
port
Inte
rven
tions
that
incl
ude
both
pre
nata
l and
pos
tnat
al c
ompo
nent
s m
ay b
e m
ost e
ffect
ive
at in
crea
sing
bre
astfe
edin
g du
ratio
n.
In ra
re c
ircum
stan
ces,
for e
xam
ple
for m
othe
rs w
ith H
IV a
nd in
fant
s w
ith g
alac
tose
mia
, bre
astfe
edin
g is
not
reco
mm
ende
d.
Inte
rven
tions
to p
rom
ote
brea
stfe
edin
g sh
ould
em
pow
er in
divi
dual
s to
mak
e in
form
ed c
hoic
es s
uppo
rted
by th
e be
st a
vaila
ble
evid
ence
.
Impl
emen
tatio
nSy
stem
-leve
l int
erve
ntio
ns w
ith s
enio
r lea
ders
hip
supp
ort m
ay b
e m
ore
likel
y to
be
sust
aine
d ov
er ti
me.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
18
SCR
EEN
ING
FO
R C
AR
OTI
D A
RTE
RY S
TEN
OSI
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dult
gene
ral p
opul
atio
n1
Rec
omm
enda
tion
Do
not s
cree
n w
ith u
ltras
ound
or o
ther
scr
eeni
ng te
sts.
Gra
de: D
Ris
k As
sess
men
tTh
e m
ajor
risk
fact
ors
for c
arot
id a
rtery
ste
nosi
s (C
AS) i
nclu
de: o
lder
age
, mal
e ge
nder
, hyp
erte
nsio
n, s
mok
ing,
hy
perc
hole
ster
olem
ia, a
nd h
eart
dise
ase.
How
ever
, acc
urat
e, re
liabl
e ris
k as
sess
men
t too
ls a
re n
ot a
vaila
ble.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Har
ms
outw
eigh
ben
efits
.
In th
e ge
nera
l pop
ulat
ion,
scr
eeni
ng w
ith c
arot
id d
uple
x ul
traso
und
wou
ld re
sult
in m
ore
fals
e-po
sitiv
e re
sults
than
true
po
sitiv
e re
sults
. Thi
s w
ould
lead
eith
er to
sur
gerie
s th
at a
re n
ot in
dica
ted
or to
con
firm
ator
y an
giog
raph
y. A
s th
e re
sult
of
thes
e pr
oced
ures
, som
e pe
ople
wou
ld s
uffe
r ser
ious
har
ms
(dea
th, s
troke
, and
myo
card
ial i
nfar
ctio
n) th
at o
utw
eigh
the
pote
ntia
l ben
efit s
urgi
cal t
reat
men
t may
hav
e in
pre
vent
ing
stro
ke.
Oth
er R
elev
ant
Rec
omm
enda
tions
from
the
USP
STF
Adul
ts s
houl
d be
scr
eene
d fo
r hyp
erte
nsio
n, h
yper
lipid
emia
, and
sm
okin
g. C
linic
ians
sho
uld
disc
uss
aspi
rin c
hem
opre
vent
ion
with
pat
ient
s at
incr
ease
d ris
k fo
r car
diov
ascu
lar d
isea
se.
Thes
e re
com
men
datio
ns a
nd re
late
d ev
iden
ce a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
1 Thi
s re
com
men
datio
n ap
plie
s to
adu
lts w
ithou
t neu
rolo
gica
l sym
ptom
s an
d w
ithou
t a h
isto
ry o
f tra
nsie
nt is
chem
ic a
ttack
s (T
IA) o
r stro
ke. I
f oth
erw
ise
elig
ible
, an
indi
vidu
al w
ho h
as a
car
otid
are
a TI
A sh
ould
be
eval
uate
d pr
ompt
ly fo
r con
side
ratio
n of
car
otid
end
arte
rect
omy.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
19
SCR
EEN
ING
FO
R C
ERVI
CA
L C
AN
CER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nW
omen
age
s 21
to 6
5 W
omen
age
s 30
to 6
5 W
omen
you
nger
than
ag
e 21
Wom
en o
lder
than
ag
e 65
who
hav
e ha
d ad
equa
te p
rior
scre
enin
g an
d ar
e no
t hi
gh ri
sk
Wom
en a
fter
hyst
erec
tom
y w
ith
rem
oval
of t
he c
ervi
x an
d w
ith n
o hi
stor
y of
hi
gh-g
rade
pre
canc
er
or c
ervi
cal c
ance
r
Wom
en y
oung
er th
an
age
30
Rec
omm
enda
tion
Scre
en w
ith c
ytol
ogy
(Pap
sm
ear)
eve
ry
3 ye
ars.
Gra
de: A
Scre
en w
ith c
ytol
ogy
ever
y 3
year
s or
co-
test
ing
(cyt
olog
y/H
PV
test
ing)
eve
ry 5
yea
rs
Gra
de: A
Do
not s
cree
n.
Gra
de: D
Do
not s
cree
n.
Gra
de: D
Do
not s
cree
n.
Gra
de: D
Do
not s
cree
n w
ith
HPV
test
ing
(alo
ne o
r w
ith c
ytol
ogy)
Gra
de: D
Ris
k As
sess
men
tH
uman
pap
illom
aviru
s (H
PV) i
nfec
tion
is a
ssoc
iate
d w
ith n
early
all
case
s of
cer
vica
l can
cer.
Oth
er fa
ctor
s th
at p
ut a
wom
an a
t inc
reas
ed ri
sk o
f cer
vica
l ca
ncer
incl
ude
HIV
infe
ctio
n, a
com
prom
ised
imm
une
syst
em, i
n ut
ero
expo
sure
to d
ieth
ylst
ilbes
trol,
and
prev
ious
trea
tmen
t of a
hig
h-gr
ade
prec
ance
rous
le
sion
or c
ervi
cal c
ance
r.
Scre
enin
g Te
sts
and
Inte
rval
Scre
enin
g w
omen
age
s 21
to 6
5 ye
ars
ever
y 3
year
s w
ith c
ytol
ogy
prov
ides
a re
ason
able
bal
ance
bet
wee
n be
nefit
s an
d ha
rms.
Sc
reen
ing
with
cyt
olog
y m
ore
ofte
n th
an e
very
3 y
ears
con
fers
littl
e ad
ditio
nal b
enefi
t, w
ith la
rge
incr
ease
s in
har
ms.
HPV
test
ing
com
bine
d w
ith c
ytol
ogy
(co-
test
ing)
eve
ry 5
yea
rs in
wom
en a
ges
30 to
65
year
s of
fers
a c
ompa
rabl
e ba
lanc
e of
ben
efits
and
har
ms,
and
is
ther
efor
e a
reas
onab
le a
ltern
ativ
e fo
r wom
en in
this
age
gro
up w
ho w
ould
pre
fer t
o ex
tend
the
scre
enin
g in
terv
al.
Tim
ing
of S
cree
ning
Scre
enin
g ea
rlier
than
age
21
year
s, re
gard
less
of s
exua
l his
tory
, lea
ds to
mor
e ha
rms
than
ben
efits
. Clin
icia
ns a
nd p
atie
nts
shou
ld b
ase
the
deci
sion
to e
nd
scre
enin
g on
whe
ther
the
patie
nt m
eets
the
crite
ria fo
r ade
quat
e pr
ior t
estin
g an
d ap
prop
riate
follo
w-u
p, p
er e
stab
lishe
d gu
idel
ines
.
Inte
rven
tions
Scre
enin
g ai
ms
to id
entif
y hi
gh-g
rade
pre
canc
erou
s ce
rvic
al le
sion
s to
pre
vent
dev
elop
men
t of c
ervi
cal c
ance
r and
ear
ly-s
tage
asy
mpt
omat
ic in
vasi
ve c
ervi
cal
canc
er.
Hig
h-gr
ade
lesi
ons
may
be
treat
ed w
ith a
blat
ive
and
exci
sion
al th
erap
ies,
incl
udin
g cr
yoth
erap
y, la
ser a
blat
ion,
loop
exc
isio
n, a
nd c
old
knife
con
izat
ion.
Ea
rly-s
tage
cer
vica
l can
cer m
ay b
e tre
ated
with
sur
gery
(hys
tere
ctom
y) o
r che
mor
adia
tion.
Bala
nce
of B
enefi
ts a
nd
Har
ms
The
bene
fits
of
scre
enin
g w
ith
cyto
logy
eve
ry 3
yea
rs
subs
tant
ially
out
wei
gh
the
harm
s.
The
bene
fits
of
scre
enin
g w
ith c
o-te
stin
g (c
ytol
ogy/
HPV
te
stin
g) e
very
5 y
ears
ou
twei
gh th
e ha
rms.
The
harm
s of
scr
eeni
ng
earli
er th
an a
ge 2
1 ye
ars
outw
eigh
the
bene
fits.
The
bene
fits
of
scre
enin
g af
ter a
ge 6
5 ye
ars
do n
ot o
utw
eigh
th
e po
tent
ial h
arm
s.
The
harm
s of
scr
eeni
ng
afte
r hys
tere
ctom
y ou
twei
gh th
e be
nefit
s.
The
pote
ntia
l har
ms
of s
cree
ning
with
HPV
te
stin
g (a
lone
or w
ith
cyto
logy
) out
wei
gh th
e po
tent
ial b
enefi
ts.
Oth
er R
elev
ant
USP
STF
Rec
omm
enda
tions
The
USP
STF
has
mad
e re
com
men
datio
ns o
n sc
reen
ing
for b
reas
t can
cer a
nd o
varia
n ca
ncer
, as
wel
l as
gene
tic ri
sk a
sses
smen
t and
BR
CA
mut
atio
n te
stin
g fo
r bre
ast a
nd o
varia
n ca
ncer
sus
cept
ibilit
y. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, ple
ase
go to
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
20
SCR
EEN
ING
FO
R C
HLA
MYD
IAL
INFE
CTI
ON
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
n
Non
-pre
gnan
t wom
enPr
egna
nt w
omen
Men
24 y
ears
and
yo
unge
r25
yea
rs a
nd o
lder
24 y
ears
and
yo
unge
r25
yea
rs a
nd o
lder
Incl
udes
ad
oles
cent
sN
ot a
t inc
reas
ed
risk
At i
ncre
ased
risk
Incl
udes
ad
oles
cent
sN
ot a
t inc
reas
ed
risk
At i
ncre
ased
risk
Rec
omm
enda
tion
Scre
en if
sex
ually
ac
tive.
Gra
de: A
Do
not
auto
mat
ical
ly
scre
en.
Gra
de: C
Scre
en.
Gra
de: A
Scre
en.
Gra
de: B
Do
not
auto
mat
ical
ly
scre
en.
Gra
de: C
Scre
en.
Gra
de: B
No
reco
mm
enda
tion.
Gra
de: I
(In
suffi
cien
t Ev
iden
ce1 )
Ris
k As
sess
men
t
Age
: Wom
en a
nd m
en a
ged
24 y
ears
and
you
nger
are
at g
reat
est r
isk.
His
tory
of:
prev
ious
Chl
amyd
ial i
nfec
tion
or o
ther
sex
ually
tran
smitt
ed in
fect
ions
, new
or m
ultip
le s
exua
l par
tner
s, in
cons
iste
nt c
ondo
m u
se, s
ex w
ork.
Dem
ogra
phic
s: A
frica
n-Am
eric
ans
and
His
pani
c w
omen
and
men
hav
e hi
gher
pre
vale
nce
rate
s th
an th
e ge
nera
l pop
ulat
ion
in m
any
com
mun
ities
.
Scre
enin
g Te
sts
Nuc
leic
aci
d am
plifi
catio
n te
sts
(NAA
Ts) c
an id
entif
y ch
lam
ydia
l inf
ectio
n in
asy
mpt
omat
ic w
omen
(non
-pre
gnan
t and
pre
gnan
t) an
d as
ympt
omat
ic m
en. N
AATs
ha
ve h
igh
spec
ifici
ty a
nd s
ensi
tivity
and
can
be
used
with
urin
e an
d va
gina
l sw
abs.
Scre
enin
g In
terv
als
Non
-Pre
gnan
t Wom
en
The
optim
al in
terv
al fo
r scr
eeni
ng is
not
kno
wn.
The
CD
C
reco
mm
ends
that
wom
en a
t inc
reas
ed ri
sk b
e sc
reen
ed a
t lea
st
annu
ally.
2
Preg
nant
Wom
en
For w
omen
24
year
s an
d yo
unge
r and
old
er w
omen
at i
ncre
ased
ris
k: S
cree
n at
the
first
pre
nata
l vis
it.
For p
atie
nts
at c
ontin
uing
risk
, or w
ho a
re n
ewly
at r
isk:
Scr
een
in
the
3rd
trim
este
r.
Not
app
licab
le
Trea
tmen
tTh
e C
ente
rs fo
r Dis
ease
Con
trol a
nd P
reve
ntio
n ha
s ou
tline
d ap
prop
riate
trea
tmen
t at:
http
://w
ww.
cdc.
gov/
STD
/trea
tmen
t. Te
st a
nd/o
r tre
at p
artn
ers
of p
atie
nts
treat
ed fo
r Chl
amyd
ial i
nfec
tion.
1 Chl
amyd
ial i
nfec
tion
resu
lts in
few
seq
uela
e in
men
. The
refo
re, t
he m
ajor
ben
efit o
f scr
eeni
ng m
en w
ould
be
to re
duce
the
likel
ihoo
d th
at in
fect
ed a
nd u
ntre
ated
men
wou
ld p
ass
the
infe
ctio
n to
sex
ual p
artn
ers.
The
re is
no
evid
ence
that
scr
eeni
ng m
en re
duce
s th
e lo
ng-te
rm c
onse
quen
ces
of c
hlam
ydia
l inf
ectio
n in
wom
en. B
ecau
se o
f thi
s la
ck o
f evi
denc
e, th
e U
SPST
F w
as n
ot a
ble
to a
sses
s th
e ba
lanc
e of
ben
efits
and
har
ms,
and
con
clud
ed th
at th
e ev
iden
ce is
insu
ffici
ent t
o re
com
men
d fo
r or a
gain
st ro
utin
ely
scre
enin
g m
en.
2 Cen
ters
for D
isea
se C
ontro
l and
Pre
vent
ion,
Sex
ually
tran
smitt
ed d
isea
ses
treat
men
t gui
delin
es, 2
006.
MM
WR
200
6. 5
5(N
o. R
R-1
1).
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
21
SCR
EEN
ING
FO
R C
HR
ON
IC O
BST
RU
CTI
VE P
ULM
ON
ARY
DIS
EASE
USI
NG
SPI
RO
MET
RY
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dult
gene
ral p
opul
atio
n
Rec
omm
enda
tion
Do
not s
cree
n fo
r chr
onic
obs
truc
tive
pulm
onar
y di
seas
e us
ing
spiro
met
ry.
Gra
de: D
Addi
tiona
l Pop
ulat
ion
Info
rmat
ion
This
scr
eeni
ng re
com
men
datio
n ap
plie
s to
hea
lthy
adul
ts w
ho d
o no
t rec
ogni
ze o
r rep
ort r
espi
rato
ry s
ympt
oms
to a
clin
icia
n.
It do
es n
ot a
pply
to in
divi
dual
s w
ith a
fam
ily h
isto
ry o
f alp
ha-1
ant
itryp
sin
defic
ienc
y.
Ris
k As
sess
men
t
Ris
k fa
ctor
s fo
r CO
PD in
clud
e:
●C
urre
nt o
r pas
t tob
acco
use
.
●Ex
posu
re to
occ
upat
iona
l and
env
ironm
enta
l pol
luta
nts.
●
Age
40 o
r old
er.
Scre
enin
g Te
sts1
Spiro
met
ry c
an b
e pe
rform
ed in
a p
rimar
y ca
re p
hysi
cian
’s o
ffice
or a
pul
mon
ary
test
ing
labo
rato
ry. T
he U
SPST
F di
d no
t re
view
evi
denc
e co
mpa
ring
the
accu
racy
of s
piro
met
ry p
erfo
rmed
in p
rimar
y ca
re v
ersu
s re
ferra
l set
tings
.
For i
ndiv
idua
ls w
ho p
rese
nt to
clin
icia
ns c
ompl
aini
ng o
f chr
onic
cou
gh, i
ncre
ased
spu
tum
pro
duct
ion,
whe
ezin
g, o
r dys
pnea
, sp
irom
etry
wou
ld b
e in
dica
ted
as a
dia
gnos
tic te
st fo
r CO
PD, a
sthm
a, a
nd o
ther
pul
mon
ary
dise
ases
.
Oth
er A
ppro
ache
s to
the
Prev
entio
n of
Pul
mon
ary
Illne
sses
Thes
e se
rvic
es s
houl
d be
offe
red
to p
atie
nts
rega
rdle
ss o
f CO
PD s
tatu
s:
●
All c
urre
nt s
mok
ers
shou
ld re
ceiv
e sm
okin
g ce
ssat
ion
coun
selin
g an
d be
offe
red
phar
mac
olog
ic th
erap
ies
dem
onst
rate
d to
incr
ease
ces
satio
n ra
tes.
●
All p
atie
nts
50 y
ears
of a
ge o
r old
er s
houl
d be
offe
red
influ
enza
imm
uniz
atio
n an
nual
ly.
●
All p
atie
nts
65 y
ears
of a
ge o
r old
er s
houl
d be
offe
red
one-
time
pneu
moc
occa
l im
mun
izat
ion.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
Clin
icia
ns s
houl
d sc
reen
all
adul
ts fo
r tob
acco
use
and
pro
vide
toba
cco
cess
atio
n in
terv
entio
ns fo
r tho
se w
ho u
se to
bacc
o pr
oduc
ts. T
he U
SPST
F to
bacc
o ce
ssat
ion
coun
selin
g re
com
men
datio
n an
d su
ppor
ting
evid
ence
are
ava
ilabl
e at
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/u
spst
f/usp
stba
c.ht
m.
1 The
pot
entia
l ben
efit o
f spi
rom
etry
-bas
ed s
cree
ning
for C
OPD
is p
reve
ntio
n of
one
or m
ore
exac
erba
tions
by
treat
ing
patie
nts
foun
d to
hav
e an
airfl
ow o
bstru
ctio
n pr
evio
usly
und
etec
ted.
How
ever
, eve
n in
gro
ups
with
the
grea
test
pre
vale
nce
of a
irflow
obs
truct
ion,
hun
dred
s of
pat
ient
s w
ould
nee
d to
be
scre
ened
with
spi
rom
etry
to d
efer
one
exa
cerb
atio
n.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
22
SCR
EEN
ING
FO
R C
OLO
REC
TAL
CA
NC
ER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dults
age
50
to 7
51 yea
rsA
dults
age
76
to 8
5 ye
ars1
Adu
lts o
lder
than
85
year
s1
Rec
omm
enda
tion
Scre
en w
ith h
igh
sens
itivi
ty fe
cal o
ccul
t bl
ood
test
ing
(FO
BT)
, sig
moi
dosc
opy,
or
colo
nosc
opy.
Gra
de: A
Do
not a
utom
atic
ally
scr
een.
Gra
de: C
Do
not s
cree
n.
Gra
de: D
For a
ll po
pula
tions
, evi
denc
e is
insu
ffici
ent t
o as
sess
the
bene
fits
and
harm
s of
scr
eeni
ng w
ith c
ompu
teriz
ed to
mog
raph
y co
lono
grap
hy (C
TC) a
nd fe
cal D
NA
test
ing.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Scre
enin
g Te
sts
Hig
h se
nsiti
vity
FO
BT, s
igm
oido
scop
y w
ith F
OBT
, and
col
onos
copy
are
effe
ctiv
e in
dec
reas
ing
colo
rect
al c
ance
r mor
talit
y.
The
risks
and
ben
efits
of t
hese
scr
eeni
ng m
etho
ds v
ary.
Col
onos
copy
and
flex
ible
sig
moi
dosc
opy
(to a
less
er d
egre
e) e
ntai
l pos
sibl
e se
rious
com
plic
atio
ns.
Scre
enin
g Te
st In
terv
als
Inte
rval
s fo
r rec
omm
ende
d sc
reen
ing
stra
tegi
es:
●
Annu
al s
cree
ning
with
hig
h-se
nsiti
vity
feca
l occ
ult b
lood
test
ing
●
Sigm
oido
scop
y ev
ery
5 ye
ars,
with
hig
h-se
nsiti
vity
feca
l occ
ult b
lood
test
ing
ever
y 3
year
s
●Sc
reen
ing
colo
nosc
opy
ever
y 10
yea
rs
Bala
nce
of B
enefi
ts a
nd H
arm
sTh
e be
nefit
s of
scr
eeni
ng o
utw
eigh
the
pote
ntia
l har
ms
for 5
0- to
75-
year
-old
s.
The
likel
ihoo
d th
at d
etec
tion
and
early
inte
rven
tion
will
yiel
d a
mor
talit
y be
nefit
dec
lines
af
ter a
ge 7
5 be
caus
e of
the
long
ave
rage
tim
e be
twee
n ad
enom
a de
velo
pmen
t and
can
cer
diag
nosi
s.
Impl
emen
tatio
n
Focu
s on
stra
tegi
es th
at m
axim
ize
the
num
ber o
f ind
ivid
uals
who
get
scr
eene
d.
Prac
tice
shar
ed d
ecis
ionm
akin
g; d
iscu
ssio
ns w
ith p
atie
nts
shou
ld in
corp
orat
e in
form
atio
n on
test
qua
lity
and
avai
labi
lity.
Indi
vidu
als
with
a p
erso
nal h
isto
ry o
f can
cer o
r ade
nom
atou
s po
lyps
are
follo
wed
by
a su
rvei
llanc
e re
gim
en, a
nd s
cree
ning
gui
delin
es a
re n
ot
appl
icab
le.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F re
com
men
ds a
gain
st th
e us
e of
asp
irin
or n
onst
eroi
dal a
nti-i
nflam
mat
ory
drug
s fo
r the
prim
ary
prev
entio
n of
col
orec
tal c
ance
r. Th
is re
com
men
datio
n is
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
1 The
se re
com
men
datio
ns d
o no
t app
ly to
indi
vidu
als
with
spe
cific
inhe
rited
syn
drom
es (L
ynch
Syn
drom
e or
Fam
ilial A
deno
mat
ous
Poly
posi
s) o
r tho
se w
ith in
flam
mat
ory
bow
el d
isea
se.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
23
USI
NG
NO
NTR
AD
ITIO
NA
L R
ISK
FA
CTO
RS
IN C
OR
ON
ARY
HEA
RT
DIS
EASE
RIS
K A
SSES
SMEN
T
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
men
and
wom
en w
ith n
o hi
stor
y of
cor
onar
y he
art d
isea
se (C
HD
), di
abet
es, o
r any
CH
D ri
sk
equi
vale
nt
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
tTh
is re
com
men
datio
n ap
plie
s to
adu
lt m
en a
nd w
omen
cla
ssifi
ed a
t int
erm
edia
te 1
0-ye
ar ri
sk fo
r CH
D (1
0% to
20%
) by
tradi
tiona
l ris
k fa
ctor
s.
Impo
rtanc
e
Cor
onar
y he
art d
isea
se (C
HD
) is
the
mos
t com
mon
cau
se o
f dea
th in
adu
lts in
the
Uni
ted
Stat
es. T
reat
men
t to
prev
ent
CH
D e
vent
s by
mod
ifyin
g ris
k fa
ctor
s is
cur
rent
ly b
ased
on
the
Fram
ingh
am ri
sk m
odel
. If t
he c
lass
ifica
tion
of in
divi
dual
s at
inte
rmed
iate
risk
cou
ld b
e im
prov
ed b
y us
ing
addi
tiona
l ris
k fa
ctor
s, tr
eatm
ent t
o pr
even
t CH
D m
ight
be
targ
eted
mor
e ef
fect
ivel
y.
Ris
k fa
ctor
s no
t cur
rent
ly p
art o
f the
Fra
min
gham
mod
el (n
ontra
ditio
nal r
isk
fact
ors)
incl
ude
high
sen
sitiv
ity C
-reac
tive
prot
ein
(hs-
CR
P), a
nkle
-bra
chia
l ind
ex (A
BI),
leuk
ocyt
e co
unt,
fast
ing
bloo
d gl
ucos
e le
vel,
perio
dont
al d
isea
se, c
arot
id in
tima-
med
ia
thic
knes
s, e
lect
ron
beam
com
pute
d to
mog
raph
y, h
omoc
yste
ine
leve
l, an
d lip
opro
tein
(a) l
evel
.
Bala
cne
of B
enefi
ts a
nd H
arm
s
Ther
e is
insu
ffici
ent e
vide
nce
to d
eter
min
e th
e pe
rcen
tage
of i
nter
med
iate
-risk
indi
vidu
als
who
wou
ld b
e re
clas
sifie
d by
sc
reen
ing
with
non
tradi
tiona
l ris
k fa
ctor
s, o
ther
than
hs-
CR
P an
d AB
I. Fo
r ind
ivid
uals
recl
assi
fied
as h
igh-
risk
on th
e ba
sis
of
hs-C
RP
or A
BI s
core
s, d
ata
are
not a
vaila
ble
to d
eter
min
e w
heth
er th
ey b
enefi
t fro
m a
dditi
onal
trea
tmen
ts.
Littl
e ev
iden
ce is
ava
ilabl
e to
det
erm
ine
the
harm
s of
usi
ng n
ontra
ditio
nal r
isk
fact
ors
in s
cree
ning
. Pot
entia
l har
ms
incl
ude
lifel
ong
use
of m
edic
atio
ns w
ithou
t pro
ven
bene
fit a
nd p
sych
olog
ical
and
oth
er h
arm
s fro
m b
eing
mis
clas
sifie
d in
a h
ighe
r ris
k ca
tego
ry.
Sugg
estio
ns fo
r pra
ctic
e
Clin
icia
ns s
houl
d co
ntin
ue to
use
the
Fram
ingh
am m
odel
to a
sses
s C
HD
risk
and
gui
de ri
sk-b
ased
pre
vent
ive
ther
apy.
Addi
ng n
ontra
ditio
nal r
isk
fact
ors
to C
HD
ass
essm
ent w
ould
requ
ire a
dditi
onal
pat
ient
and
clin
ical
sta
ff tim
e an
d ef
fort.
R
outin
ely
scre
enin
g w
ith n
ontra
ditio
nal r
isk
fact
ors
coul
d re
sult
in lo
st o
ppor
tuni
ties
to p
rovi
de o
ther
impo
rtant
hea
lth s
ervi
ces
of p
rove
n be
nefit
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsU
SPST
F re
com
men
datio
ns o
n ris
k as
sess
men
t for
CH
D, t
he u
se o
f asp
irin
to p
reve
nt c
ardi
ovas
cula
r dis
ease
, and
scr
eeni
ng
for h
igh
bloo
d pr
essu
re c
an b
e ac
cess
ed a
t http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
24
SCR
EEN
ING
FO
R D
EPR
ESSI
ON
IN A
DU
LTS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nN
onpr
egna
nt a
dults
18
year
s or
old
er
Rec
omm
enda
tion
Scre
en w
hen
staf
f-ass
iste
d de
pres
sion
car
e su
ppor
ts1
are
in p
lace
to a
ssur
e ac
cura
te d
iagn
osis
, effe
ctiv
e tr
eatm
ent,
and
follo
wup
. G
rade
: B
Do
not a
utom
atic
ally
scr
een
whe
n st
aff-a
ssis
ted
depr
essi
on c
are
supp
orts
1 are
not
in p
lace
. G
rade
: C
Ris
k As
sess
men
t
Pers
ons
at in
crea
sed
risk
for d
epre
ssio
n ar
e co
nsid
ered
at r
isk
thro
ugho
ut th
eir l
ifetim
e. G
roup
s at
incr
ease
d ris
k in
clud
e pe
rson
s w
ith o
ther
psy
chia
tric
diso
rder
s, in
clud
ing
subs
tanc
e m
isus
e; p
erso
ns w
ith a
fam
ily h
isto
ry o
f dep
ress
ion;
pe
rson
s w
ith c
hron
ic m
edic
al d
isea
ses;
and
per
sons
who
are
une
mpl
oyed
or o
f low
er s
ocio
econ
omic
sta
tus.
Als
o,
wom
en a
re a
t inc
reas
ed ri
sk c
ompa
red
with
men
. How
ever
, the
pre
senc
e of
risk
fact
ors
alon
e ca
nnot
dis
tingu
ish
depr
esse
d pa
tient
s fro
m n
onde
pres
sed
patie
nts.
Scre
enin
g Te
sts
Sim
ple
scre
enin
g qu
estio
ns m
ay p
erfo
rm a
s w
ell a
s m
ore
com
plex
inst
rum
ents
. Any
pos
itive
scr
eeni
ng te
st re
sult
shou
ld tr
igge
r a fu
ll di
agno
stic
inte
rvie
w u
sing
sta
ndar
d di
agno
stic
crit
eria
.
Tim
ing
of S
cree
ning
The
optim
al in
terv
al fo
r scr
eeni
ng is
unk
now
n. In
old
er
adul
ts, s
igni
fican
t dep
ress
ive
sym
ptom
s ar
e as
soci
ated
w
ith c
omm
on li
fe e
vent
s, in
clud
ing
med
ical
illn
ess,
co
gniti
ve d
eclin
e, b
erea
vem
ent,
and
inst
itutio
nal
plac
emen
t in
resi
dent
ial o
r inp
atie
nt s
ettin
gs.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Lim
ited
evid
ence
sug
gest
s th
at s
cree
ning
for d
epre
ssio
n in
the
abse
nce
of s
taff-
assi
sted
dep
ress
ion
care
doe
s no
t im
prov
e de
pres
sion
out
com
es.
Sugg
estio
ns fo
r Pra
ctic
e“S
taff-
assi
sted
dep
ress
ion
care
sup
ports
” ref
ers
to c
linic
al s
taff
that
ass
ists
the
prim
ary
care
clin
icia
n by
pro
vidi
ng s
ome
dire
ct d
epre
ssio
n ca
re a
nd/o
r coo
rdin
atio
n, c
ase
man
agem
ent,
or m
enta
l hea
lth tr
eatm
ent.
Rel
evan
t USP
STF
Rec
omm
enda
tions
R
elat
ed U
SPST
F re
com
men
datio
ns o
n sc
reen
ing
for s
uici
dalit
y an
d sc
reen
ing
child
ren
and
adol
esce
nts
for d
epre
ssio
n ar
e av
aila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
1 Go
to th
e Su
gges
tions
for P
ract
ice
sect
ion
of th
is fi
gure
for f
urth
er e
xpla
natio
n.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
25
SCR
EEN
ING
FO
R T
YPE
2 D
IAB
ETES
MEL
LITU
S IN
AD
ULT
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts w
ith s
usta
ined
blo
od p
ress
ure
grea
ter
than
135
/80
mm
Hg
Asy
mpt
omat
ic a
dults
with
sus
tain
ed b
lood
pre
ssur
e 13
5/80
m
m H
g or
low
er
Rec
omm
enda
tion
Scre
en fo
r typ
e 2
diab
etes
mel
litus
.
Gra
de: B
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
t
Thes
e re
com
men
datio
ns a
pply
to a
dults
with
no
sym
ptom
s of
type
2 d
iabe
tes
mel
litus
or e
vide
nce
of p
ossi
ble
com
plic
atio
ns o
f dia
bete
s.
Bloo
d pr
essu
re m
easu
rem
ent i
s an
impo
rtant
pre
dict
or o
f car
diov
ascu
lar c
ompl
icat
ions
in p
eopl
e w
ith ty
pe 2
dia
bete
s m
ellit
us.
The
first
ste
p in
app
lyin
g th
is re
com
men
datio
n sh
ould
be
mea
sure
men
t of b
lood
pre
ssur
e (B
P).
Adul
ts w
ith tr
eate
d or
unt
reat
ed B
P >1
35/8
0 m
m H
g sh
ould
be
scre
ened
for d
iabe
tes.
Scre
enin
g Te
sts
Thre
e te
sts
have
bee
n us
ed to
scr
een
for d
iabe
tes:
●
Fast
ing
plas
ma
gluc
ose
(FPG
).
●2-
hour
pos
tload
pla
sma.
●
Hem
oglo
bin
A1c.
The
Amer
ican
Dia
bete
s As
soci
atio
n (A
DA)
reco
mm
ends
scr
eeni
ng w
ith F
PG, d
efine
s di
abet
es a
s FP
G ≥
126
mg/
dL, a
nd re
com
men
ds
confi
rmat
ion
with
a re
peat
ed s
cree
ning
test
on
a se
para
te d
ay.
Scre
enin
g In
terv
als
The
optim
al s
cree
ning
inte
rval
is n
ot k
now
n. T
he A
DA,
on
the
basi
s of
exp
ert o
pini
on, r
ecom
men
ds a
n in
terv
al o
f eve
ry 3
yea
rs.
Sugg
estio
ns fo
r pra
ctic
e re
gard
ing
insu
ffici
ent e
vide
nce
Whe
n BP
is ≤
135
/80
mm
Hg,
scr
eeni
ng m
ay b
e co
nsid
ered
on
an in
divi
dual
bas
is w
hen
know
ledg
e of
dia
bete
s st
atus
wou
ld h
elp
info
rm
deci
sion
s ab
out c
oron
ary
hear
t dis
ease
(CH
D) p
reve
ntiv
e st
rate
gies
, inc
ludi
ng c
onsi
dera
tion
of li
pid-
low
erin
g ag
ents
or a
spiri
n.
To d
eter
min
e w
heth
er s
cree
ning
wou
ld b
e he
lpfu
l on
an in
divi
dual
bas
is, i
nfor
mat
ion
abou
t 10-
year
CH
D ri
sk m
ust b
e co
nsid
ered
. For
ex
ampl
e, if
CH
D ri
sk w
ithou
t dia
bete
s w
as 1
7% a
nd ri
sk w
ith d
iabe
tes
was
>20
%, s
cree
ning
for d
iabe
tes
wou
ld b
e he
lpfu
l bec
ause
di
abet
es s
tatu
s w
ould
det
erm
ine
lipid
trea
tmen
t. In
con
trast
, if r
isk
with
out d
iabe
tes
was
10%
and
risk
with
dia
bete
s w
as 1
5%, s
cree
ning
w
ould
not
affe
ct th
e de
cisi
on to
use
lipi
d-lo
wer
ing
treat
men
t.
Oth
er re
leva
nt in
form
atio
n fro
m th
e U
SPST
F an
d th
e C
omm
unity
Pre
vent
ive
Serv
ices
Tas
k Fo
rce
Evid
ence
and
USP
STF
reco
mm
enda
tions
rega
rdin
g bl
ood
pres
sure
, die
t, ph
ysic
al a
ctiv
ity, a
nd o
besi
ty a
re a
vaila
ble
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
The
revi
ews
and
reco
mm
enda
tions
of t
he C
omm
unity
Pre
vent
ive
Serv
ices
Tas
k Fo
rce
may
be
foun
d at
ht
tp://
ww
w.th
ecom
mun
itygu
ide.
org.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
26
FOLI
C A
CID
FO
R T
HE
PREV
ENTI
ON
OF
NEU
RA
L TU
BE
DEF
ECTS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nW
omen
pla
nnin
g a
preg
nanc
y or
cap
able
of b
ecom
ing
preg
nant
Rec
omm
enda
tion
Take
a d
aily
vita
min
sup
plem
ent c
onta
inin
g 0.
4 to
0.8
mg
(400
to 8
00 µ
g) o
f fol
ic a
cid.
G
rade
: A
Ris
k As
sess
men
t
Ris
k fa
ctor
s in
clud
e:
●
A pe
rson
al o
r fam
ily h
isto
ry o
f a p
regn
ancy
affe
cted
by
a ne
ural
tube
def
ect
●
The
use
of c
erta
in a
ntis
eizu
re m
edic
atio
ns
●
Mut
atio
ns in
fola
te-re
late
d en
zym
es
●
Mat
erna
l dia
bete
s
●
Mat
erna
l obe
sity
Not
e: T
his
reco
mm
enda
tion
does
not
app
ly to
wom
en w
ho h
ave
had
a pr
evio
us p
regn
ancy
affe
cted
by
neur
al tu
be
defe
cts
or w
omen
taki
ng c
erta
in a
ntis
eizu
re m
edic
ines
. The
se w
omen
may
be
advi
sed
to ta
ke h
ighe
r dos
es o
f fol
ic a
cid.
Tim
ing
of M
edic
atio
nSt
art s
uppl
emen
tatio
n at
leas
t 1 m
onth
bef
ore
conc
eptio
n.
Con
tinue
thro
ugh
first
2 to
3 m
onth
s of
pre
gnan
cy.
Rec
omm
enda
tions
of O
ther
sAC
OG
, AAF
P, a
nd m
ost o
ther
org
aniz
atio
ns re
com
men
d 4
mg/
d fo
r wom
en w
ith a
his
tory
of a
pre
gnan
cy a
ffect
ed b
y a
neur
al tu
be d
efec
t. A
bbre
viat
ions
: AAF
P =
Amer
ican
Aca
dem
y of
Fam
ily P
hysi
cian
s; A
CO
G =
Am
eric
an C
olle
ge o
f Obs
tetri
cian
s an
d G
ynec
olog
ists
.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
27
SCR
EEN
ING
FO
R G
ENIT
AL
HER
PES
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
pre
gnan
t wom
enA
sym
ptom
atic
ado
lesc
ents
and
adu
lts
Rec
omm
enda
tion
Do
not s
cree
n fo
r her
pes
sim
plex
viru
s.G
rade
: DD
o no
t scr
een
for h
erpe
s si
mpl
ex v
irus.
Gra
de: D
Scre
enin
g Te
sts
Met
hods
for d
etec
ting
herp
es s
impl
ex v
irus
incl
ude
vira
l cul
ture
, pol
ymer
ase
chai
n re
actio
n, a
nd a
ntib
ody-
base
d te
sts,
suc
h as
the
wes
tern
blo
t ass
ay a
nd ty
pe-s
peci
fic g
lyco
prot
ein
G s
erol
ogic
al te
sts.
Inte
rven
tions
Ther
e is
lim
ited
evid
ence
that
the
use
of a
ntiv
iral t
hera
py in
w
omen
with
a h
isto
ry o
f rec
urre
nt in
fect
ion,
or p
erfo
rman
ce
of c
esar
ean
deliv
ery
in w
omen
with
act
ive
herp
es le
sion
s at
th
e tim
e of
del
iver
y, d
ecre
ases
neo
nata
l her
pes
infe
ctio
n.
Ther
e is
als
o lim
ited
evid
ence
of t
he s
afet
y of
ant
ivira
l th
erap
y in
pre
gnan
t wom
en a
nd n
eona
tes.
Antiv
iral t
hera
py im
prov
es h
ealth
out
com
es in
sym
ptom
atic
pe
rson
s (e
.g.,
thos
e w
ith m
ultip
le re
curre
nces
); ho
wev
er,
ther
e is
no
evid
ence
that
the
use
of a
ntiv
iral t
hera
py
impr
oves
hea
lth o
utco
mes
in th
ose
with
asy
mpt
omat
ic
infe
ctio
n. T
here
are
mul
tiple
effi
caci
ous
regi
men
s th
at m
ay
be u
sed
to p
reve
nt th
e re
curre
nce
of c
linic
al g
enita
l her
pes.
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
pote
ntia
l har
ms
of s
cree
ning
asy
mpt
omat
ic p
regn
ant
wom
en in
clud
e fa
lse-
posi
tive
test
resu
lts, l
abel
ing,
an
d an
xiet
y, a
s w
ell a
s fa
lse-
nega
tive
test
s an
d fa
lse
reas
sura
nce,
alth
ough
thes
e po
tent
ial h
arm
s ar
e no
t wel
l st
udie
d. T
he U
SPST
F de
term
ined
that
ther
e ar
e no
ben
efits
as
soci
ated
with
scr
eeni
ng, a
nd th
eref
ore
the
pote
ntia
l har
ms
outw
eigh
the
bene
fits.
The
pote
ntia
l har
ms
of s
cree
ning
asy
mpt
omat
ic a
dole
scen
ts
and
adul
ts in
clud
e fa
lse-
posi
tive
test
resu
lts, l
abel
ing,
an
d an
xiet
y, a
lthou
gh th
ese
pote
ntia
l har
ms
are
not w
ell
stud
ied.
The
USP
STF
dete
rmin
ed th
e be
nefit
s of
scr
eeni
ng
are
min
imal
, at b
est,
and
the
pote
ntia
l har
ms
outw
eigh
the
pote
ntia
l ben
efits
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r chl
amyd
ia, g
onor
rhea
, HIV
, and
sev
eral
oth
er s
exua
lly
trans
mitt
ed in
fect
ions
. The
se re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
28
SCR
EEN
ING
FO
R G
ESTA
TIO
NA
L D
IAB
ETES
MEL
LITU
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nPr
egna
nt w
omen
who
hav
e no
t pre
viou
sly
been
dia
gnos
ed w
ith d
iabe
tes
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e1 ).
Ris
k As
sess
men
t
Wom
en a
t inc
reas
ed ri
sk o
f dev
elop
ing
gest
atio
nal d
iabe
tes
mel
litus
(GD
M) i
nclu
de th
ose
who
:
●Ar
e ob
ese.
●
Are
olde
r tha
n 25
yea
rs.
●
Hav
e a
fam
ily h
isto
ry o
f dia
bete
s.
●H
ave
a hi
stor
y of
GD
M.
●
Are
of c
erta
in e
thni
c gr
oups
(His
pani
c, A
mer
ican
Indi
an, A
sian
, or A
frica
n-Am
eric
an).
Bala
cne
of B
enefi
ts a
nd H
arm
s
The
curre
nt e
vide
nce
is in
suffi
cien
t to
asse
ss th
e ba
lanc
e be
twee
n th
e be
nefit
s an
d ha
rms
of s
cree
ning
wom
en
for G
DM
eith
er b
efor
e or
afte
r 24
wee
ks g
esta
tion.
Har
ms
of s
cree
ning
incl
ude
shor
t-ter
m a
nxie
ty in
som
e w
omen
with
pos
itive
scr
eeni
ng re
sults
, and
inco
nven
ienc
e to
man
y w
omen
and
med
ical
pra
ctic
es b
ecau
se
mos
t pos
itive
scr
eeni
ng te
sts
are
likel
y fa
lse-
posi
tives
.
Sugg
estio
ns fo
r Pra
ctic
eU
ntil
ther
e is
bet
ter e
vide
nce,
clin
icia
ns s
houl
d di
scus
s sc
reen
ing
for G
DM
with
thei
r pat
ient
s an
d m
ake
case
-by
-cas
e de
cisi
ons.
The
dis
cuss
ion
shou
ld in
clud
e in
form
atio
n ab
out t
he u
ncer
tain
ben
efits
and
har
ms
as w
ell
as th
e fre
quen
cy a
nd u
ncer
tain
mea
ning
of a
pos
itive
scr
eeni
ng te
st re
sult.
Scre
enin
g Te
sts
If a
deci
sion
is m
ade
to s
cree
n fo
r GD
M:
The
scre
enin
g te
st m
ost c
omm
only
use
d in
the
Uni
ted
Stat
es is
an
initi
al 5
0-gr
am 1
-hou
r glu
cose
cha
lleng
e te
st (G
CT)
. If t
he re
sult
on th
e G
CT
is a
bnor
mal
, the
pat
ient
und
ergo
es a
100
-gra
m 3
-hou
r ora
l glu
cose
to
lera
nce
test
(OG
TT).
Two
or m
ore
abno
rmal
val
ues
on th
e O
GTT
are
con
side
red
a di
agno
sis
of G
DM
.
Scre
enin
g In
terv
als
Mos
t scr
eeni
ng is
con
duct
ed b
etw
een
24 a
nd 2
8 w
eeks
ges
tatio
n. T
here
is li
ttle
evid
ence
abo
ut th
e va
lue
of
earli
er s
cree
ning
.
Oth
er A
ppro
ache
s to
Pre
vent
ion
Nea
rly a
ll pr
egna
nt w
omen
sho
uld
be e
ncou
rage
d to
:
●
Achi
eve
mod
erat
e w
eigh
t gai
n ba
sed
on th
eir p
re-p
regn
ancy
bod
y m
ass
inde
x.
●Pa
rtici
pate
in p
hysi
cal a
ctiv
ity.
1 The
cur
rent
evi
denc
e is
insu
ffici
ent t
o es
tabl
ish
the
bala
nce
of b
enefi
ts a
nd h
arm
s fo
r scr
eeni
ng fo
r ges
tatio
nal d
iabe
tes
mel
litus
, eith
er b
efor
e or
afte
r 24
wee
ks g
esta
tion.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
29
SCR
EEN
ING
FO
R G
LAU
CO
MA
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
tTh
e pr
imar
y ris
k fa
ctor
for d
evel
opin
g pr
imar
y op
en-a
ngle
gla
ucom
a (P
OAG
) is
incr
ease
d in
traoc
ular
pre
ssur
e. O
ther
im
porta
nt ri
sk fa
ctor
s ar
e fa
mily
his
tory
, old
er a
ge, a
nd b
eing
of A
frica
n Am
eric
an d
esce
nt. A
dditi
onal
risk
fact
ors
may
incl
ude
decr
ease
d ce
ntra
l cor
nea
thic
knes
s, lo
w d
iast
olic
per
fusi
on p
ress
ure,
dia
bete
s, a
nd s
ever
e m
yopi
a.
Scre
enin
g Te
sts
The
diag
nosi
s of
PO
AG is
not
mad
e on
the
basi
s of
a s
ingl
e te
st, b
ut o
n th
e fin
ding
of c
hara
cter
istic
deg
ener
ativ
e ch
ange
s in
th
e op
tic d
isc,
alo
ng w
ith a
loss
of v
isua
l fiel
d se
nsiti
vity
.
Perim
etry
ass
esse
s vi
sual
fiel
d lo
ss b
y m
appi
ng a
pat
ient
’s re
spon
se to
vis
ual s
timul
i pre
sent
ed in
var
ious
loca
tions
with
in
the
visu
al fi
eld.
Per
imet
ry m
ay b
e pe
rform
ed b
y m
anua
l or a
utom
ated
met
hods
.
Seve
ral c
onsi
sten
t per
imet
ry m
easu
rem
ents
are
nee
ded
to e
stab
lish
the
pres
ence
of d
efec
ts.
Dila
ted
opth
alm
osco
py o
r slit
lam
p ex
amin
atio
ns a
re u
sed
by s
peci
alis
ts to
exa
min
e ch
ange
s in
the
optic
dis
c; h
owev
er, t
here
is
wid
e va
riabi
lity
in it
s re
liabi
lity
for d
etec
ting
glau
com
atou
s op
tic d
isc
prog
ress
ion.
Inte
rven
tions
The
prim
ary
treat
men
ts fo
r PO
AG re
duce
intra
ocul
ar p
ress
ure;
thes
e in
clud
e m
edic
atio
ns, l
aser
ther
apy,
or s
urge
ry. T
hese
tre
atm
ents
can
effe
ctiv
ely
redu
ce th
e de
velo
pmen
t and
pro
gres
sion
of s
mal
l vis
ual fi
eld
defe
cts.
How
ever
, the
ir ef
fect
iven
ess
in re
duci
ng im
pairm
ent i
n vi
sion
-rela
ted
func
tion
is u
ncer
tain
. Har
ms
caus
ed b
y th
ese
inte
rven
tions
incl
ude
form
atio
n of
ca
tara
cts,
har
ms
resu
lting
from
cat
arac
t sur
gery
, and
har
ms
of to
pica
l med
icat
ion.
Bala
nce
of B
enefi
ts a
nd H
arm
sBe
caus
e of
the
unce
rtain
ty o
f the
mag
nitu
de o
f ben
efit f
rom
ear
ly tr
eatm
ent a
nd g
iven
the
know
n ha
rms
of s
cree
ning
and
ea
rly tr
eatm
ent,
the
USP
STF
coul
d no
t det
erm
ine
the
bala
nce
betw
een
the
bene
fits
and
harm
s of
scr
eeni
ng fo
r gla
ucom
a.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
a re
com
men
datio
n on
scr
eeni
ng fo
r im
paire
d vi
sual
acu
ity in
old
er a
dults
. Thi
s re
com
men
datio
n is
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
30
SCR
EEN
ING
FO
R G
ON
OR
RH
EA
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
n
Sexu
ally
act
ive
wom
en,
incl
udin
g th
ose
who
are
pr
egna
nt, w
ho a
re a
t inc
reas
ed
risk
for i
nfec
tion
Men
who
are
at i
ncre
ased
risk
fo
r inf
ectio
nM
en a
nd w
omen
who
are
at l
ow
risk
for i
nfec
tion
Preg
nant
wom
en w
ho a
re
not a
t inc
reas
ed ri
sk fo
r in
fect
ion
Rec
omm
enda
tion
Scre
en fo
r gon
orrh
ea.
Gra
de: B
No
reco
mm
enda
tion.
Gra
de: I
(In
suffi
cien
t Evi
denc
e)
Do
not s
cree
n fo
r gon
orrh
ea.
Gra
de: D
No
reco
mm
enda
tion.
Gra
de: I
(In
suffi
cien
t Evi
denc
e)
Ris
k As
sess
men
tW
omen
and
men
you
nger
than
age
25
year
s—in
clud
ing
sexu
ally
act
ive
adol
esce
nts—
are
at h
ighe
st ri
sk fo
r gon
orrh
ea in
fect
ion.
Ris
k fa
ctor
s fo
r gon
orrh
ea in
clud
e a
hist
ory
of p
revi
ous
gono
rrhea
infe
ctio
n, o
ther
sex
ually
tran
smitt
ed in
fect
ions
, new
or m
ultip
le s
exua
l par
tner
s,
inco
nsis
tent
con
dom
use
, sex
wor
k, a
nd d
rug
use.
Ris
k fa
ctor
s fo
r pre
gnan
t wom
en a
re th
e sa
me
as fo
r non
-pre
gnan
t wom
en.
Scre
enin
g Te
sts
Vagi
nal c
ultu
re is
an
accu
rate
scr
eeni
ng te
st w
hen
trans
port
cond
ition
s ar
e su
itabl
e. N
ewer
scr
eeni
ng te
sts,
incl
udin
g nu
clei
c ac
id a
mpl
ifica
tion
and
hybr
idiz
atio
n te
sts,
hav
e de
mon
stra
ted
impr
oved
sen
sitiv
ity a
nd c
ompa
rabl
e sp
ecifi
city
whe
n co
mpa
red
with
cer
vica
l cul
ture
. Som
e ne
wer
te
sts
can
be u
sed
with
urin
e an
d va
gina
l sw
abs,
whi
ch e
nabl
es s
cree
ning
whe
n a
pelv
ic e
xam
inat
ion
is n
ot p
erfo
rmed
.
Tim
ing
of S
cree
ning
Scre
enin
g is
reco
mm
ende
d at
the
first
pre
nata
l vis
it fo
r pre
gnan
t wom
en w
ho a
re in
a h
igh-
risk
grou
p fo
r gon
orrh
ea in
fect
ion.
For
pre
gnan
t w
omen
who
are
at c
ontin
ued
risk,
and
for t
hose
who
acq
uire
a n
ew ri
sk fa
ctor
, a s
econ
d sc
reen
ing
shou
ld b
e co
nduc
ted
durin
g th
e th
ird
trim
este
r. Th
e op
timal
inte
rval
for s
cree
ning
in th
e no
n-pr
egna
nt p
opul
atio
n is
not
kno
wn.
Inte
rven
tions
Gen
ital g
onor
rhea
infe
ctio
n in
men
and
wom
en, i
nclu
ding
pre
gnan
t wom
en, m
ay b
e tre
ated
with
a th
ird-g
ener
atio
n ce
phal
ospo
rin. B
ecau
se o
f in
crea
sed
prev
alen
ce o
f res
ista
nt o
rgan
ism
s, fl
uoro
quin
olon
es s
houl
d no
t be
used
to tr
eat g
onor
rhea
. Cur
rent
gui
delin
es fo
r tre
atin
g go
norrh
ea
infe
ctio
n ar
e av
aila
ble
from
the
Cen
ters
for D
isea
se C
ontro
l and
Pre
vent
ion
(http
://w
ww.
cdc.
gov/
std/
treat
men
t).
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
USP
STF
conc
lude
d th
at
the
bene
fits
of s
cree
ning
wom
en
at in
crea
sed
risk
for g
onor
rhea
in
fect
ion
outw
eigh
the
pote
ntia
l ha
rms.
The
USP
STF
coul
d no
t de
term
ine
the
bala
nce
of b
enefi
ts
and
harm
s of
scr
eeni
ng fo
r go
norrh
ea in
men
at i
ncre
ased
ris
k fo
r inf
ectio
n.
Giv
en th
e lo
w p
reva
lenc
e of
go
norrh
ea in
fect
ion
in th
e ge
nera
l pop
ulat
ion,
the
USP
STF
conc
lude
d th
at th
e po
tent
ial
harm
s of
scr
eeni
ng in
low
-pr
eval
ence
pop
ulat
ions
out
wei
gh
the
bene
fits.
The
USP
STF
coul
d no
t de
term
ine
the
bala
nce
betw
een
the
bene
fits
and
harm
s of
scr
eeni
ng fo
r go
norrh
ea in
pre
gnan
t wom
en
who
are
not
at i
ncre
ased
risk
fo
r inf
ectio
n.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
a re
com
men
datio
n on
ocu
lar p
roph
ylax
is in
new
born
s fo
r gon
ococ
cal o
phth
alm
ia n
eona
toru
m.
This
reco
mm
enda
tion
is a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, ple
ase
go to
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
31
SCR
EEN
ING
FO
R H
EMO
CH
RO
MAT
OSI
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
gen
eral
pop
ulat
ion
Rec
omm
enda
tion
Do
not s
cree
n fo
r her
edita
ry h
emoc
hrom
atos
is.
Gra
de: D
Ris
k As
sess
men
tC
linic
ally
reco
gniz
ed h
ered
itary
hem
ochr
omat
osis
is p
rimar
ily a
ssoc
iate
d w
ith m
utat
ions
on
the
hem
ochr
omat
osis
(HFE
) ge
ne. A
lthou
gh th
is is
a re
lativ
ely
com
mon
mut
atio
n in
the
U.S
. pop
ulat
ion,
onl
y a
smal
l sub
set w
ill de
velo
p sy
mpt
oms
of
hem
ochr
omat
osis
. An
even
sm
alle
r pro
porti
on o
f the
se in
divi
dual
s w
ill de
velo
p ad
vanc
ed s
tage
s of
clin
ical
dis
ease
.
Scre
enin
g Te
sts
Gen
etic
scr
eeni
ng fo
r HFE
mut
atio
ns c
an a
ccur
atel
y id
entif
y in
divi
dual
s at
risk
for h
ered
itary
hem
ochr
omat
osis
. How
ever
, id
entif
ying
an
indi
vidu
al w
ith th
e ge
noty
pic
pred
ispo
sitio
n do
es n
ot a
ccur
atel
y pr
edic
t the
futu
re ri
sk fo
r dis
ease
man
ifest
atio
n.
Inte
rven
tions
Ther
apeu
tic p
hleb
otom
y is
the
mai
n tre
atm
ent f
or h
ered
itary
hem
ochr
omat
osis
. Phl
ebot
omy
is g
ener
ally
thou
ght t
o ha
ve fe
w
side
effe
cts.
Bala
nce
of B
enefi
ts a
nd H
arm
s
●
Scre
enin
g co
uld
lead
to id
entifi
catio
n of
a la
rge
num
ber o
f ind
ivid
uals
who
pos
sess
the
high
-risk
gen
otyp
e bu
t may
nev
er
man
ifest
the
clin
ical
dis
ease
. Thi
s m
ay re
sult
in u
nnec
essa
ry s
urve
illanc
e an
d di
agno
stic
pro
cedu
res,
labe
ling,
anx
iety
, an
d, p
oten
tially
, unn
eces
sary
trea
tmen
ts.
●
Ther
e is
poo
r evi
denc
e th
at e
arly
ther
apeu
tic p
hleb
otom
y im
prov
es m
orbi
dity
and
mor
talit
y in
indi
vidu
als
with
scr
eeni
ng-
dete
cted
ver
sus
clin
ical
ly-d
etec
ted
hem
ochr
omat
osis
.
●
The
USP
STF
conc
lude
d th
at th
e po
tent
ial h
arm
s of
gen
etic
scr
eeni
ng fo
r her
edita
ry h
emoc
hrom
atos
is o
utw
eigh
the
pote
ntia
l ben
efits
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
The
USP
STF
has
also
mad
e re
com
men
datio
ns o
n ge
netic
test
ing
for m
utat
ions
in th
e br
east
can
cer s
usce
ptib
ility
gene
to
pred
ict b
reas
t and
ova
rian
canc
er s
usce
ptib
ility.
The
se re
com
men
datio
ns a
re a
vaila
ble
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
32
SCR
EEN
ING
FO
R H
EPAT
ITIS
B V
IRU
S IN
FEC
TIO
N
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nG
ener
al a
sym
ptom
atic
pop
ulat
ion
Rec
omm
enda
tion
Do
not s
cree
n fo
r hep
atiti
s B
viru
s (H
BV)
infe
ctio
n.
Gra
de: D
Ris
k As
sess
men
t
The
mai
n ris
k fa
ctor
s fo
r HBV
infe
ctio
n in
clud
e di
agno
sis
with
a s
exua
lly tr
ansm
itted
dis
ease
, int
rave
nous
dru
g us
e, s
exua
l co
ntac
t with
mul
tiple
par
tner
s, m
ale
hom
osex
ual a
ctiv
ity, a
nd h
ouse
hold
con
tact
with
chr
onic
ally
infe
cted
per
sons
. How
ever
, sc
reen
ing
stra
tegi
es to
iden
tify
indi
vidu
als
at h
igh
risk
have
poo
r pre
dict
ive
valu
e, s
ince
30–
40 p
erce
nt o
f inf
ecte
d in
divi
dual
s do
not
hav
e an
y ea
sily
iden
tifiab
le ri
sk fa
ctor
s.
Scre
enin
g Te
sts
Rou
tine
scre
enin
g of
the
gene
ral p
opul
atio
n fo
r HBV
infe
ctio
n is
not
reco
mm
ende
d.
Inte
rven
tions
Rou
tine
hepa
titis
vac
cina
tion
has
had
sign
ifica
nt im
pact
in re
duci
ng th
e nu
mbe
r of n
ew H
BV in
fect
ions
per
yea
r, w
ith th
e gr
eate
st d
eclin
e am
ong
child
ren
and
adol
esce
nts.
Pro
gram
s th
at v
acci
nate
hea
lth c
are
wor
kers
als
o re
duce
the
trans
mis
sion
of
HBV
infe
ctio
n.
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
USP
STF
foun
d no
evi
denc
e th
at s
cree
ning
the
gene
ral p
opul
atio
n fo
r HBV
infe
ctio
n im
prov
es lo
ng-te
rm h
ealth
out
com
es
such
as
cirrh
osis
, hep
atoc
ellu
lar c
arci
nom
a, o
r mor
talit
y. T
he p
reva
lenc
e of
HBV
infe
ctio
n is
low
; the
maj
ority
of i
nfec
ted
indi
vidu
als
do n
ot d
evel
op c
hron
ic in
fect
ion,
cirr
hosi
s, o
r HBV
-rela
ted
liver
dis
ease
. Pot
entia
l har
ms
of s
cree
ning
incl
ude
labe
ling,
alth
ough
ther
e is
lim
ited
evid
ence
to d
eter
min
e th
e m
agni
tude
of t
his
harm
.
As a
resu
lt, th
e U
SPST
F co
nclu
ded
that
the
pote
ntia
l har
ms
of s
cree
ning
for H
BV in
fect
ion
in th
e ge
nera
l pop
ulat
ion
are
likel
y to
exc
eed
any
pote
ntia
l ben
efits
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r hep
atiti
s B
infe
ctio
n in
pre
gnan
t wom
en a
nd s
cree
ning
for
hepa
titis
C v
irus
infe
ctio
n. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
33
SCR
EEN
ING
FO
R H
EPAT
ITIS
B V
IRU
S IN
FEC
TIO
N IN
PR
EGN
AN
CY
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll pr
egna
nt w
omen
Rec
omm
enda
tion
Scre
en fo
r hep
atiti
s B
viru
s (H
BV)
at t
he fi
rst p
rena
tal v
isit.
G
rade
: A
Scre
enin
g Te
sts
Sero
logi
c id
entifi
catio
n of
hep
atiti
s B
surfa
ce a
ntig
en (H
BsAg
).
Rep
orte
d se
nsiti
vity
and
spe
cific
ity a
re g
reat
er th
an 9
8%.
Tim
ing
of S
cree
ning
Ord
er H
BsAg
test
ing
at th
e fir
st p
rena
tal v
isit.
Re-
scre
en w
omen
with
unk
now
n H
BsAg
sta
tus
or n
ew o
r con
tinui
ng ri
sk fa
ctor
s at
adm
issi
on to
hos
pita
l, bi
rth c
ente
r, or
ot
her d
eliv
ery
setti
ng.
Inte
rven
tions
Adm
inis
ter h
epat
itis
B va
ccin
e an
d he
patit
is B
imm
une
glob
ulin
to H
BV-e
xpos
ed in
fant
s w
ithin
12
hour
s of
birt
h.
Ref
er w
omen
who
test
pos
itive
for c
ouns
elin
g an
d m
edic
al m
anag
emen
t.
Cou
nsel
ing
shou
ld in
clud
e in
form
atio
n ab
out h
ow to
pre
vent
tran
smis
sion
to s
exua
l par
tner
s an
d ho
useh
old
cont
acts
.
Rea
ssur
e pa
tient
s th
at b
reas
tfeed
ing
is s
afe
for i
nfan
ts w
ho re
ceiv
e ap
prop
riate
pro
phyl
axis
.
Impl
emen
tatio
nEs
tabl
ish
syst
ems
for t
imel
y tra
nsfe
r of m
ater
nal H
BsAg
test
resu
lts to
the
labo
r and
del
iver
y an
d ne
wbo
rn m
edic
al re
cord
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsU
SPST
F re
com
men
datio
ns o
n th
e sc
reen
ing
of p
regn
ant w
omen
for o
ther
infe
ctio
ns, i
nclu
ding
asy
mpt
omat
ic b
acte
riuria
, ba
cter
ial v
agin
osis
, chl
amyd
ia, H
IV, a
nd s
yphi
lis, c
an b
e fo
und
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
34
SCR
EEN
ING
FO
R H
EPAT
ITIS
C V
IRU
S IN
AD
ULT
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts w
ho a
re n
ot a
t inc
reas
ed ri
sk fo
r in
fect
ion
Adu
lts w
ho a
re a
t hig
h ris
k fo
r inf
ectio
n
Rec
omm
enda
tion
Do
not s
cree
n fo
r hep
atiti
s C
viru
s (H
CV)
infe
ctio
n.
Gra
de: D
No
reco
mm
enda
tion.
G
rade
: I S
tate
men
t (In
suffi
cien
t Evi
denc
e)
Ris
k As
sess
men
t
Esta
blis
hed
risk
fact
ors
for H
CV
infe
ctio
n in
clud
e cu
rrent
or p
ast i
ntra
veno
us d
rug
use,
rece
ivin
g a
bloo
d tra
nsfu
sion
be
fore
199
0, d
ialy
sis,
and
bei
ng a
chi
ld o
f an
HC
V-in
fect
ed m
othe
r. Su
rroga
te m
arke
rs, s
uch
as h
igh-
risk
sexu
al b
ehav
ior
(par
ticul
arly
sex
with
som
eone
infe
cted
with
HC
V) a
nd th
e us
e of
ille
gal d
rugs
, suc
h as
coc
aine
or m
ariju
ana,
hav
e al
so b
een
asso
ciat
ed w
ith in
crea
sed
risk
for H
CV
infe
ctio
n.
Scre
enin
g Te
sts
Initi
al te
stin
g fo
r HC
V in
fect
ion
is ty
pica
lly d
one
by e
nzym
e im
mun
oass
ay.
Inte
rven
tions
Alth
ough
ther
e is
goo
d ev
iden
ce th
at a
ntiv
iral t
hera
py im
prov
es in
term
edia
te o
utco
mes
, suc
h as
vire
mia
, the
re is
lim
ited
evid
ence
that
suc
h tre
atm
ent i
mpr
oves
long
-term
hea
lth o
utco
mes
. The
cur
rent
trea
tmen
t reg
imen
is lo
ng a
nd c
ostly
and
is
asso
ciat
ed w
ith a
hig
h pa
tient
dro
pout
rate
due
to a
dver
se e
ffect
s. A
s of
200
4, th
ere
was
insu
ffici
ent e
vide
nce
that
new
er
treat
men
t reg
imen
s fo
r HC
V in
fect
ion,
suc
h as
peg
ylat
ed in
terfe
ron
plus
riba
virin
, im
prov
e lo
ng-te
rm h
ealth
out
com
es.
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
prev
alen
ce o
f HC
V in
fect
ion
in th
e ge
nera
l pop
ulat
ion
is lo
w, a
nd m
ost w
ho a
re in
fect
ed d
o no
t dev
elop
cirr
hosi
s or
oth
er m
ajor
neg
ativ
e he
alth
out
com
es. T
here
is n
o ev
iden
ce th
at s
cree
ning
for H
CV
infe
ctio
n le
ads
to
impr
oved
long
-term
hea
lth o
utco
mes
, suc
h as
dec
reas
ed
cirrh
osis
, hep
atoc
ellu
lar c
ance
r, or
mor
talit
y. P
oten
tial
harm
s of
scr
eeni
ng in
clud
e un
nece
ssar
y bi
opsi
es a
nd
labe
ling,
alth
ough
ther
e is
lim
ited
evid
ence
to d
eter
min
e th
e m
agni
tude
of t
hese
har
ms.
As a
resu
lt, th
e U
SPST
F co
nclu
ded
that
the
pote
ntia
l har
ms
of s
cree
ning
for H
CV
infe
ctio
n in
adu
lts w
ho a
re n
ot a
t in
crea
sed
risk
for H
CV
infe
ctio
n ar
e lik
ely
to e
xcee
d th
e po
tent
ial b
enefi
ts.
The
USP
STF
foun
d no
evi
denc
e th
at s
cree
ning
for H
CV
in
fect
ion
in a
dults
at h
igh
risk
lead
s to
impr
oved
long
-term
he
alth
out
com
es. T
he p
ropo
rtion
of p
erso
ns in
fect
ed w
ith
HC
V w
ho p
rogr
ess
to li
ver d
isea
se is
unc
erta
in. P
oten
tial
harm
s of
scr
eeni
ng a
nd tr
eatm
ent i
nclu
de la
belin
g, a
dver
se
treat
men
t effe
cts,
and
unn
eces
sary
bio
psie
s, a
lthou
gh th
ere
is li
mite
d ev
iden
ce to
det
erm
ine
the
mag
nitu
de o
f the
se
harm
s.
As a
resu
lt, th
e U
SPST
F co
uld
not d
eter
min
e th
e ba
lanc
e of
be
nefit
s an
d ha
rms
of s
cree
ning
for H
CV
infe
ctio
n in
adu
lts
at in
crea
sed
risk
for i
nfec
tion.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r hep
atiti
s B
viru
s in
fect
ion
in th
e ge
nera
l pop
ulat
ion
and
in
preg
nant
wom
en. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
35
SCR
EEN
ING
FO
R H
IGH
BLO
OD
PR
ESSU
RE
IN A
DU
LTS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dult
gene
ral p
opul
atio
n1
Rec
omm
enda
tion
Scre
en fo
r hig
h bl
ood
pres
sure
.G
rade
: A
Scre
enin
g Te
sts
Hig
h bl
ood
pres
sure
(hyp
erte
nsio
n) is
usu
ally
defi
ned
in a
dults
as:
sys
tolic
blo
od p
ress
ure
(SBP
) of 1
40 m
m H
g or
hig
her,
or
dia
stol
ic b
lood
pre
ssur
e (D
BP) o
f 90
mm
Hg
or h
ighe
r.
Due
to v
aria
bilit
y in
indi
vidu
al b
lood
pre
ssur
e m
easu
rem
ents
, it i
s re
com
men
ded
that
hyp
erte
nsio
n be
dia
gnos
ed o
nly
afte
r 2
or m
ore
elev
ated
read
ings
are
obt
aine
d on
at l
east
2 v
isits
ove
r a p
erio
d of
1 to
sev
eral
wee
ks.
Scre
enin
g In
terv
als
The
optim
al in
terv
al fo
r scr
eeni
ng a
dults
for h
yper
tens
ion
is n
ot k
now
n.
The
Join
t Nat
iona
l Com
mitt
ee o
n Pr
even
tion,
Det
ectio
n, E
valu
atio
n, a
nd T
reat
men
t of H
igh
Bloo
d Pr
essu
re (J
NC
7)
reco
mm
ends
:
●
Scre
enin
g ev
ery
2 ye
ars
with
BP
<120
/80.
●
Scre
enin
g ev
ery
year
with
SBP
of 1
20-1
39 m
mH
g or
DBP
of 8
0-90
mm
Hg.
Trea
tmen
t
A va
riety
of p
harm
acol
ogic
al a
gent
s ar
e av
aila
ble
to tr
eat h
yper
tens
ion.
JN
C 7
gui
delin
es fo
r tre
atm
ent o
f hyp
erte
nsio
n ca
n be
acc
esse
d at
http
://w
ww.
nhlb
i.nih
.gov
/gui
delin
es/h
yper
tens
ion/
jnci
ntro
.htm
.
The
follo
win
g no
n-ph
arm
acol
ogic
al th
erap
ies
are
asso
ciat
ed w
ith re
duct
ions
in b
lood
pre
ssur
e:
●
Red
uctio
n of
die
tary
sod
ium
inta
ke.
●
Pota
ssiu
m s
uppl
emen
tatio
n.
●In
crea
sed
phys
ical
act
ivity
, wei
ght l
oss.
●
Stre
ss m
anag
emen
t.
●R
educ
tion
of a
lcoh
ol in
take
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
Adul
ts w
ith h
yper
tens
ion
shou
ld b
e sc
reen
ed fo
r dia
bete
s.
Adul
ts s
houl
d be
scr
eene
d fo
r hyp
erlip
idem
ia (d
epen
ding
on
age,
sex
, ris
k fa
ctor
s) a
nd s
mok
ing.
Clin
icia
ns s
houl
d di
scus
s as
pirin
che
mop
reve
ntio
n w
ith p
atie
nts
at in
crea
sed
risk
for c
ardi
ovas
cula
r dis
ease
.
Thes
e re
com
men
datio
ns a
nd re
late
d ev
iden
ce a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
1 Thi
s re
com
men
datio
n ap
plie
s to
adu
lts w
ithou
t kno
wn
hype
rtens
ion.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
36
SCR
EEN
ING
FO
R H
IV
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dole
scen
ts a
nd a
dults
at i
ncre
ased
risk
for H
IV
infe
ctio
nA
dole
scen
ts a
nd a
dults
who
are
not
at i
ncre
ased
risk
fo
r HIV
infe
ctio
nPr
egna
nt w
omen
Rec
omm
enda
tion
Scre
en fo
r HIV
.
Gra
de: A
No
reco
mm
enda
tion
for o
r aga
inst
scr
eeni
ng.
Gra
de: C
Scre
en fo
r HIV
.
Gra
de: A
Ris
k As
sess
men
t
A pe
rson
is c
onsi
dere
d at
incr
ease
d ris
k fo
r HIV
infe
ctio
n if
he/s
he re
ports
one
or m
ore
indi
vidu
al ri
sk fa
ctor
s or
rece
ives
hea
lth c
are
in a
hig
h-pr
eval
ence
or h
igh-
risk
clin
ical
set
ting.
H
igh-
risk
setti
ngs
incl
ude
sexu
ally
tran
smitt
ed in
fect
ion
(STI
) clin
ics,
cor
rect
iona
l fac
ilitie
s, h
omel
ess
shel
ters
, tub
ercu
losi
s cl
inic
s, c
linic
s se
rvin
g m
en w
ho h
ave
sex
with
men
, and
ad
oles
cent
hea
lth c
linic
s w
ith a
hig
h pr
eval
ence
of S
TIs.
Hig
h-pr
eval
ence
set
tings
are
defi
ned
as th
ose
know
n to
hav
e a
1% o
r gre
ater
pre
vale
nce
of in
fect
ion
amon
g th
e pa
tient
po
pula
tion
bein
g se
rved
.
Indi
vidu
al ri
sk fo
r HIV
infe
ctio
n is
ass
esse
d th
roug
h a
care
ful p
atie
nt h
isto
ry. I
ndiv
idua
ls a
t inc
reas
ed ri
sk in
clud
e:
●M
en w
ho h
ave
had
sex
with
men
afte
r 197
5
●Pe
rson
s ha
ving
unp
rote
cted
sex
with
mul
tiple
par
tner
s
●Pe
rson
s w
ho a
re p
ast o
r pre
sent
inje
ctio
n dr
ug u
sers
●Pe
rson
s w
ho e
xcha
nge
sex
for m
oney
or d
rugs
or h
ave
sex
partn
ers
who
do
●
Pers
ons
who
se p
ast o
r pre
sent
sex
par
tner
s ar
e H
IV-in
fect
ed, b
isex
ual,
or in
ject
ion
drug
use
rs
●
Pers
ons
bein
g tre
ated
for s
exua
lly tr
ansm
itted
dis
ease
s
●Pe
rson
s w
ith a
his
tory
of b
lood
tran
sfus
ion
betw
een
1978
and
198
5
●Pe
rson
s w
ho re
ques
t an
HIV
test
des
pite
repo
rting
no
risk
fact
ors
(sin
ce th
is g
roup
is li
kely
to in
clud
e in
divi
dual
s no
t willi
ng to
dis
clos
e hi
gh ri
sk b
ehav
iors
)
Scre
enin
g Te
sts
The
stan
dard
test
for d
iagn
osin
g H
IV in
fect
ion
is th
e re
peat
edly
reac
tive
enzy
me
imm
unoa
ssay
, fol
low
ed b
y co
nfirm
ator
y w
este
rn b
lot o
r im
mun
ofluo
resc
ent a
ssay
. Rap
id H
IV
antib
ody
test
ing
is a
lso
high
ly a
ccur
ate,
can
be
perfo
rmed
in 1
0 to
30
min
utes
, and
whe
n of
fere
d at
the
poin
t of c
are,
is u
sefu
l for
scr
eeni
ng h
igh-
risk
patie
nts
who
do
not r
ecei
ve
regu
lar m
edic
al c
are
(e.g
., th
ose
seen
in e
mer
genc
y de
partm
ents
), as
wel
l as
wom
en w
ith u
nkno
wn
HIV
sta
tus
who
pre
sent
in a
ctiv
e la
bor.
Inte
rven
tions
Evid
ence
sup
ports
the
bene
fit o
f ide
ntify
ing
and
treat
ing
asym
ptom
atic
indi
vidu
als
in im
mun
olog
ical
ly a
dvan
ced
stag
es o
f HIV
dis
ease
(i.e
., C
D4
cell
coun
ts <
200
cells
/mm
3 ) w
ith
high
ly a
ctiv
e an
tiret
rovi
ral t
hera
py (H
AAR
T). A
ppro
pria
te p
roph
ylax
is a
nd im
mun
izat
ion
agai
nst c
erta
in o
ppor
tuni
stic
infe
ctio
ns h
ave
also
bee
n sh
own
to b
e ef
fect
ive
inte
rven
tions
for
thes
e in
divi
dual
s. U
se o
f HAA
RT
can
be c
onsi
dere
d fo
r asy
mpt
omat
ic in
divi
dual
s w
ho a
re in
an
earli
er s
tage
of d
isea
se b
ut a
t hig
h ris
k fo
r dis
ease
pro
gres
sion
(i.e
., C
D4
cell
coun
t <3
50 c
ells
/mm
3 or v
iral l
oad
>100
,000
cop
ies/
mL.
Rec
omm
ende
d re
gim
ens
of H
AAR
T ar
e ac
cept
able
to p
regn
ant w
omen
and
lead
to s
igni
fican
tly re
duce
d ra
tes
of m
othe
r-to-
child
tran
smis
sion
. Ear
ly d
etec
tion
of m
ater
nal H
IV
infe
ctio
n al
so a
llow
s fo
r dis
cuss
ion
of e
lect
ive
cesa
rean
sec
tion
and
avoi
danc
e of
bre
astfe
edin
g, b
oth
of w
hich
are
ass
ocia
ted
with
low
er H
IV tr
ansm
issi
on ra
tes.
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
USP
STF
foun
d go
od e
vide
nce
that
scr
eeni
ng
accu
rate
ly d
etec
ts H
IV in
fect
ion
and
that
app
ropr
iate
ly
timed
inte
rven
tions
, par
ticul
arly
HAA
RT,
lead
to
impr
oved
hea
lth o
utco
mes
for m
any
of th
ose
scre
ened
. Fa
lse-
posi
tive
test
resu
lts a
re ra
re, a
nd m
ost a
dver
se
even
ts a
ssoc
iate
d w
ith tr
eatm
ent,
incl
udin
g m
etab
olic
di
stur
banc
es w
ith a
n in
crea
sed
risk
for c
ardi
ovas
cula
r ev
ents
, may
be
amel
iora
ted
by c
hang
es in
regi
men
.
The
USP
STF
conc
lude
d th
at th
e be
nefit
s of
scr
eeni
ng
indi
vidu
als
at in
crea
sed
risk
subs
tant
ially
out
wei
gh
pote
ntia
l har
ms.
The
USP
STF
foun
d fa
ir ev
iden
ce th
at s
cree
ning
indi
vidu
als
who
are
not
kno
wn
to b
e at
incr
ease
d ris
k fo
r HIV
can
de
tect
add
ition
al in
divi
dual
s w
ith H
IV, a
nd g
ood
evid
ence
th
at a
ppro
pria
tely
tim
ed in
terv
entio
ns le
ad to
impr
oved
he
alth
out
com
es fo
r som
e of
thes
e in
divi
dual
s. H
owev
er,
the
yiel
d of
scr
eeni
ng p
erso
ns w
ithou
t ris
k fa
ctor
s w
ould
be
low,
and
ther
e ar
e po
tent
ial h
arm
s of
scr
eeni
ng.
The
USP
STF
conc
lude
d th
at th
e be
nefit
of s
cree
ning
in
divi
dual
s w
ithou
t ris
k fa
ctor
s fo
r HIV
is to
o sm
all r
elat
ive
to th
e po
tent
ial h
arm
s to
just
ify a
gen
eral
reco
mm
enda
tion.
The
USP
STF
foun
d go
od e
vide
nce
that
scr
eeni
ng
accu
rate
ly d
etec
ts H
IV in
fect
ion
in p
regn
ant w
omen
, an
d fa
ir ev
iden
ce th
at p
rena
tal c
ouns
elin
g an
d vo
lunt
ary
test
ing
incr
ease
s th
e pr
opor
tion
of H
IV-
infe
cted
wom
en w
ho a
re d
iagn
osed
and
trea
ted
befo
re
deliv
ery.
The
re is
no
evid
ence
of f
etal
ano
mal
ies
or
othe
r clin
ical
ly i
mpo
rtant
feta
l har
m a
ssoc
iate
d w
ith
curre
ntly
reco
mm
ende
d an
tiret
rovi
ral r
egim
ens
(exc
ept
for e
favi
renz
). Se
rious
or f
atal
mat
erna
l eve
nts
are
rare
us
ing
curre
ntly
reco
mm
ende
d co
mbi
natio
n th
erap
ies.
The
USP
STF
conc
lude
d th
at th
e be
nefit
s of
scr
eeni
ng
all p
regn
ant w
omen
sub
stan
tially
out
wei
gh th
e po
tent
ial
harm
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g an
d co
unse
ling
for o
ther
sex
ually
tran
smitt
ed in
fect
ions
. The
se re
com
men
datio
ns a
re a
vaila
ble
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, ple
ase
go to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
37
HO
RM
ON
E R
EPLA
CEM
ENT
THER
APY
FO
R T
HE
PREV
ENTI
ON
OF
CH
RO
NIC
CO
ND
ITIO
NS
IN
PO
STM
ENO
PAU
SAL
WO
MEN
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nPo
stm
enop
ausa
l wom
enPo
stm
enop
ausa
l wom
en w
ho h
ave
had
a hy
ster
ecto
my
Rec
omm
enda
tion
Do
not u
se c
ombi
ned
estr
ogen
and
pro
gest
in fo
r the
pre
vent
ion
of c
hron
ic c
ondi
tions
.
Gra
de: D
Do
not u
se u
nopp
osed
est
roge
n fo
r the
pre
vent
ion
of c
hron
ic
cond
ition
s.
Gra
de: D
Ris
k As
sess
men
t
The
prob
abilit
y th
at a
men
opau
sal w
oman
will
deve
lop
vario
us c
hron
ic d
isea
ses
durin
g he
r life
time
is e
stim
ated
to b
e:
●46
% fo
r cor
onar
y he
art d
isea
se
●
20%
for s
troke
●15
% fo
r hip
frac
ture
●10
% fo
r bre
ast c
ance
r
●2.
6% fo
r end
omet
rial c
ance
r
Prev
entiv
e M
edic
atio
n
●
Com
bine
d es
troge
n-pr
oges
tin re
duce
s th
e ris
k fo
r fra
ctur
es
and
may
pos
sibl
y de
crea
se c
olor
ecta
l can
cer r
isk,
but
it h
as n
o be
nefic
ial e
ffect
on
coro
nary
hea
rt di
seas
e.
●
Com
bine
d es
troge
n-pr
oges
tin in
crea
ses
the
risk
for s
troke
, bre
ast
canc
er, d
emen
tia a
nd lo
wer
glo
bal c
ogni
tive
func
tion,
ven
ous
thro
mbo
embo
lism
, and
cho
lecy
stiti
s.
●
Ther
e is
not
eno
ugh
evid
ence
to d
eter
min
e th
e ef
fect
s of
ho
rmon
e th
erap
y on
the
inci
denc
e of
ova
rian
canc
er, m
orta
lity
from
bre
ast c
ance
r or c
oron
ary
hear
t dis
ease
, or a
ll-ca
use
mor
talit
y.
●
Evid
ence
abo
ut th
e ef
fect
s of
diff
eren
t dos
ages
, typ
es, a
nd
deliv
ery
mod
es o
f hor
mon
e th
erap
y re
mai
ns in
suffi
cien
t.
●
Estro
gen
alon
e de
crea
ses
a w
oman
’s ri
sk fo
r fra
ctur
es, b
ut it
has
no
ben
efici
al e
ffect
on
coro
nary
hea
rt di
seas
e.
●
Estro
gen
alon
e in
crea
ses
the
risk
for s
troke
, dem
entia
and
low
er
glob
al c
ogni
tive
func
tion,
and
thro
mbo
embo
lism
.
●Th
e ev
iden
ce is
insu
ffici
ent t
o de
term
ine
the
effe
cts
of u
nopp
osed
es
troge
n on
the
inci
denc
e of
bre
ast c
ance
r, ov
aria
n ca
ncer
, or
colo
rect
al c
ance
r, as
wel
l as
brea
st c
ance
r mor
talit
y or
all-
caus
e m
orta
lity.
Bala
nce
of B
enefi
ts a
nd H
arm
sO
vera
ll, th
e ha
rmfu
l effe
cts
of c
ombi
ned
estro
gen
and
prog
estin
are
lik
ely
to e
xcee
d th
e be
nefit
s of
chr
onic
dis
ease
pre
vent
ion
for m
ost
wom
en.
Ove
rall,
the
harm
ful e
ffect
s of
uno
ppos
ed e
stro
gen
are
likel
y to
ex
ceed
the
chro
nic
dise
ase
prev
entio
n be
nefit
s in
mos
t wom
en.
Clin
ical
Con
side
ratio
ns
The
bala
nce
of b
enefi
ts a
nd h
arm
s fo
r a w
oman
will
be in
fluen
ced
by h
er p
erso
nal p
refe
renc
es, h
er ri
sks
for s
peci
fic c
hron
ic d
isea
ses,
and
the
pres
ence
of m
enop
ausa
l sym
ptom
s. A
sha
red
deci
sion
mak
ing
appr
oach
to p
reve
ntin
g ch
roni
c di
seas
es in
per
imen
opau
sal a
nd p
ostm
enop
ausa
l w
omen
invo
lves
con
side
ratio
n of
indi
vidu
al ri
sk fa
ctor
s an
d pr
efer
ence
s in
sel
ectin
g ef
fect
ive
inte
rven
tions
for r
educ
ing
the
risks
for f
ract
ure,
he
art d
isea
se, a
nd c
ance
r.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsO
ther
USP
STF
reco
mm
enda
tions
for p
reve
ntio
n of
chr
onic
dis
ease
s (s
cree
ning
for o
steo
poro
sis,
hig
h bl
ood
pres
sure
, lip
id d
isor
ders
, bre
ast
canc
er, a
nd c
olor
ecta
l can
cer a
nd c
ouns
elin
g to
pre
vent
toba
cco
use)
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/. Fo
r a s
umm
ary
of th
e ev
iden
ce s
yste
mat
ical
ly re
view
ed in
mak
ing
this
reco
mm
enda
tion,
the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
38
SCR
EEN
ING
FO
R IL
LIC
IT D
RU
G U
SE
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dole
scen
ts, a
dults
, and
pre
gnan
t wom
en n
ot p
revi
ousl
y id
entifi
ed a
s us
ers
of il
licit
drug
s
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de I:
(Ins
uffic
ient
Evi
denc
e)
Scre
enin
g Te
sts
Toxi
colo
gic
test
s of
blo
od o
r urin
e ca
n pr
ovid
e ob
ject
ive
evid
ence
of d
rug
use,
but
do
not d
istin
guis
h oc
casi
onal
use
rs fr
om
impa
ired
drug
use
rs.
Valid
and
relia
ble
stan
dard
ized
que
stio
nnai
res
are
avai
labl
e to
scr
een
adol
esce
nts
and
adul
ts fo
r dru
g us
e or
mis
use.
Ther
e is
insu
ffici
ent e
vide
nce
to e
valu
ate
the
clin
ical
util
ity o
f the
se in
stru
men
ts w
hen
wid
ely
appl
ied
in p
rimar
y ca
re s
ettin
gs.
Bala
nce
of B
enefi
ts a
nd H
arm
sTh
e U
SPST
F co
nclu
des
that
for a
dole
scen
ts, a
dults
, and
pre
gnan
t wom
en, t
he e
vide
nce
is in
suffi
cien
t to
dete
rmin
e th
e be
nefit
s an
d ha
rms
of s
cree
ning
for i
llicit
drug
use
.
Sugg
estio
ns fo
r Pra
ctic
eC
linic
ians
sho
uld
be a
lert
to th
e si
gns
and
sym
ptom
s of
illic
it dr
ug u
se in
pat
ient
s.
Trea
tmen
tM
ore
evid
ence
is n
eede
d on
the
effe
ctiv
enes
s of
prim
ary
care
offi
ce-b
ased
trea
tmen
ts fo
r illic
it dr
ug u
se/d
epen
denc
e.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F re
com
men
datio
n fo
r scr
eeni
ng a
nd c
ouns
elin
g in
terv
entio
ns to
redu
ce a
lcoh
ol m
isus
e by
adu
lts a
nd p
regn
ant
wom
en c
an b
e fo
und
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/u
spst
f/usp
sdrin
.htm
.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
39
SCR
EEN
ING
FO
R IM
PAIR
ED V
ISU
AL
AC
UIT
Y IN
OLD
ER A
DU
LTS1
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
Popu
latio
nA
dults
age
65
and
olde
r
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
t
Old
er a
ge is
an
impo
rtant
risk
fact
or fo
r mos
t typ
es o
f vis
ual i
mpa
irmen
t.
Addi
tiona
l ris
k fa
ctor
s in
clud
e:
●
Smok
ing,
alc
ohol
use
, exp
osur
e to
ultr
avio
let l
ight
, dia
bete
s, c
ortic
oste
roid
s, a
nd b
lack
race
(for
cat
arac
ts).
●
Smok
ing,
fam
ily h
isto
ry, a
nd w
hite
race
(for
age
-rela
ted
mac
ular
deg
ener
atio
n).
Scre
enin
g Te
sts
Visu
al a
cuity
test
ing
(for e
xam
ple,
the
Snel
len
eye
char
t) is
the
usua
l met
hod
for s
cree
ning
for i
mpa
irmen
t of v
isua
l acu
ity in
th
e pr
imar
y ca
re s
ettin
g.
Scre
enin
g qu
estio
ns a
re n
ot a
s ac
cura
te a
s a
visu
al a
cuity
test
.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Ther
e is
no
dire
ct e
vide
nce
that
scr
eeni
ng fo
r vis
ion
impa
irmen
t in
olde
r adu
lts in
prim
ary
care
set
tings
is a
ssoc
iate
d w
ith
impr
oved
clin
ical
out
com
es.
Ther
e is
evi
denc
e th
at e
arly
trea
tmen
t of r
efra
ctiv
e er
ror,
cata
ract
s, a
nd a
ge-re
late
d m
acul
ar d
egen
erat
ion
may
lead
to h
arm
s th
at a
re s
mal
l.
The
mag
nitu
de o
f net
ben
efit f
or s
cree
ning
can
not b
e ca
lcul
ated
bec
ause
of a
lack
of e
vide
nce.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsR
ecom
men
datio
ns o
n sc
reen
ing
for g
lauc
oma
and
on s
cree
ning
for h
earin
g lo
ss in
old
er a
dults
can
be
acce
ssed
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
1 Thi
s re
com
men
datio
n do
es n
ot c
over
scr
eeni
ng fo
r gla
ucom
a.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
40
SCR
EEN
ING
FO
R L
IPID
DIS
OR
DER
S IN
AD
ULT
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
n
●
Men
age
35
year
s an
d ol
der
●
Wom
en a
ge 4
5 ye
ars
and
olde
r w
ho a
re a
t inc
reas
ed ri
sk fo
r co
rona
ry h
eart
dis
ease
(CH
D)
●
Men
age
s 20
to 3
5 ye
ars
who
are
at
incr
ease
d ris
k fo
r CH
D
●
Wom
en a
ges
20 to
45
year
s w
ho
are
at in
crea
sed
risk
for C
HD
●
Men
age
s 20
to 3
5 ye
ars
●
Wom
en a
ge 2
0 ye
ars
and
olde
r w
ho a
re n
ot a
t inc
reas
ed ri
sk fo
r C
HD
Rec
omm
enda
tion
Scre
en fo
r lip
id d
isor
ders
. G
rade
: ASc
reen
for l
ipid
dis
orde
rs.
Gra
de: B
No
reco
mm
enda
tion
for o
r aga
inst
sc
reen
ing
Gra
de: C
Ris
k As
sess
men
tC
onsi
dera
tion
of li
pid
leve
ls a
long
with
oth
er ri
sk fa
ctor
s al
low
s fo
r an
accu
rate
est
imat
ion
of C
HD
risk
. Ris
k fa
ctor
s fo
r C
HD
incl
ude
diab
etes
, his
tory
of p
revi
ous
CH
D o
r ath
eros
cler
osis
, fam
ily h
isto
ry o
f car
diov
ascu
lar d
isea
se, t
obac
co u
se,
hype
rtens
ion,
and
obe
sity
(bod
y m
ass
inde
x ≥3
0 kg
/m2 ).
Scre
enin
g Te
sts
The
pref
erre
d sc
reen
ing
test
s fo
r dys
lipid
emia
are
mea
surin
g se
rum
lipi
d (to
tal c
hole
ster
ol, h
igh-
dens
ity a
nd lo
w-d
enis
ty
lipop
rote
in c
hole
ster
ol) l
evel
s in
non
-fast
ing
or fa
stin
g sa
mpl
es. A
bnor
mal
scr
eeni
ng re
sults
sho
uld
be c
onfir
med
by
a re
peat
ed s
ampl
e on
a s
epar
ate
occa
sion
, and
the
aver
age
of b
oth
resu
lts s
houl
d be
use
d fo
r ris
k as
sess
men
t.
Tim
ing
of S
cree
ning
The
optim
al in
terv
al fo
r scr
eeni
ng is
unc
erta
in. R
easo
nabl
e op
tions
incl
ude
ever
y 5
year
s, s
horte
r int
erva
ls fo
r peo
ple
who
hav
e lip
id le
vels
clo
se to
thos
e w
arra
ntin
g th
erap
y, a
nd lo
nger
inte
rval
s fo
r tho
se n
ot a
t inc
reas
ed ri
sk w
ho h
ave
had
repe
ated
ly n
orm
al li
pid
leve
ls.
An a
ge a
t whi
ch to
sto
p sc
reen
ing
has
not b
een
esta
blis
hed.
Scr
eeni
ng m
ay b
e ap
prop
riate
in o
lder
peo
ple
who
hav
e ne
ver
been
scr
eene
d; re
peat
ed s
cree
ning
is le
ss im
porta
nt in
old
er p
eopl
e be
caus
e lip
id le
vels
are
less
like
ly to
incr
ease
afte
r age
65
yea
rs.
Inte
rven
tions
Dru
g th
erap
y is
usu
ally
mor
e ef
fect
ive
than
die
t alo
ne in
impr
ovin
g lip
id p
rofil
es, b
ut c
hoic
e of
trea
tmen
t sho
uld
cons
ider
ov
eral
l ris
k, c
osts
of t
reat
men
t, an
d pa
tient
pre
fere
nces
. Gui
delin
es fo
r tre
atin
g lip
id d
isor
ders
are
ava
ilabl
e fro
m th
e N
atio
nal
Cho
lest
erol
Edu
catio
n Pr
ogra
m o
f the
Nat
iona
l Ins
titut
es o
f Hea
lth (h
ttp://
ww
w.nh
lbi.n
ih.g
ov/a
bout
/nce
p/).
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
bene
fits
of s
cree
ning
for a
nd
treat
ing
lipid
dis
orde
rs in
men
age
35
and
olde
r and
wom
en a
ge 4
5 an
d ol
der
at in
crea
sed
risk
for C
HD
sub
stan
tially
ou
twei
gh th
e po
tent
ial h
arm
s.
The
bene
fits
of s
cree
ning
for a
nd
treat
ing
lipid
dis
orde
rs in
you
ng a
dults
at
incr
ease
d ris
k fo
r CH
D m
oder
atel
y ou
twei
gh th
e po
tent
ial h
arm
s.
The
net b
enefi
ts o
f scr
eeni
ng fo
r lip
id d
isor
ders
in y
oung
adu
lts n
ot a
t in
crea
sed
risk
for C
HD
are
not
suf
ficie
nt
to m
ake
a ge
nera
l rec
omm
enda
tion.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
The
USP
STF
has
mad
e re
com
men
datio
ns o
n sc
reen
ing
for l
ipid
dis
orde
rs in
chi
ldre
n an
d sc
reen
ing
for c
arot
id a
rtery
st
enos
is, c
oron
ary
hear
t dis
ease
, hig
h bl
ood
pres
sure
, and
per
iphe
ral a
rteria
l dis
ease
. The
se re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
41
SCR
EEN
ING
FO
R L
UN
G C
AN
CER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
per
sons
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
tC
igar
ette
sm
okin
g is
the
maj
or ri
sk fa
ctor
for l
ung
canc
er. O
ther
risk
fact
ors
incl
ude
fam
ily h
isto
ry, c
hron
ic o
bstru
ctiv
e pu
lmon
ary
dise
ase,
idio
path
ic p
ulm
onar
y fib
rosi
s, e
nviro
nmen
tal r
adon
exp
osur
e, p
assi
ve s
mok
ing,
asb
esto
s ex
posu
re, a
nd
certa
in o
ccup
atio
nal e
xpos
ures
.
Scre
enin
g Te
sts
Scre
enin
g w
ith lo
w d
ose
com
pute
rized
tom
ogra
phy,
che
st x
-ray,
or s
putu
m c
ytol
ogy
can
dete
ct lu
ng c
ance
r at e
arlie
r sta
ges;
ho
wev
er, a
s of
200
4, th
ere
is in
suffi
cien
t evi
denc
e th
at a
ny s
cree
ning
stra
tegy
for l
ung
canc
er d
ecre
ases
mor
talit
y.
Bala
nce
of B
enefi
ts a
nd H
arm
s
As o
f 200
4, th
e be
nefit
of s
cree
ning
for l
ung
canc
er h
as n
ot b
een
esta
blis
hed
in a
ny g
roup
, inc
ludi
ng a
sym
ptom
atic
hig
h-ris
k po
pula
tions
suc
h as
old
er s
mok
ers.
The
bal
ance
of B
enefi
ts a
nd H
arm
s be
com
es in
crea
sing
ly u
nfav
orab
le fo
r per
sons
at
low
er ri
sk, s
uch
as n
onsm
oker
s.
Beca
use
of th
e in
vasi
ve n
atur
e of
dia
gnos
tic te
stin
g an
d th
e po
ssib
ility
of a
hig
h nu
mbe
r of f
alse
-pos
itive
resu
lts in
cer
tain
po
pula
tions
, the
re is
pot
entia
l for
sig
nific
ant h
arm
s fro
m s
cree
ning
.
Ther
efor
e, th
e U
SPST
F co
uld
not d
eter
min
e th
e ba
lanc
e be
twee
n th
e be
nefit
s an
d ha
rms
of s
cree
ning
for l
ung
canc
er.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r man
y ot
her t
ypes
of c
ance
r. Th
ese
reco
mm
enda
tions
are
av
aila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
42
PRIM
ARY
CA
RE
CO
UN
SELI
NG
FO
R P
RO
PER
USE
OF
MO
TOR
VEH
ICLE
OC
CU
PAN
T R
ESTR
AIN
TS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
S
Popu
latio
nG
ener
al p
rimar
y ca
re p
opul
atio
n
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Inte
rven
tions
Ther
e is
goo
d ev
iden
ce th
at c
omm
unity
and
pub
lic h
ealth
inte
rven
tions
, inc
ludi
ng le
gisl
atio
n, la
w e
nfor
cem
ent c
ampa
igns
, ca
r sea
t dis
tribu
tion
cam
paig
ns, m
edia
cam
paig
ns, a
nd o
ther
com
mun
ity-b
ased
inte
rven
tions
, are
effe
ctiv
e in
impr
ovin
g th
e pr
oper
use
of c
ar s
eats
, boo
ster
sea
ts, a
nd s
eat b
elts
.
Sugg
estio
ns fo
r Pra
ctic
e
Cur
rent
evi
denc
e is
insu
ffici
ent t
o as
sess
the
incr
emen
tal b
enefi
t of c
ouns
elin
g in
prim
ary
care
set
tings
, bey
ond
incr
ease
s re
late
d to
oth
er in
terv
entio
ns, i
n im
prov
ing
rate
s of
pro
per u
se o
f mot
or v
ehic
le o
ccup
ant r
estra
ints
.
Link
ages
bet
wee
n pr
imar
y ca
re a
nd c
omm
unity
inte
rven
tions
are
crit
ical
for i
mpr
ovin
g pr
oper
car
sea
t, bo
oste
r sea
t, an
d se
at
belt
use.
Rel
evan
t Rec
omm
enda
tions
fro
m th
e G
uide
to C
omm
unity
P
reve
ntiv
e S
ervi
ces
The
Com
mun
ity P
reve
ntiv
e Se
rvic
es T
ask
Forc
e ha
s re
view
ed e
vide
nce
of th
e ef
fect
iven
ess
of s
elec
ted
popu
latio
n-ba
sed
inte
rven
tions
to re
duce
mot
or v
ehic
le o
ccup
ant i
njur
ies,
focu
sing
on
thre
e st
rate
gic
area
s:
●
Incr
easi
ng th
e pr
oper
use
of c
hild
saf
ety
seat
s.
●
Incr
easi
ng th
e us
e of
saf
ety
belts
.
●
Red
ucin
g al
coho
l-im
paire
d dr
ivin
g.
Mul
tiple
inte
rven
tions
in th
ese
area
s ha
ve b
een
reco
mm
ende
d. R
ecom
men
datio
ns c
an b
e ac
cess
ed a
t ht
tp://
ww
w.th
ecom
mun
itygu
ide.
org/
mvo
i/
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
43
SCR
EEN
ING
FO
R O
RA
L C
AN
CER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I S
tate
men
t (In
suffi
cien
t Evi
denc
e)
Ris
k As
sess
men
tTo
bacc
o us
e in
all
form
s is
the
bigg
est r
isk
fact
or fo
r ora
l can
cer.
Alco
hol a
buse
com
bine
d w
ith to
bacc
o us
e in
crea
ses
risk.
C
linic
ians
sho
uld
be a
lert
to th
e po
ssib
ility
of o
ral c
ance
r whe
n tre
atin
g pa
tient
s w
ho u
se to
bacc
o or
alc
ohol
.
Scre
enin
g Te
sts
Dire
ct in
spec
tion
and
palp
atio
n of
the
oral
cav
ity is
the
mos
t com
mon
ly re
com
men
ded
met
hod
of s
cree
ning
for o
ral c
ance
r, al
thou
gh th
ere
are
little
dat
a on
the
sens
itivi
ty a
nd s
peci
ficity
of t
his
met
hod.
Scr
eeni
ng te
chni
ques
oth
er th
an in
spec
tion
and
palp
atio
n ar
e be
ing
eval
uate
d bu
t are
stil
l exp
erim
enta
l.
Inte
rven
tions
Patie
nts
shou
ld b
e en
cour
aged
to n
ot u
se to
bacc
o an
d to
lim
it al
coho
l use
in o
rder
to d
ecre
ase
thei
r ris
k fo
r ora
l can
cer,
as
wel
l as
for h
eart
dise
ase,
stro
ke, l
ung
canc
er, a
nd c
irrho
sis.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Ther
e is
no
good
-qua
lity
evid
ence
that
scr
eeni
ng fo
r ora
l can
cer l
eads
to im
prov
ed h
ealth
out
com
es fo
r eith
er h
igh-
risk
adul
ts (i
.e.,
adul
ts o
lder
than
age
50
year
s w
ho u
se to
bacc
o) o
r ave
rage
-risk
adu
lts in
the
gene
ral p
opul
atio
n. It
is u
nlik
ely
that
con
trolle
d tri
als
of s
cree
ning
for o
ral c
ance
r will
ever
be
cond
ucte
d in
the
gene
ral p
opul
atio
n be
caus
e of
the
very
low
in
cide
nce
of o
ral c
ance
r in
the
Uni
ted
Stat
es. T
here
is a
lso
no e
vide
nce
of th
e ha
rms
of s
cree
ning
.
As a
resu
lt, th
e U
SPST
F co
uld
not d
eter
min
e th
e ba
lanc
e be
twee
n th
e be
nefit
s an
d ha
rms
of s
cree
ning
for o
ral c
ance
r.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r man
y ot
her t
ypes
of c
ance
r. Th
ese
reco
mm
enda
tions
are
av
aila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
44
SCR
EEN
ING
FO
R O
STEO
POR
OSI
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nW
omen
age
≥65
yea
rs w
ithou
t pr
evio
us k
now
n fr
actu
res
or
seco
ndar
y ca
uses
of o
steo
poro
sis
Wom
en a
ge <
65 y
ears
who
se
10-y
ear f
ract
ure
risk
is e
qual
to o
r gr
eate
r tha
n th
at o
f a 6
5-ye
ar-o
ld
whi
te w
oman
with
out a
dditi
onal
risk
fa
ctor
s
Men
with
out p
revi
ous
know
n fr
actu
res
or s
econ
dary
cau
ses
of
oste
opor
osis
Rec
omm
enda
tion
Scre
en fo
r ost
eopo
rosi
s.G
rade
: BN
o re
com
men
datio
n.G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
t
As m
any
as 1
in 2
pos
tmen
opau
sal w
omen
and
1 in
5 o
lder
men
are
at r
isk
for a
n os
teop
oros
is-re
late
d fra
ctur
e.
Ost
eopo
rosi
s is
com
mon
in a
ll ra
cial
gro
ups
but i
s m
ost c
omm
on in
whi
te p
erso
ns. R
ates
of o
steo
poro
sis
incr
ease
with
age
. El
derly
peo
ple
are
parti
cula
rly s
usce
ptib
le to
frac
ture
s. A
ccor
ding
to th
e FR
AX fr
actu
re ri
sk a
sses
smen
t too
l, av
aila
ble
at
http
://w
ww.
shef
.ac.
uk/F
RAX
/, th
e 10
-yea
r fra
ctur
e ris
k in
a 6
5-ye
ar-o
ld w
hite
wom
an w
ithou
t add
ition
al ri
sk fa
ctor
s is
9.3
%.
Scre
enin
g Te
sts
Cur
rent
dia
gnos
tic a
nd tr
eatm
ent c
riter
ia re
ly o
n du
al-e
nerg
y x-
ray
abso
rptio
met
ry o
f the
hip
and
lum
bar s
pine
.
Tim
ing
of S
cree
ning
Evid
ence
is la
ckin
g ab
out o
ptim
al in
terv
als
for r
epea
ted
scre
enin
g.
Inte
rven
tion
In a
dditi
on to
ade
quat
e ca
lciu
m a
nd v
itam
in D
inta
ke a
nd w
eigh
t-bea
ring
exer
cise
, mul
tiple
U.S
. Foo
d an
d D
rug
Adm
inis
tratio
n–ap
prov
ed th
erap
ies
redu
ce fr
actu
re ri
sk in
wom
en w
ith lo
w b
one
min
eral
den
sity
and
no
prev
ious
frac
ture
s,
incl
udin
g bi
spho
spho
nate
s, p
arat
hyro
id h
orm
one,
ralo
xife
ne, a
nd e
stro
gen.
The
cho
ice
of tr
eatm
ent s
houl
d ta
ke in
to
acco
unt t
he p
atie
nt’s
clin
ical
situ
atio
n an
d th
e tra
deof
f bet
wee
n be
nefit
s an
d ha
rms.
Clin
icia
ns s
houl
d pr
ovid
e ed
ucat
ion
abou
t how
to m
inim
ize
drug
sid
e ef
fect
s.
Sugg
estio
ns fo
r Pra
ctic
e R
egar
ding
the
I Sta
tem
ent f
or
Men
Clin
icia
ns s
houl
d co
nsid
er:
●
pote
ntia
l pre
vent
able
bur
den:
incr
easi
ng b
ecau
se o
f the
agi
ng o
f the
U.S
. pop
ulat
ion
●
pote
ntia
l har
ms:
like
ly to
be
smal
l, m
ostly
opp
ortu
nity
cos
ts
●cu
rrent
pra
ctic
e: ro
utin
e sc
reen
ing
of m
en n
ot w
ides
prea
d
●co
sts:
add
ition
al s
cann
ers
requ
ired
to s
cree
n si
zeab
le p
opul
atio
nsM
en m
ost l
ikel
y to
ben
efit f
rom
scr
eeni
ng h
ave
a 10
-yea
r ris
k fo
r ost
eopo
rotic
frac
ture
equ
al to
or g
reat
er th
an th
at o
f a
65-y
ear-o
ld w
hite
wom
an w
ithou
t ris
k fa
ctor
s. H
owev
er, c
urre
nt e
vide
nce
is in
suffi
cien
t to
asse
ss th
e ba
lanc
e of
ben
efits
an
d ha
rms
of s
cree
ning
for o
steo
poro
sis
in m
en.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
45
SCR
EEN
ING
FO
R O
VAR
IAN
CA
NC
ER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dult
wom
en
Rec
omm
enda
tion
Do
not s
cree
n fo
r ova
rian
canc
er.
Gra
de: D
Ris
k As
sess
men
tTh
e fo
llow
ing
risk
fact
ors
are
asso
ciat
ed w
ith o
varia
n ca
ncer
: fam
ily h
isto
ry, c
arry
ing
the
BR
CA
1 or
BR
CA
2 ge
ne m
utat
ions
, an
d po
ssib
ly ta
king
est
roge
n su
pple
men
tatio
n fo
r pos
tmen
opau
sal c
hron
ic c
ondi
tions
.
Scre
enin
g Te
sts
Scre
enin
g w
ith s
erum
CA-
125
leve
l or t
rans
vagi
nal u
ltras
onog
raph
y m
ay d
etec
t ova
rian
canc
er a
t ear
lier s
tage
s th
an in
the
abse
nce
of s
cree
ning
; how
ever
, ear
lier d
etec
tion
likel
y ha
s a
smal
l effe
ct, a
t bes
t, on
mor
talit
y fro
m o
varia
n ca
ncer
. Als
o,
beca
use
ther
e is
a lo
w in
cide
nce
of o
varia
n ca
ncer
in th
e ge
nera
l pop
ulat
ion,
scr
eeni
ng fo
r ova
rian
canc
er is
like
ly to
hav
e a
rela
tivel
y lo
w y
ield
.
Bala
nce
of B
enefi
ts a
nd H
arm
sBe
caus
e of
the
low
pre
vale
nce
of o
varia
n ca
ncer
and
the
inva
sive
nat
ure
of d
iagn
ostic
test
ing
afte
r a p
ositi
ve s
cree
ning
test
, th
ere
is fa
ir ev
iden
ce th
at s
cree
ning
cou
ld li
kely
lead
to im
porta
nt h
arm
s. T
here
fore
, the
pot
entia
l har
ms
of s
cree
ning
for
ovar
ian
canc
er o
utw
eigh
the
pote
ntia
l ben
efits
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
The
USP
STF
has
also
mad
e re
com
men
datio
ns o
n ge
netic
risk
ass
essm
ent a
nd B
RC
A m
utat
ion
test
ing
for o
varia
n an
d br
east
can
cer s
usce
ptib
ility,
as
wel
l as
scre
enin
g fo
r bre
ast c
ance
r and
cer
vica
l can
cer.
Thes
e re
com
men
datio
ns a
re
avai
labl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.. Fo
r a s
umm
ary
of th
e ev
iden
ce s
yste
mat
ical
ly re
view
ed in
mak
ing
this
reco
mm
enda
tion,
the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
46
SCR
EEN
ING
FO
R P
AN
CR
EATI
C C
AN
CER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts
Rec
omm
enda
tion
Do
not s
cree
n fo
r pan
crea
tic c
ance
r.G
rade
: D
Ris
k As
sess
men
tPe
rson
s w
ith h
ered
itary
pan
crea
titis
may
hav
e a
high
er li
fetim
e ris
k fo
r dev
elop
ing
panc
reat
ic c
ance
r. H
owev
er, t
he U
SPST
F di
d no
t rev
iew
the
effe
ctiv
enes
s of
scr
eeni
ng th
ese
patie
nts.
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
USP
STF
foun
d no
evi
denc
e th
at s
cree
ning
for p
ancr
eatic
can
cer i
s ef
fect
ive
in re
duci
ng m
orta
lity.
The
re is
a p
oten
tial
for s
igni
fican
t har
m d
ue to
the
very
low
pre
vale
nce
of p
ancr
eatic
can
cer,
limite
d ac
cura
cy o
f ava
ilabl
e sc
reen
ing
test
s, th
e in
vasi
ve n
atur
e of
dia
gnos
tic te
sts,
and
the
poor
out
com
es o
f tre
atm
ent.
As a
resu
lt, th
e U
SPST
F co
nclu
ded
that
the
harm
s of
scr
eeni
ng fo
r pan
crea
tic c
ance
r exc
eed
any
pote
ntia
l ben
efits
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r man
y ty
pes
of c
ance
r. Th
ese
reco
mm
enda
tions
are
ava
ilabl
e at
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
47
SCR
EEN
ING
FO
R P
ERIP
HER
AL
AR
TER
IAL
DIS
EASE
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts
Rec
omm
enda
tion
Do
not s
cree
n fo
r per
iphe
ral a
rter
ial d
isea
se (P
AD
). G
rade
: D
Ris
k As
sess
men
tR
isk
fact
ors
asso
ciat
ed w
ith P
AD in
clud
e ol
der a
ge, c
igar
ette
sm
okin
g, d
iabe
tes
mel
litus
, hyp
erch
oles
tero
lem
ia,
hype
rtens
ion,
and
pos
sibl
y ge
netic
fact
ors.
Scre
enin
g Te
sts
Ankl
e br
achi
al in
dex
(ABI
) is
a si
mpl
e an
d ac
cura
te n
onin
vasi
ve te
st fo
r the
scr
eeni
ng a
nd d
iagn
osis
of P
AD. T
he A
BI h
as
dem
onst
rate
d be
tter a
ccur
acy
than
oth
er m
etho
ds o
f scr
eeni
ng, i
nclu
ding
his
tory
taki
ng, q
uest
ionn
aire
s, a
nd p
alpa
tion
of
perip
hera
l pul
ses.
An
ABI v
alue
of l
ess
than
0.9
0 (9
5% s
ensi
tive
and
spec
ific
for a
ngio
grap
hic
PAD
) is
stro
ngly
ass
ocia
ted
with
lim
itatio
ns in
low
er e
xtre
mity
func
tioni
ng a
nd p
hysi
cal a
ctiv
ity to
lera
nce.
Inte
rven
tions
Smok
ing
cess
atio
n an
d ph
ysic
al a
ctiv
ity tr
aini
ng a
lso
incr
ease
max
imal
wal
king
dis
tanc
e am
ong
men
with
ear
ly P
AD.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Scre
enin
g fo
r PAD
in a
sym
ptom
atic
adu
lts in
the
gene
ral p
opul
atio
n ha
s fe
w o
r no
bene
fits,
bec
ause
the
prev
alen
ce o
f PAD
in
this
gro
up is
low
and
bec
ause
ther
e is
littl
e ev
iden
ce th
at tr
eatm
ent o
f PAD
at t
his
asym
ptom
atic
sta
ge o
f dis
ease
, bey
ond
treat
men
t bas
ed o
n st
anda
rd c
ardi
ovas
cula
r ris
k as
sess
men
t, im
prov
es h
ealth
out
com
es.
Scre
enin
g as
ympt
omat
ic a
dults
with
the
ankl
e br
achi
al in
dex
coul
d le
ad to
som
e sm
all d
egre
e of
har
m, i
nclu
ding
fals
e-po
sitiv
e re
sults
and
unn
eces
sary
wor
kups
. The
refo
re, t
he h
arm
s of
rout
ine
scre
enin
g fo
r PAD
exc
eed
the
bene
fits
for
asym
ptom
atic
adu
lts.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r car
otid
arte
ry s
teno
sis,
cor
onar
y he
art d
isea
se, h
igh
bloo
d pr
essu
re, a
nd li
pid
diso
rder
s. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, ple
ase
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
48
SCR
EEN
ING
FO
R R
h (D
) IN
CO
MPA
TIB
ILIT
Y
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nPr
egna
nt w
omen
pre
sent
ing
at th
e fir
st v
isit
for
pren
atal
car
eU
nsen
sitiz
ed R
h (D
)-neg
ativ
e w
omen
at 2
4–28
wee
ks’
gest
atio
n
Rec
omm
enda
tion
Perf
orm
Rh
(D) b
lood
typi
ng a
nd a
ntib
ody
test
ing.
G
rade
: AR
epea
t Rh
(D) b
lood
typi
ng a
nd a
ntib
ody
test
ing.
G
rade
: B
Scre
enin
g Te
sts
Rh
(D) b
lood
typi
ng a
nd a
ntib
ody
test
ing
prev
ents
mat
erna
l sen
sitiz
atio
n an
d im
prov
es o
utco
mes
for n
ewbo
rns.
Tim
ing
of S
cree
ning
Rep
eate
d an
tibod
y te
stin
g in
uns
ensi
tized
Rh
(D)-n
egat
ive
wom
en, u
nles
s th
e fa
ther
is a
lso
know
n to
be
R
h (D
)-neg
ativ
e, p
rovi
des
addi
tiona
l ben
efit o
ver a
sin
gle
test
at t
he fi
rst p
rena
tal v
isit.
Inte
rven
tions
●
Adm
inis
tratio
n of
a fu
ll (3
00 µ
g) d
ose
of R
h (D
) im
mun
oglo
bulin
is re
com
men
ded
for a
ll un
sens
itize
d R
h (D
)-neg
ativ
e w
omen
afte
r rep
eate
d an
tibod
y te
stin
g at
24–
28 w
eeks
’ ges
tatio
n.
●
If an
Rh
(D)-p
ositi
ve o
r wea
kly
Rh
(D)-p
ositi
ve in
fant
is d
eliv
ered
, a d
ose
of R
h (D
) im
mun
oglo
bulin
sho
uld
be
repe
ated
pos
tpar
tum
, pre
fera
bly
with
in 7
2 ho
urs
afte
r del
iver
y.
●
Unl
ess
the
biol
ogic
al fa
ther
is k
now
n to
be
Rh
(D)-n
egat
ive,
a fu
ll do
se o
f Rh
(D) i
mm
unog
lobu
lin is
reco
mm
ende
d fo
r all
unse
nsiti
zed
Rh
(D)-n
egat
ive
wom
en a
fter a
mni
ocen
tesi
s an
d af
ter i
nduc
ed o
r spo
ntan
eous
abo
rtion
; ho
wev
er, i
f the
pre
gnan
cy is
less
than
13
wee
ks, a
50
µg d
ose
is s
uffic
ient
.
Bala
nce
of B
enefi
ts a
nd H
arm
sTh
e be
nefit
s of
Rh
(D) b
lood
typi
ng a
nd a
ntib
ody
test
ing
at
the
first
pre
nata
l vis
it su
bsta
ntia
lly o
utw
eigh
any
pot
entia
l ha
rms.
The
bene
fits
of re
peat
ed te
stin
g su
bsta
ntia
lly o
utw
eigh
an
y po
tent
ial h
arm
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
man
y ty
pes
of o
bste
tric
scre
enin
gs. T
hese
reco
mm
enda
tions
are
av
aila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
49
BEH
AVIO
RA
L C
OU
NSE
LIN
G T
O P
REV
ENT
SEXU
ALL
Y TR
AN
SMIT
TED
INFE
CTI
ON
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll se
xual
ly a
ctiv
e ad
oles
cent
sA
dults
at i
ncre
ased
risk
for S
TIs
Non
-sex
ually
-act
ive
adol
esce
nts
and
adul
ts n
ot a
t inc
reas
ed ri
sk fo
r STI
s
Rec
omm
enda
tion
Offe
r hig
h-in
tens
ity c
ouns
elin
g.G
rade
: B
Offe
r hig
h-in
tens
ity c
ouns
elin
g.G
rade
: B
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
t
All s
exua
lly a
ctiv
e ad
oles
cent
s ar
e at
incr
ease
d ris
k fo
r STI
s an
d sh
ould
be
offe
red
coun
selin
g.
Adul
ts s
houl
d be
con
side
red
at in
crea
sed
risk
and
offe
red
coun
selin
g if
they
hav
e:
●
Cur
rent
STI
s or
hav
e ha
d an
STI
with
in th
e pa
st y
ear.
●
Mul
tiple
sex
ual p
artn
ers.
In c
omm
uniti
es o
r pop
ulat
ions
with
hig
h ra
tes
of S
TIs,
all
sexu
ally
act
ive
patie
nts
in n
on-m
onog
amou
s re
latio
nshi
ps m
ay b
e co
nsid
ered
at i
ncre
ased
risk
.
Inte
rven
tions
Cha
ract
eris
tics
of s
ucce
ssfu
l hig
h-in
tens
ity c
ouns
elin
g in
terv
entio
ns:
●
Mul
tiple
ses
sion
s of
cou
nsel
ing.
●
Freq
uent
ly d
eliv
ered
in g
roup
set
tings
.
Sugg
estio
ns fo
r Pra
ctic
e
Hig
h-in
tens
ity c
ouns
elin
g m
ay b
e de
liver
ed in
prim
ary
care
set
tings
, or i
n ot
her
sect
ors
of th
e he
alth
sys
tem
and
com
mun
ity s
ettin
gs a
fter r
efer
ral.
Del
iver
y of
this
ser
vice
may
be
grea
tly im
prov
ed b
y st
rong
link
ages
bet
wee
n th
e pr
imar
y ca
re s
ettin
g an
d co
mm
unity
.
Evid
ence
is li
mite
d re
gard
ing
coun
selin
g fo
r ado
lesc
ents
who
ar
e no
t sex
ually
act
ive.
Inte
nsiv
e co
unse
ling
for a
ll ad
oles
cent
s in
ord
er
to re
ach
thos
e w
ho a
re a
t ris
k bu
t ha
ve n
ot b
een
appr
opria
tely
iden
tified
is
not
sup
porte
d by
cur
rent
evi
denc
e.
Evid
ence
is la
ckin
g re
gard
ing
the
effe
ctiv
enes
s of
cou
nsel
ing
for a
dults
no
t at i
ncre
ased
risk
for S
TIs.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
USP
STF
reco
mm
enda
tions
on
scre
enin
g fo
r chl
amyd
ial i
nfec
tion,
gon
orrh
ea, g
enita
l her
pes,
hep
atiti
s B,
hep
atiti
s C
, HIV
, an
d sy
philis
can
be
foun
d at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
Abb
revi
atio
n: S
TI =
Sex
ually
Tra
nsm
itted
Infe
ctio
n
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
50
SCR
EEN
ING
FO
R S
KIN
CA
NC
ER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dult
gene
ral p
opul
atio
n1
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
t
Skin
can
cer r
isks
: fam
ily h
isto
ry o
f ski
n ca
ncer
, con
side
rabl
e hi
stor
y of
sun
exp
osur
e an
d su
nbur
n.
Gro
ups
at in
crea
sed
risk
for m
elan
oma:
●
Fair-
skin
ned
men
and
wom
en o
ver t
he a
ge o
f 65
year
s.
●Pa
tient
s w
ith a
typi
cal m
oles
.
●Pa
tient
s w
ith m
ore
than
50
mol
es.
Scre
enin
g Te
sts
Ther
e is
insu
ffici
ent e
vide
nce
to a
sses
s th
e ba
lanc
e of
ben
efits
and
har
ms
of w
hole
bod
y sk
in e
xam
inat
ion
by a
clin
icia
n or
pa
tient
ski
n se
lf-ex
amin
atio
n fo
r the
ear
ly d
etec
tion
of s
kin
canc
er.
Scre
enin
g In
terv
als
Not
app
licab
le.
Sugg
estio
ns fo
r Pra
ctic
eC
linic
ians
sho
uld
rem
ain
aler
t for
ski
n le
sion
s w
ith m
alig
nant
feat
ures
that
are
not
ed w
hile
per
form
ing
phys
ical
exa
min
atio
ns
for o
ther
pur
pose
s. F
eatu
res
asso
ciat
ed w
ith in
crea
sed
risk
for m
alig
nanc
y in
clud
e: a
sym
met
ry, b
orde
r irre
gula
rity,
col
or
varia
bilit
y, d
iam
eter
>6m
m (“
A,” “
B,” “
C,”
“D”),
or r
apid
ly c
hang
ing
lesi
ons.
Sus
pici
ous
lesi
ons
shou
ld b
e bi
opsi
ed.
Oth
er R
elev
ant
Rec
omm
enda
tions
from
the
USP
STF
and
the
Com
mun
ity
Prev
entiv
e Se
rvic
es T
ask
Forc
e
The
USP
STF
has
revi
ewed
the
evid
ence
for c
ouns
elin
g to
pre
vent
ski
n ca
ncer
. The
reco
mm
enda
tion
stat
emen
t and
su
ppor
ting
docu
men
ts c
an b
e ac
cess
ed a
t http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
The
Com
mun
ity P
reve
ntiv
e Se
rvic
es T
ask
Forc
e ha
s re
view
ed th
e ev
iden
ce o
n pu
blic
hea
lth in
terv
entio
ns to
redu
ce s
kin
canc
er. T
he re
com
men
datio
ns c
an b
e ac
cess
ed a
t http
://w
ww.
thec
omm
unity
guid
e.or
g.
1 The
USP
STF
does
not
exa
min
e ou
tcom
es re
late
d to
sur
veilla
nce
of p
atie
nts
with
fam
ilial s
yndr
omes
, suc
h as
fam
ilial a
typi
cal m
ole
and
mel
anom
a (F
AM-M
) syn
drom
e.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
51
SCR
EEN
ING
FO
R S
UIC
IDE
RIS
K
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nG
ener
al p
opul
atio
n
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
t
The
stro
nges
t ris
k fa
ctor
s fo
r atte
mpt
ed s
uici
de in
clud
e m
ood
diso
rder
s or
oth
er m
enta
l dis
orde
rs, c
omor
bid
subs
tanc
e ab
use
diso
rder
s, h
isto
ry o
f del
iber
ate
self-
harm
, and
a h
isto
ry o
f sui
cide
atte
mpt
s. D
elib
erat
e se
lf-ha
rm re
fers
to in
tent
iona
lly
initi
ated
act
s of
sel
f-har
m w
ith a
non
fata
l out
com
e (in
clud
ing
self-
pois
onin
g an
d se
lf-in
jury
). Su
icid
e ris
k is
ass
esse
d al
ong
a co
ntin
uum
rang
ing
from
sui
cida
l ide
atio
n al
one
(rela
tivel
y le
ss s
ever
e) to
sui
cida
l ide
atio
n w
ith a
pla
n (m
ore
seve
re).
Suic
idal
id
eatio
n w
ith a
spe
cific
pla
n of
act
ion
is a
ssoc
iate
d w
ith a
sig
nific
ant r
isk
for a
ttem
pted
sui
cide
.
Scre
enin
g Te
sts
Ther
e is
lim
ited
evid
ence
on
the
accu
racy
of s
cree
ning
tool
s to
iden
tify
suic
ide
risk
in th
e pr
imar
y ca
re s
ettin
g, in
clud
ing
tool
s to
iden
tify
thos
e at
hig
h ris
k. T
he c
hara
cter
istic
s of
the
mos
t com
mon
ly u
sed
scre
enin
g in
stru
men
ts (S
cale
for S
uici
de
Idea
tion,
Sca
le fo
r Sui
cide
Idea
tion–
Wor
st, a
nd th
e Su
icid
al Id
eatio
n Q
uest
ionn
aire
) hav
e no
t bee
n va
lidat
ed to
ass
ess
suic
ide
risk
in p
rimar
y ca
re s
ettin
gs.
Inte
rven
tions
Ther
e is
insu
ffici
ent e
vide
nce
to d
eter
min
e if
treat
men
t of p
erso
ns a
t hig
h ris
k fo
r sui
cide
redu
ces
suic
ide
atte
mpt
s or
m
orta
lity.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Ther
e is
no
evid
ence
that
scr
eeni
ng fo
r sui
cide
risk
redu
ces
suic
ide
atte
mpt
s or
mor
talit
y. T
here
is in
suffi
cien
t evi
denc
e to
de
term
ine
if tre
atm
ent o
f per
sons
at h
igh
risk
redu
ces
suic
ide
atte
mpt
s or
mor
talit
y. T
here
are
no
stud
ies
that
dire
ctly
add
ress
th
e ha
rms
of s
cree
ning
and
trea
tmen
t for
sui
cide
risk
.
As a
resu
lt, th
e U
SPST
F co
uld
not d
eter
min
e th
e ba
lanc
e of
ben
efits
and
har
ms
of s
cree
ning
for s
uici
de ri
sk in
the
prim
ary
care
set
ting.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r alc
ohol
mis
use,
dep
ress
ion,
and
illic
it dr
ug u
se. T
hese
re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
52
SCR
EEN
ING
FO
R S
YPH
ILIS
INFE
CTI
ON
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nPe
rson
s at
incr
ease
d ris
k fo
r syp
hilis
infe
ctio
nA
sym
ptom
atic
per
sons
who
are
not
at i
ncre
ased
risk
fo
r syp
hilis
infe
ctio
n
Rec
omm
enda
tion
Scre
en fo
r syp
hilis
infe
ctio
n.
Gra
de: A
Do
not s
cree
n fo
r syp
hilis
infe
ctio
n.
Gra
de: D
Ris
k As
sess
men
t
Popu
latio
ns a
t inc
reas
ed ri
sk fo
r syp
hilis
infe
ctio
n in
clud
e m
en w
ho h
ave
sex
with
men
and
eng
age
in h
igh-
risk
sexu
al
beha
vior
, com
mer
cial
sex
wor
kers
, per
sons
who
exc
hang
e se
x fo
r dru
gs, a
nd th
ose
in a
dult
corre
ctio
nal f
acilit
ies.
Pe
rson
s di
agno
sed
with
oth
er s
exua
lly tr
ansm
itted
dis
ease
s m
ay b
e m
ore
likel
y th
an o
ther
s to
eng
age
in h
igh-
risk
beha
vior
, pla
cing
them
at i
ncre
ased
risk
.
Scre
enin
g Te
sts
Scre
enin
g fo
r syp
hilis
infe
ctio
n is
a tw
o-st
ep p
roce
ss th
at in
volv
es a
n in
itial
non
trepo
nem
al te
st (V
ener
eal D
isea
se
Res
earc
h La
bora
tory
or R
apid
Pla
sma
Rea
gin)
, fol
low
ed b
y a
confi
rmat
ory
trepo
nem
al te
st (fl
uore
scen
t tre
pone
mal
an
tibod
y ab
sorb
ed o
r T. p
allid
um p
artic
le a
gglu
tinat
ion)
.
Tim
ing
of S
cree
ning
The
optim
al s
cree
ning
inte
rval
in a
vera
ge- a
nd h
igh-
risk
pers
ons
has
not b
een
dete
rmin
ed.
Inte
rven
tions
Pref
erre
d tre
atm
ent c
onsi
sts
of a
ntib
iotic
ther
apy
with
par
ente
rally
adm
inis
tere
d pe
nici
llin G
.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Scre
enin
g m
ay re
sult
in p
oten
tial h
arm
s (s
uch
as fa
lse-
posi
tive
resu
lts, u
nnec
essa
ry a
nxie
ty to
the
patie
nt,
and
harm
s of
ant
ibio
tic u
se).
How
ever
, the
ben
efits
of
scre
enin
g pe
rson
s at
incr
ease
d ris
k fo
r syp
hilis
infe
ctio
n su
bsta
ntia
lly o
utw
eigh
the
pote
ntia
l har
ms.
Giv
en th
e lo
w in
cide
nce
of in
fect
ion
in th
e ge
nera
l po
pula
tion
and
the
cons
eque
nt lo
w y
ield
of s
uch
scre
enin
g, th
e po
tent
ial h
arm
s of
scr
eeni
ng (i
.e.,
oppo
rtuni
ty c
osts
, fal
se-p
ositi
ve te
sts,
and
labe
ling)
in a
lo
w-in
cide
nt p
opul
atio
n ou
twei
gh th
e be
nefit
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
The
USP
STF
has
mad
e ot
her r
ecom
men
datio
ns o
n sc
reen
ing
for s
exua
lly tr
ansm
itted
infe
ctio
ns,
incl
udin
g sc
reen
ing
for s
yphi
lis in
fect
ion
in p
regn
ant w
omen
. The
se re
com
men
datio
ns a
re a
vaila
ble
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/. Fo
r a s
umm
ary
of th
e ev
iden
ce s
yste
mat
ical
ly re
view
ed in
mak
ing
this
reco
mm
enda
tion,
the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
53
SCR
EEN
ING
FO
R S
YPH
ILIS
INFE
CTI
ON
IN P
REG
NA
NC
Y
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll pr
egna
nt w
omen
Rec
omm
enda
tion
Scre
en fo
r syp
hilis
infe
ctio
n.
Gra
de: A
Scre
enin
g Te
sts
Non
trepo
nem
al te
sts
com
mon
ly u
sed
for i
nitia
l scr
eeni
ng in
clud
e:
●
Vene
real
Dis
ease
Res
earc
h La
bora
tory
(VD
RL)
●
Rap
id P
lasm
a R
eagi
n (R
PR)
Con
firm
ator
y te
sts
incl
ude:
●
Fluo
resc
ent t
repo
nem
al a
ntib
ody
abso
rbed
(FTA
-ABS
)
●
Trep
onem
a pa
llidum
par
ticle
agg
lutin
atio
n (T
PPA)
Tim
ing
of S
cree
ning
Test
all
preg
nant
wom
en a
t the
firs
t pre
nata
l vis
it.
Oth
er C
linic
al C
onsi
dera
tions
Mos
t org
aniz
atio
ns re
com
men
d te
stin
g hi
gh-ri
sk w
omen
aga
in d
urin
g th
e th
ird tr
imes
ter a
nd a
t del
iver
y. G
roup
s at
incr
ease
d ris
k in
clud
e:
●
Uni
nsur
ed w
omen
●
Wom
en li
ving
in p
over
ty
●Se
x w
orke
rs
●Ill
icit
drug
use
rs
●Th
ose
diag
nose
d w
ith o
ther
sex
ually
tran
smitt
ed in
fect
ions
(STI
s)
●O
ther
wom
en li
ving
in c
omm
uniti
es w
ith h
igh
syph
ilis m
orbi
dity
Prev
alen
ce is
hig
her i
n so
uthe
rn U
.S. a
nd in
met
ropo
litan
are
as a
nd in
His
pani
c an
d Af
rican
Am
eric
an p
opul
atio
ns.
Inte
rven
tions
The
Cen
ters
for D
isea
se C
ontro
l and
Pre
vent
ion
(CD
C) r
ecom
men
ds tr
eatm
ent w
ith p
aren
tera
l ben
zath
ine
peni
cillin
G.
Wom
en w
ith p
enic
illin
alle
rgie
s sh
ould
be
dese
nsiti
zed
and
treat
ed w
ith p
enic
illin.
Con
sult
the
CD
C fo
r the
mos
t up-
to-d
ate
reco
mm
enda
tions
: http
://w
ww.
cdc.
gov/
std/
treat
men
t/.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsR
ecom
men
datio
ns o
n sc
reen
ing
for o
ther
STI
s, a
nd o
n co
unse
ling
for S
TIs,
can
be
foun
d at
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
54
SCR
EEN
ING
FO
R T
ESTI
CU
LAR
CA
NC
ER
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dole
scen
t and
adu
lt m
ales
Rec
omm
enda
tion
Do
not s
cree
n.
Gra
de: D
Scre
enin
g Te
sts
Ther
e is
inad
equa
te e
vide
nce
that
scr
eeni
ng a
sym
ptom
atic
pat
ient
s by
mea
ns o
f sel
f-exa
min
atio
n or
clin
icia
n ex
amin
atio
n ha
s gr
eate
r yie
ld o
r acc
urac
y fo
r det
ectin
g te
stic
ular
can
cer a
t mor
e cu
rabl
e st
ages
.
Inte
rven
tions
Man
agem
ent o
f tes
ticul
ar c
ance
r con
sist
s of
orc
hiec
tom
y an
d m
ay in
clud
e ot
her s
urge
ry, r
adia
tion
ther
apy,
or c
hem
othe
rapy
, de
pend
ing
on s
tage
and
tum
or ty
pe. R
egar
dles
s of
dis
ease
sta
ge, o
ver 9
0% o
f all
new
ly d
iagn
osed
cas
es o
f tes
ticul
ar c
ance
r w
ill be
cur
ed.
Bala
nce
of B
enefi
ts a
nd H
arm
sSc
reen
ing
by s
elf-e
xam
inat
ion
or c
linic
ian
exam
inat
ion
is u
nlik
ely
to o
ffer m
eani
ngfu
l hea
lth b
enefi
ts, g
iven
the
very
low
in
cide
nce
and
high
cur
e ra
te o
f eve
n ad
vanc
ed te
stic
ular
can
cer.
Pote
ntia
l har
ms
incl
ude
fals
e-po
sitiv
e re
sults
, anx
iety
, and
har
ms
from
dia
gnos
tic te
sts
or p
roce
dure
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
Rec
omm
enda
tions
on
scre
enin
g fo
r oth
er ty
pes
of c
ance
r can
be
foun
d at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
55
SCR
EEN
ING
FO
R T
HYR
OID
DIS
EASE
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
adu
lts
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I S
tate
men
t (In
suffi
cien
t Evi
denc
e)
Ris
k As
sess
men
tPe
ople
at h
ighe
r ris
k fo
r thy
roid
dys
func
tion
incl
ude
the
elde
rly, p
ostp
artu
m w
omen
, per
sons
with
hig
h le
vels
of r
adia
tion
expo
sure
(>20
mG
y), a
nd p
atie
nts
with
Dow
n sy
ndro
me.
Scre
enin
g Te
sts
Scre
enin
g fo
r thy
roid
dys
func
tion
can
be p
erfo
rmed
usi
ng th
e m
edic
al h
isto
ry, p
hysi
cal e
xam
inat
ion,
or a
ny o
f sev
eral
ser
um
thyr
oid
func
tion
test
s. T
hyro
id s
timul
atin
g ho
rmon
e (T
SH) i
s us
ually
reco
mm
ende
d be
caus
e it
can
dete
ct a
bnor
mal
ities
bef
ore
othe
r tes
ts b
ecom
e ab
norm
al.
Inte
rven
tions
A po
tent
ial b
enefi
t of t
reat
ing
subc
linic
al th
yroi
d di
seas
e is
to p
reve
nt th
e sp
onta
neou
s de
velo
pmen
t of o
vert
hypo
thyr
oidi
sm
or h
yper
thyr
oidi
sm, b
ut th
is p
oten
tial b
enefi
t has
not
bee
n w
ell s
tudi
ed in
clin
ical
tria
ls a
s of
200
4.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Ther
e is
fair
evid
ence
that
the
TSH
test
can
det
ect s
ubcl
inic
al th
yroi
d di
seas
e in
per
sons
with
out s
ympt
oms
of th
yroi
d dy
sfun
ctio
n, b
ut p
oor e
vide
nce
that
trea
tmen
t im
prov
es c
linic
ally
impo
rtant
out
com
es in
adu
lts w
ith s
cree
n-de
tect
ed th
yroi
d di
seas
e. T
here
is th
e po
tent
ial f
or h
arm
cau
sed
by fa
lse-
posi
tive
scre
enin
g te
sts;
how
ever
, the
mag
nitu
de o
f har
m is
not
kn
own.
The
re is
goo
d ev
iden
ce th
at o
vertr
eatm
ent w
ith le
voth
yrox
ine
occu
rs in
a s
ubst
antia
l pro
porti
on o
f pat
ient
s, b
ut th
e lo
ng-te
rm h
arm
ful e
ffect
s of
ove
rtrea
tmen
t are
not
kno
wn.
As a
resu
lt, th
e U
SPST
F co
uld
not d
eter
min
e th
e ba
lanc
e of
ben
efits
and
har
ms
of s
cree
ning
asy
mpt
omat
ic a
dults
for t
hyro
id
dise
ase.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r dia
bete
s, h
emoc
hrom
atos
is, i
ron
defic
ienc
y an
emia
, and
ob
esity
. The
se re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
56
CO
UN
SELI
NG
AN
D IN
TER
VEN
TIO
NS
TO P
REV
ENT
TOB
AC
CO
USE
AN
D T
OB
AC
CO
-CA
USE
D D
ISEA
SE
IN A
DU
LTS
AN
D P
REG
NA
NT
WO
MEN
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dults
age
≥ 1
8 ye
ars
Preg
nant
wom
en o
f any
age
Rec
omm
enda
tion
Ask
abo
ut to
bacc
o us
e. P
rovi
de to
bacc
o ce
ssat
ion
inte
rven
tions
to th
ose
who
use
toba
cco
prod
ucts
. G
rade
: A
Ask
abo
ut to
bacc
o us
e. P
rovi
de a
ugm
ente
d pr
egna
ncy-
tailo
red
coun
selin
g fo
r wom
en w
ho s
mok
e.
Gra
de: A
Cou
nsel
ing
The
“5-A
” fra
mew
ork
prov
ides
a u
sefu
l cou
nsel
ing
stra
tegy
:
1. A
sk a
bout
toba
cco
use.
2. A
dvis
e to
qui
t thr
ough
cle
ar p
erso
naliz
ed m
essa
ges.
3. A
sses
s w
illing
ness
to q
uit.
4. A
ssis
t to
quit.
5. A
rrang
e fo
llow
-up
and
supp
ort.
Inte
nsity
of c
ouns
elin
g m
atte
rs: b
rief o
ne-ti
me
coun
selin
g w
orks
; how
ever
, lon
ger s
essi
ons
or m
ultip
le s
essi
ons
are
mor
e ef
fect
ive.
Tele
phon
e co
unse
ling
“qui
t lin
es” a
lso
impr
ove
cess
atio
n ra
tes.
Phar
mac
othe
rapy
Com
bina
tion
ther
apy
with
cou
nsel
ing
and
med
icat
ions
is
mor
e ef
fect
ive
than
eith
er c
ompo
nent
alo
ne. F
DA-
appr
oved
pha
rmac
othe
rapy
incl
udes
nic
otin
e re
plac
emen
t th
erap
y, s
usta
ined
-rele
ase
bupr
opio
n, a
nd v
aren
iclin
e.
The
USP
STF
foun
d in
adeq
uate
evi
denc
e to
eva
luat
e th
e sa
fety
or e
ffica
cy o
f pha
rmac
othe
rapy
dur
ing
preg
nanc
y.
Impl
emen
tatio
n
Succ
essf
ul im
plem
enta
tion
stra
tegi
es fo
r prim
ary
care
pra
ctic
e in
clud
e:
●
Inst
itutin
g a
toba
cco
user
iden
tifica
tion
syst
em.
●
Prom
otin
g cl
inic
ian
inte
rven
tion
thro
ugh
educ
atio
n, re
sour
ces,
and
feed
back
.
●
Ded
icat
ing
staf
f to
prov
ide
treat
men
t, an
d as
sess
ing
the
deliv
ery
of tr
eatm
ent i
n st
aff p
erfo
rman
ce e
valu
atio
ns.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
Rec
omm
enda
tions
on
othe
r beh
avio
ral c
ouns
elin
g to
pics
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
Abb
revi
atio
ns: F
DA
= U
.S. F
ood
and
Dru
g Ad
min
istra
tion;
USP
STF
= U
.S. P
reve
ntiv
e Se
rvic
es T
ask
Forc
e
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
Recommendations for Children and Adolescents
All clinical summaries in this Guide are abridged recommendations. To see the full recommendation statements and recommendations published after March 2012, go to www.USPreventiveServicesTaskForce.org.
59
SCR
EEN
ING
FO
R E
LEVA
TED
BLO
OD
LEA
D L
EVEL
S IN
CH
ILD
REN
AN
D P
REG
NA
NT
WO
MEN
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
chi
ldre
n ag
es 1
to 5
ye
ars
who
are
at i
ncre
ased
risk
Asy
mpt
omat
ic c
hild
ren
ages
1 to
5
year
s w
ho a
re a
t ave
rage
risk
Asy
mpt
omat
ic p
regn
ant w
omen
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Do
not s
cree
n fo
r ele
vate
d bl
ood
lead
leve
ls.
Gra
de: D
Do
not s
cree
n fo
r ele
vate
d bl
ood
lead
leve
ls.
Gra
de: D
Ris
k As
sess
men
t
Chi
ldre
n yo
unge
r tha
n ag
e 5
year
s ar
e at
gre
ater
risk
for e
leva
ted
bloo
d le
ad le
vels
and
lead
toxi
city
bec
ause
of i
ncre
ased
ha
nd-to
-mou
th a
ctiv
ity, i
ncre
ased
lead
abs
orpt
ion
from
the
gast
roin
test
inal
trac
t, an
d th
e gr
eate
r vul
nera
bilit
y of
the
deve
lopi
ng c
entra
l ner
vous
sys
tem
.
Ris
k fa
ctor
s fo
r inc
reas
ed b
lood
lead
leve
ls in
chi
ldre
n an
d ad
ults
incl
ude:
min
ority
race
/eth
nici
ty; u
rban
resi
denc
e; lo
w
inco
me;
low
edu
catio
nal a
ttain
men
t; ol
der (
pre-
1950
) hou
sing
; rec
ent o
r ong
oing
hom
e re
nova
tion
or re
mod
elin
g; p
ica;
use
of
ethn
ic re
med
ies,
cer
tain
cos
met
ics,
and
exp
osur
e to
lead
-gla
zed
potte
ry; o
ccup
atio
nal e
xpos
ure;
and
rece
nt im
mig
ratio
n.
Addi
tiona
l ris
k fa
ctor
s fo
r pre
gnan
t wom
en in
clud
e al
coho
l use
and
sm
okin
g.
Scre
enin
g Te
sts
Veno
us s
ampl
ing
accu
rate
ly d
etec
ts e
leva
ted
bloo
d le
ad le
vels
. Scr
eeni
ng q
uest
ionn
aire
s m
ay b
e of
val
ue in
iden
tifyi
ng
child
ren
at ri
sk fo
r ele
vate
d bl
ood
lead
leve
ls, b
ut s
houl
d be
tailo
red
for a
nd v
alid
ated
in s
peci
fic c
omm
uniti
es fo
r clin
ical
use
.
Inte
rven
tions
Trea
tmen
t opt
ions
for e
leva
ted
bloo
d le
ad le
vels
incl
ude
resi
dent
ial l
ead
haza
rd-c
ontro
l effo
rts (i
.e.,
coun
selin
g an
d ed
ucat
ion,
dus
t or p
aint
rem
oval
, and
soi
l aba
tem
ent),
che
latio
n, a
nd n
utrit
iona
l int
erve
ntio
ns.
Com
mun
ity-b
ased
inte
rven
tions
for t
he p
reve
ntio
n of
lead
exp
osur
e ar
e lik
ely
to b
e m
ore
effe
ctiv
e, a
nd m
ay b
e m
ore
cost
-ef
fect
ive,
than
offi
ce-b
ased
scr
eeni
ng, t
reat
men
t, an
d co
unse
ling.
Rel
ocat
ing
child
ren
who
do
not y
et h
ave
elev
ated
blo
od
lead
leve
ls b
ut w
ho li
ve in
set
tings
with
hig
h le
ad e
xpos
ure
may
be
espe
cial
ly h
elpf
ul.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Ther
e is
not
eno
ugh
evid
ence
to
asse
ss th
e ba
lanc
e be
twee
n th
e po
tent
ial b
enefi
ts a
nd h
arm
s of
rout
ine
scre
enin
g fo
r ele
vate
d bl
ood
lead
le
vels
in c
hild
ren
at in
crea
sed
risk.
Giv
en th
e si
gnifi
cant
pot
entia
l har
ms
of tr
eatm
ent a
nd re
side
ntia
l lea
d ha
zard
aba
tem
ent,
and
no e
vide
nce
of tr
eatm
ent b
enefi
t, th
e ha
rms
of
scre
enin
g fo
r ele
vate
d bl
ood
lead
le
vels
in c
hild
ren
at a
vera
ge ri
sk
outw
eigh
the
bene
fits.
Giv
en th
e si
gnifi
cant
pot
entia
l har
ms
of tr
eatm
ent a
nd re
side
ntia
l lea
d ha
zard
aba
tem
ent,
and
no e
vide
nce
of tr
eatm
ent b
enefi
t, th
e ha
rms
of
scre
enin
g fo
r ele
vate
d bl
ood
lead
leve
ls
in a
sym
ptom
atic
pre
gnan
t wom
en
outw
eigh
the
bene
fits.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
60
SCR
EEN
ING
FO
R C
ON
GEN
ITA
L H
YPO
THYR
OID
ISM
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll ne
wbo
rn in
fant
s1
Rec
omm
enda
tion
Scre
en fo
r con
geni
tal h
ypot
hyro
idis
m.
Gra
de: A
Scre
enin
g Te
sts
Two
met
hods
of s
cree
ning
are
use
d m
ost f
requ
ently
in th
e U
nite
d St
ates
:
●
Prim
ary
TSH
with
bac
kup
T4.
●
Prim
ary
T4 w
ith b
acku
p TS
H.
Scre
enin
g fo
r con
geni
tal h
ypot
hyro
idis
m (C
H) i
s m
anda
ted
in a
ll 50
sta
tes
and
the
Dis
trict
of C
olum
bia.
Clin
icia
ns s
houl
d be
com
e fa
milia
r with
the
test
s us
ed in
thei
r are
a an
d th
e lim
itatio
ns o
f the
scr
eeni
ng s
trate
gies
em
ploy
ed.
Tim
ing
of S
cree
ning
Infa
nts
shou
ld b
e te
sted
bet
wee
n 2
and
4 da
ys o
f age
.
Infa
nts
disc
harg
ed fr
om h
ospi
tals
bef
ore
48 h
ours
of l
ife s
houl
d be
test
ed im
med
iate
ly b
efor
e di
scha
rge.
Sp
ecim
ens
obta
ined
in th
e fir
st 2
4-48
hou
rs o
f age
may
be
fals
ely
elev
ated
for T
SH re
gard
less
of t
he s
cree
ning
met
hod
used
.
Sugg
estio
ns fo
r Pra
ctic
e
Infa
nts
with
abn
orm
al s
cree
ns s
houl
d re
ceiv
e co
nfirm
ator
y te
stin
g an
d be
gin
appr
opria
te tr
eatm
ent w
ith th
yroi
d ho
rmon
e re
plac
emen
t with
in 2
wee
ks a
fter b
irth.
Chi
ldre
n w
ith p
ositi
ve c
onfir
mat
ory
test
ing
in w
hom
no
perm
anen
t cau
se o
f CH
is fo
und
shou
ld u
nder
go a
30-
day
trial
of
redu
ced
or d
isco
ntin
ued
thyr
oid
horm
one
repl
acem
ent t
hera
py to
det
erm
ine
if th
e hy
poth
yroi
dism
is p
erm
anen
t or t
rans
ient
. Th
is tr
ial o
f red
uced
or d
isco
ntin
ued
ther
apy
shou
ld ta
ke p
lace
at s
ome
time
afte
r the
chi
ld re
ache
s 3
year
s of
age
.
Oth
er R
elev
ant
Rec
omm
enda
tions
from
the
USP
STF
Addi
tiona
l USP
STF
reco
mm
enda
tions
rega
rdin
g sc
reen
ing
test
s fo
r new
born
s ca
n be
acc
esse
d at
: ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/re
com
men
datio
ns.h
tm#p
edia
tric
1 Thi
s re
com
men
datio
n ap
plie
s to
all
infa
nts
born
in th
e U
.S. P
rem
atur
e, v
ery
low
birt
h w
eigh
t and
ill i
nfan
ts m
ay b
enefi
t fro
m a
dditi
onal
scr
eeni
ng. T
hese
con
ditio
ns a
re a
ssoc
iate
d w
ith d
ecre
ased
sen
sitiv
ity a
nd s
peci
ficity
of
scr
eeni
ng te
sts.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
61
SCR
EEN
ING
FO
R D
EVEL
OPM
ENTA
L D
YSPL
ASI
A O
F TH
E H
IP
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nIn
fant
s w
ho d
o no
t hav
e ob
viou
s hi
p di
sloc
atio
ns o
r oth
er a
bnor
mal
ities
evi
dent
with
out s
cree
ning
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
tR
isk
fact
ors
for d
evel
opm
enta
l dys
plas
ia o
f the
hip
incl
ude
fem
ale
sex,
fam
ily h
isto
ry, b
reec
h po
sitio
ning
, and
in u
tero
po
stur
al d
efor
miti
es. H
owev
er, t
he m
ajor
ity o
f cas
es o
f dev
elop
men
tal d
yspl
asia
of t
he h
ip h
ave
no id
entifi
able
risk
fact
ors.
Scre
enin
g Te
sts
Scre
enin
g te
sts
for d
evel
opm
enta
l dys
plas
ia o
f the
hip
hav
e lim
ited
accu
racy
. The
mos
t com
mon
met
hods
of s
cree
ning
are
se
rial p
hysi
cal e
xam
inat
ions
of t
he h
ip a
nd lo
wer
ext
rem
ities
, usi
ng th
e Ba
rlow
and
Orto
lani
pro
cedu
res,
and
ultr
ason
ogra
phy.
Inte
rven
tions
Trea
tmen
ts fo
r dev
elop
men
tal d
yspl
asia
of t
he h
ip in
clud
e bo
th n
onsu
rgic
al a
nd s
urgi
cal o
ptio
ns. N
onsu
rgic
al tr
eatm
ent w
ith
abdu
ctio
n de
vice
s is
use
d as
ear
ly tr
eatm
ent a
nd in
clud
es th
e co
mm
only
pre
scrib
ed P
avlik
met
hod.
Surg
ical
inte
rven
tion
is u
sed
whe
n th
e dy
spla
sia
is s
ever
e or
dia
gnos
ed la
te, o
r afte
r an
unsu
cces
sful
tria
l of n
onsu
rgic
al
treat
men
t. Av
ascu
lar n
ecro
sis
of th
e hi
p is
the
mos
t com
mon
and
mos
t sev
ere
pote
ntia
l har
m o
f bot
h su
rgic
al a
nd n
onsu
rgic
al
inte
rven
tions
, and
can
resu
lt in
gro
wth
arre
st o
f the
hip
and
eve
ntua
l joi
nt d
estru
ctio
n, w
ith s
igni
fican
t dis
abilit
y.
Bala
nce
of B
enefi
ts a
nd H
arm
sTh
e U
SPST
F w
as u
nabl
e to
ass
ess
the
bala
nce
of b
enefi
ts a
nd h
arm
s of
scr
eeni
ng fo
r dev
elop
men
tal d
yspl
asia
of t
he h
ip
due
to in
suffi
cien
t evi
denc
e. T
here
are
con
cern
s ab
out t
he p
oten
tial h
arm
s as
soci
ated
with
trea
tmen
t of i
nfan
ts id
entifi
ed b
y ro
utin
e sc
reen
ing.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
The
USP
STF
has
mad
e re
com
men
datio
ns o
n sc
reen
ing
for h
yper
bilir
ubin
emia
, phe
nylk
eton
uria
, sic
kle
cell
dise
ase,
co
ngen
ital h
ypot
hyro
idis
m, a
nd h
earin
g lo
ss in
new
born
s. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
62
OC
ULA
R P
RO
PHYL
AXI
S FO
R G
ON
OC
OC
CA
L O
PHTH
ALM
IA N
EON
ATO
RU
M
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REA
FFIR
MAT
ION
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll ne
wbo
rn in
fant
s
Rec
omm
enda
tion
Prov
ide
prop
hyla
ctic
ocu
lar t
opic
al m
edic
atio
n fo
r the
pre
vent
ion
of g
onoc
occa
l oph
thal
mia
ne
onat
orum
.G
rade
: A
Ris
k As
sess
men
tAl
l new
born
s sh
ould
rece
ive
prop
hyla
xis.
How
ever
, som
e ne
wbo
rns
are
at in
crea
sed
risk,
incl
udin
g th
ose
with
a m
ater
nal h
isto
ry o
f no
pren
atal
car
e,
sexu
ally
tran
smitt
ed in
fect
ions
, or s
ubst
ance
abu
se.
Prev
entiv
e In
terv
entio
nsPr
even
tive
med
icat
ions
incl
ude
0.5%
ery
thro
myc
in o
phth
alm
ic o
intm
ent,
1.0%
sol
utio
n of
silv
er n
itrat
e, a
nd
1.0%
tetra
cycl
ine
oint
men
t. Al
l are
con
side
red
equa
lly e
ffect
ive;
how
ever
, the
latte
r tw
o ar
e no
long
er a
vaila
ble
in th
e U
nite
d St
ates
.
Tim
ing
of In
terv
entio
nW
ithin
24
hour
s af
ter b
irth.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
Seve
ral r
ecom
men
datio
ns o
n sc
reen
ing
and
coun
selin
g fo
r inf
ectio
us d
isea
ses
and
perin
atal
car
e ca
n be
foun
d at
: http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
. Fo
r a s
umm
ary
of th
e ev
iden
ce s
yste
mat
ical
ly re
view
ed in
mak
ing
thes
e re
com
men
datio
ns, t
he fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
63
UN
IVER
SAL
SCR
EEN
ING
FO
R H
EAR
ING
LO
SS IN
NEW
BO
RN
S
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll ne
wbo
rn in
fant
s
Rec
omm
enda
tion
Scre
en fo
r hea
ring
loss
in a
ll ne
wbo
rn in
fant
s.
Gra
de: B
Ris
k As
sess
men
t
The
prev
alen
ce o
f hea
ring
loss
in n
ewbo
rn in
fant
s w
ith s
peci
fic ri
sk in
dica
tors
is 1
0 to
20
times
hig
her t
han
in th
e ge
nera
l po
pula
tion
of n
ewbo
rns.
Ris
k in
dica
tors
ass
ocia
ted
with
per
man
ent b
ilate
ral c
onge
nita
l hea
ring
loss
incl
ude:
●
Neo
nata
l int
ensi
ve c
are
unit
adm
issi
on fo
r 2 o
r mor
e da
ys.
●
Fam
ily h
isto
ry o
f her
edita
ry c
hild
hood
sen
sorin
eura
l hea
ring
loss
.
●
Cra
niof
acia
l abn
orm
aliti
es.
●
Cer
tain
con
geni
tal s
yndr
omes
and
infe
ctio
ns.
Appr
oxim
atel
y 50
% o
f new
born
s w
ith p
erm
anen
t bila
tera
l con
geni
tal h
earin
g lo
ss d
o no
t hav
e an
y kn
own
risk
indi
cato
rs.
Scre
enin
g Te
sts
Scre
enin
g pr
ogra
ms
shou
ld b
e co
nduc
ted
usin
g a
one-
step
or t
wo-
step
val
idat
ed p
roto
col.
A fre
quen
tly-u
sed
2-st
ep
scre
enin
g pr
oces
s in
volv
es o
toac
oust
ic e
mis
sion
s fo
llow
ed b
y au
dito
ry b
rain
ste
m re
spon
se in
new
born
s w
ho fa
il th
e fir
st
test
. Inf
ants
with
pos
itive
scr
eeni
ng te
sts
shou
ld re
ceiv
e ap
prop
riate
aud
iolo
gic
eval
uatio
n an
d fo
llow
-up
afte
r dis
char
ge.
Proc
edur
es fo
r scr
eeni
ng a
nd fo
llow
-up
shou
ld b
e in
pla
ce fo
r new
born
s de
liver
ed a
t hom
e, b
irthi
ng c
ente
rs, o
r hos
pita
ls
with
out h
earin
g sc
reen
ing
faci
litie
s.
Tim
ing
of S
cree
ning
All i
nfan
ts s
houl
d ha
ve h
earin
g sc
reen
ing
befo
re o
ne m
onth
of a
ge. I
nfan
ts w
ho d
o no
t pas
s th
e ne
wbo
rn s
cree
ning
sho
uld
unde
rgo
audi
olog
ic a
nd m
edic
al e
valu
atio
n be
fore
3 m
onth
s of
age
.
Trea
tmen
t
Early
inte
rven
tion
serv
ices
for h
earin
g-im
paire
d in
fant
s sh
ould
mee
t the
indi
vidu
aliz
ed n
eeds
of t
he in
fant
and
fam
ily,
incl
udin
g ac
quis
ition
of c
omm
unic
atio
n co
mpe
tenc
e, s
ocia
l ski
lls, e
mot
iona
l wel
l-bei
ng, a
nd p
ositi
ve s
elf-e
stee
m.
Early
inte
rven
tion
com
pris
es e
valu
atio
n fo
r am
plifi
catio
n or
sen
sory
dev
ices
, sur
gica
l and
med
ical
eva
luat
ion,
and
co
mm
unic
atio
n as
sess
men
t and
ther
apy.
Coc
hlea
r im
plan
ts a
re u
sual
ly c
onsi
dere
d fo
r chi
ldre
n w
ith s
ever
e-to
-pro
foun
d he
arin
g lo
ss o
nly
afte
r ina
dequ
ate
resp
onse
to h
earin
g ai
ds.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsAd
ditio
nal U
SPST
F re
com
men
datio
ns re
gard
ing
scre
enin
g te
sts
for n
ewbo
rns
can
be a
cces
sed
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/reco
mm
enda
tions
.htm
#ped
iatri
c.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
64
SCR
EEN
ING
OF
INFA
NTS
FO
R H
YPER
BIL
IRU
BIN
EMIA
TO
PR
EVEN
T C
HR
ON
IC
BIL
IRU
BIN
EN
CEP
HA
LOPA
THY
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nH
ealth
y ne
wbo
rn in
fant
s ≥3
5 w
eeks
’ ges
tatio
nal a
ge
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
tR
isk
fact
ors
for h
yper
bilir
ubin
emia
incl
ude
fam
ily h
isto
ry o
f neo
nata
l jau
ndic
e, e
xclu
sive
bre
astfe
edin
g, b
ruis
ing,
cep
halo
hem
atom
a, e
thni
city
(A
sian
, bla
ck),
mat
erna
l age
>25
yea
rs, m
ale
gend
er, G
6PD
defi
cien
cy, a
nd g
esta
tiona
l age
<36
wee
ks.
The
spec
ific
cont
ribut
ion
of th
ese
risk
fact
ors
to c
hron
ic b
ilirub
in e
ncep
halo
path
y in
hea
lthy
child
ren
is n
ot w
ell u
nder
stoo
d.
Impo
rtanc
eC
hron
ic b
ilirub
in e
ncep
halo
path
y is
a ra
re b
ut d
evas
tatin
g co
nditi
on. N
ot a
ll ch
ildre
n w
ith c
hron
ic b
ilirub
in e
ncep
halo
path
y ha
ve a
his
tory
of
hype
rbilir
ubin
emia
.
Bala
nce
of B
enefi
ts a
nd H
arm
sEv
iden
ce a
bout
the
bene
fits
and
harm
s of
scr
eeni
ng is
lack
ing.
The
refo
re, t
he U
SPST
F co
uld
not d
eter
min
e th
e ba
lanc
e of
ben
efits
and
har
ms
of s
cree
ning
new
born
s fo
r hyp
erbi
lirub
inem
ia to
pre
vent
chr
onic
bilir
ubin
enc
epha
lopa
thy.
Con
side
ratio
ns fo
r Pra
ctic
e
In d
ecid
ing
whe
ther
to s
cree
n, c
linic
ians
sho
uld
cons
ider
the
follo
win
g:
●
Pote
ntia
l pre
vent
able
bur
den.
Bilir
ubin
enc
epha
lopa
thy
is a
rela
tivel
y ra
re d
isor
der.
Hyp
erbi
lirub
inem
ia a
lone
doe
s no
t acc
ount
for t
he
neur
olog
ic c
ondi
tion
of c
hron
ic b
ilirub
in e
ncep
halo
path
y. T
here
is n
o kn
own
scre
enin
g te
st th
at w
ill re
liabl
y id
entif
y al
l inf
ants
at r
isk
of
deve
lopi
ng c
hron
ic b
ilirub
in e
ncep
halo
path
y.
●
Pote
ntia
l har
ms.
Pot
entia
l har
ms
of s
cree
ning
are
unm
easu
red
but m
ay b
e im
porta
nt. E
vide
nce
abou
t the
pot
entia
l har
ms
of
phot
othe
rapy
is la
ckin
g. H
arm
s of
trea
tmen
t by
exch
ange
tran
sfus
ion
may
incl
ude
apne
a, b
rady
card
ia, c
yano
sis,
vas
ospa
sm, t
hrom
bosi
s,
necr
otiz
ing
ente
roco
litis
, and
, rar
ely,
dea
th.
●
Cur
rent
pra
ctic
e. U
nive
rsal
scr
eeni
ng is
wid
espr
ead
in th
e U
nite
d St
ates
.
Scre
enin
g Te
sts
Scre
enin
g m
ay c
onsi
st o
f ris
k-fa
ctor
ass
essm
ent,
mea
sure
men
t of b
ilirub
in le
vel e
ither
in s
erum
or b
y tra
nscu
tane
ous
estim
atio
n, o
r a
com
bina
tion
of m
etho
ds.
Inte
rven
tions
Phot
othe
rapy
is c
omm
only
use
d to
trea
t hyp
erbi
lirub
inem
ia.
Exch
ange
tran
sfus
ion
is u
sed
to tr
eat e
xtre
me
hype
rbilir
ubin
emia
.
Rel
evan
t USP
STF
Rec
omm
enda
tions
USP
STF
reco
mm
enda
tions
on
scre
enin
g ne
wbo
rns
for h
earin
g lo
ss, c
onge
nita
l hyp
othy
roid
ism
, hem
oglo
bino
path
ies,
and
phe
nylk
eton
uria
(P
KU) c
an b
e fo
und
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts, p
leas
e go
to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
65
PAR
T I:
SCR
EEN
ING
FO
R IR
ON
DEF
ICIE
NC
Y A
NEM
IA IN
CH
ILD
REN
AN
D P
REG
NA
NT
WO
MEN
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
chi
ldre
n ag
es 6
to 1
2 m
onth
sA
sym
ptom
atic
pre
gnan
t wom
en
Rec
omm
enda
tion
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)Sc
reen
for i
ron
defic
ienc
y an
emia
.G
rade
: B
Ris
k As
sess
men
tIn
divi
dual
s co
nsid
ered
to b
e at
hig
h ris
k fo
r iro
n de
ficie
ncy
incl
ude
adul
t wom
en, r
ecen
t im
mig
rant
s, a
nd, a
mon
g ad
oles
cent
fe
mal
es, f
ad d
iete
rs, a
s w
ell a
s th
ose
who
are
obe
se. P
rem
atur
e an
d lo
w b
irth
wei
ght i
nfan
ts a
re a
lso
at in
crea
sed
risk
for
iron
defic
ienc
y.
Scre
enin
g Te
sts
Seru
m h
emog
lobi
n or
hem
atoc
rit is
the
prim
ary
scre
enin
g te
st fo
r ide
ntify
ing
anem
ia. H
emog
lobi
n is
sen
sitiv
e fo
r iro
n de
ficie
ncy
anem
ia; h
owev
er, i
t is
not s
ensi
tive
for i
ron
defic
ienc
y be
caus
e m
ild d
efici
ency
sta
tes
may
not
affe
ct h
emog
lobi
n le
vels
.
Pote
ntia
l har
ms
of s
cree
ning
incl
ude
fals
e-po
sitiv
e re
sults
, anx
iety
, and
cos
t.
Inte
rven
tions
Iron
defic
ienc
y an
emia
is u
sual
ly tr
eate
d w
ith o
ral i
ron
prep
arat
ions
. The
like
lihoo
d th
at ir
on d
efici
ency
ane
mia
iden
tified
by
scre
enin
g w
ill re
spon
d to
trea
tmen
t is
uncl
ear,
beca
use
man
y fa
milie
s do
not
adh
ere
to tr
eatm
ent a
nd b
ecau
se th
e ra
te o
f sp
onta
neou
s re
solu
tion
is h
igh.
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
USP
STF
was
una
ble
to d
eter
min
e th
e ba
lanc
e be
twee
n th
e be
nefit
s an
d ha
rms
of ro
utin
e sc
reen
ing
for i
ron
defic
ienc
y an
emia
in a
sym
ptom
atic
chi
ldre
n ag
es 6
to 1
2 m
onth
s.
The
bene
fits
of ro
utin
e sc
reen
ing
for i
ron
defic
ienc
y an
emia
in
asy
mpt
omat
ic p
regn
ant w
omen
out
wei
gh th
e po
tent
ial
harm
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r blo
od le
ad le
vels
in c
hild
ren
and
preg
nant
wom
en. T
hese
re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, ple
ase
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
66
PAR
T II:
IRO
N S
UPP
LEM
ENTA
TIO
N F
OR
CH
ILD
REN
AN
D P
REG
NA
NT
WO
MEN
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
chi
ldre
n ag
es 6
to 1
2 m
onth
s w
ho a
re a
t inc
reas
ed ri
sk fo
r iro
n de
ficie
ncy
anem
ia
Asy
mpt
omat
ic c
hild
ren
ages
6 to
12
mon
ths
who
are
at a
vera
ge ri
sk fo
r iro
n de
ficie
ncy
anem
iaPr
egna
nt w
omen
who
are
not
ane
mic
Rec
omm
enda
tion
Prov
ide
rout
ine
iron
supp
lem
enta
tion.
Gra
de: B
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)N
o re
com
men
datio
n.G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
tA
valid
ated
risk
ass
essm
ent t
ool t
o gu
ide
prim
ary
care
phy
sici
ans
in id
entif
ying
indi
vidu
als
who
wou
ld b
enefi
t fro
m ir
on s
uppl
emen
tatio
n ha
s no
t bee
n de
velo
ped.
Prev
entiv
e M
edic
atio
n
Iron
supp
lem
enta
tion,
suc
h as
iron
-forti
fied
form
ula
or ir
on s
uppl
emen
ts, m
ay im
prov
e ne
urod
evel
opm
enta
l out
com
es in
chi
ldre
n at
in
crea
sed
risk
for i
ron
defic
ienc
y an
emia
. The
re is
poo
r evi
denc
e th
at it
impr
oves
neu
rode
velo
pmen
tal o
r hea
lth o
utco
mes
in o
ther
po
pula
tions
.
Ora
l iro
n su
pple
men
tatio
n in
crea
ses
the
risk
for u
nint
entio
nal o
verd
ose
and
gast
roin
test
inal
sym
ptom
s. G
iven
app
ropr
iate
pro
tect
ion
agai
nst o
verd
ose,
thes
e ha
rms
are
smal
l.
Bala
nce
of B
enefi
ts
and
Har
ms
The
mod
erat
e be
nefit
s of
iron
su
pple
men
tatio
n in
asy
mpt
omat
ic
child
ren
ages
6 to
12
mon
ths
who
are
at
incr
ease
d ris
k fo
r iro
n de
ficie
ncy
anem
ia
outw
eigh
the
pote
ntia
l har
ms.
The
USP
STF
was
una
ble
to d
eter
min
e th
e ba
lanc
e be
twee
n th
e be
nefit
s an
d ha
rms
of ir
on s
uppl
emen
tatio
n in
chi
ldre
n ag
es 6
to 1
2 m
onth
s w
ho a
re a
t ave
rage
ris
k fo
r iro
n de
ficie
ncy
anem
ia.
The
USP
STF
was
una
ble
to d
eter
min
e th
e ba
lanc
e be
twee
n th
e be
nefit
s an
d ha
rms
of
iron
supp
lem
enta
tion
in n
on-a
nem
ic p
regn
ant
wom
en.
Oth
er R
elev
ant
USP
STF
Rec
omm
enda
tions
The
USP
STF
has
also
mad
e re
com
men
datio
ns o
n fo
lic a
cid
supp
lem
enta
tion
in w
omen
pla
nnin
g or
cap
able
of p
regn
ancy
and
vita
min
D
supp
lem
enta
tion
to p
reve
nt c
ance
r and
frac
ture
s. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
67
SCR
EEN
ING
FO
R L
IPID
DIS
OR
DER
S IN
CH
ILD
REN
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
infa
nts,
chi
ldre
n, a
dole
scen
ts, a
nd y
oung
adu
lts (a
ge 2
0 ye
ars
or y
oung
er)
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
tR
isk
fact
ors
for d
yslip
idem
ia in
clud
e ov
erw
eigh
t, di
abet
es, a
nd a
fam
ily h
isto
ry o
f com
mon
fam
ilial d
yslip
idem
ias
(e.g
., fa
milia
l hy
perc
hole
ster
olem
ia).
Scre
enin
g Te
sts
Seru
m li
pid
(tota
l cho
lest
erol
, hig
h-de
nsity
and
low
-den
sity
lipo
prot
ein
chol
este
rol)
leve
ls a
re a
ccur
ate
scre
enin
g te
sts
for
child
hood
dys
lipid
emia
, alth
ough
man
y ch
ildre
n w
ith m
ultif
acto
rial t
ypes
of d
yslip
idem
ia w
ill ha
ve n
orm
al li
pid
leve
ls in
ad
ulth
ood.
The
use
of f
amily
his
tory
as
a sc
reen
ing
tool
for d
yslip
idem
ia h
as v
aria
ble
accu
racy
, lar
gely
bec
ause
defi
nitio
ns o
f a
posi
tive
fam
ily h
isto
ry a
nd li
pid
thre
shol
d va
lues
var
y su
bsta
ntia
lly.
Inte
rven
tions
The
effe
ctiv
enes
s of
trea
tmen
t int
erve
ntio
ns (d
iet,
exer
cise
, lip
id-lo
wer
ing
agen
ts) i
n im
prov
ing
heal
th o
utco
mes
in c
hild
ren
with
dys
lipid
emia
(inc
ludi
ng m
ultif
acto
rial d
yslip
idem
ia) r
emai
ns a
crit
ical
rese
arch
gap
. Pot
entia
l har
ms
of s
cree
ning
may
in
clud
e la
belin
g of
chi
ldre
n w
hose
dys
lipid
emia
wou
ld n
ot p
ersi
st in
to a
dulth
ood
or c
ause
hea
lth p
robl
ems.
Adv
erse
effe
cts
from
lipi
d-lo
wer
ing
med
icat
ions
and
low
-fat d
iets
, inc
ludi
ng p
oten
tial l
ong-
term
har
ms,
hav
e be
en in
adeq
uate
ly e
valu
ated
in
child
ren.
Bala
nce
of B
enefi
ts a
nd H
arm
sTh
e U
SPST
F w
as u
nabl
e to
det
erm
ine
the
bala
nce
betw
een
the
pote
ntia
l ben
efits
and
har
ms
of ro
utin
ely
scre
enin
g ch
ildre
n an
d ad
oles
cent
s fo
r dys
lipid
emia
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
The
USP
STF
has
mad
e re
com
men
datio
ns o
n sc
reen
ing
for l
ipid
dis
orde
rs in
adu
lts a
nd s
cree
ning
for c
arot
id a
rtery
ste
nosi
s,
coro
nary
hea
rt di
seas
e, h
igh
bloo
d pr
essu
re, a
nd p
erip
hera
l arte
rial d
isea
se. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
. For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
68
SCR
EEN
ING
AN
D T
REA
TMEN
T FO
R M
AJO
R D
EPR
ESSI
VE D
ISO
RD
ER IN
CH
ILD
REN
AN
D A
DO
LESC
ENTS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
dole
scen
ts (1
2-18
yea
rs)
Chi
ldre
n (7
-11
year
s)
Rec
omm
enda
tion
Scre
en w
hen
syst
ems
for d
iagn
osis
, tre
atm
ent,
and
follo
wup
are
in p
lace
. G
rade
: B
No
Rec
omm
enda
tion
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
tR
isk
fact
ors
for m
ajor
dep
ress
ive
diso
rder
(MD
D) i
nclu
de p
aren
tal d
epre
ssio
n, h
avin
g co
mor
bid
men
tal h
ealth
or c
hron
ic
med
ical
con
ditio
ns, a
nd h
avin
g ex
perie
nced
a m
ajor
neg
ativ
e lif
e ev
ent.
Scre
enin
g Te
sts
The
follo
win
g sc
reen
ing
test
s ha
ve b
een
show
n to
do
wel
l in
teen
s in
prim
ary
care
set
tings
:
●
Patie
nt H
ealth
Que
stio
nnai
re fo
r Ado
lesc
ents
(P
HQ
-A).
●
Beck
Dep
ress
ion
Inve
ntor
y-Pr
imar
y C
are
Vers
ion
(BD
I-PC
).
Scre
enin
g in
stru
men
ts p
erfo
rm le
ss w
ell i
n yo
unge
r ch
ildre
n.
Trea
tmen
ts
Amon
g ph
arm
acot
hera
pies
fluo
xetin
e, a
sel
ectiv
e se
roto
nin
reup
take
inhi
bito
r (SS
RI),
has
bee
n fo
und
effic
acio
us. H
owev
er, b
ecau
se o
f ris
k of
sui
cida
lity,
SSR
Is
shou
ld b
e co
nsid
ered
onl
y if
clin
ical
mon
itorin
g is
pos
sibl
e.
Vario
us m
odes
of p
sych
othe
rapy
, and
pha
rmac
othe
rapy
co
mbi
ned
with
psy
chot
hera
py, h
ave
been
foun
d ef
ficac
ious
.
Evid
ence
on
the
bala
nce
of b
enefi
ts a
nd h
arm
s of
tre
atm
ent o
f you
nger
chi
ldre
n is
insu
ffici
ent f
or a
re
com
men
datio
n.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
69
SCR
EEN
ING
FO
R O
BES
ITY
IN C
HIL
DR
EN A
ND
AD
OLE
SCEN
TS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nC
hild
ren
and
adol
esce
nts
6 to
18
year
s of
age
Rec
omm
enda
tion
Scre
en c
hild
ren
aged
6 y
ears
and
old
er fo
r obe
sity
. O
ffer o
r ref
er fo
r int
ensi
ve c
ouns
elin
g an
d be
havi
oral
inte
rven
tions
.G
rade
: B
Scre
enin
g Te
sts
BMI i
s ca
lcul
ated
from
the
wei
ght i
n ki
logr
ams
divi
ded
by th
e sq
uare
of t
he h
eigh
t in
met
ers.
H
eigh
t and
wei
ght,
from
whi
ch B
MI i
s ca
lcul
ated
, are
rout
inel
y m
easu
red
durin
g he
alth
mai
nten
ance
vis
its.
BMI p
erce
ntile
can
be
plot
ted
on a
cha
rt or
obt
aine
d fro
m o
nlin
e ca
lcul
ator
s.
Ove
rwei
ght =
age
- and
gen
der-s
peci
fic B
MI a
t ≥85
th to
94t
h pe
rcen
tile
Obe
sity
= a
ge- a
nd g
ende
r-spe
cific
BM
I at ≥
95th
per
cent
ile
Tim
ing
of S
cree
ning
No
evid
ence
was
foun
d on
app
ropr
iate
scr
eeni
ng in
terv
als.
Inte
rven
tions
Ref
er p
atie
nts
to c
ompr
ehen
sive
mod
erat
e- to
hig
h-in
tens
ity p
rogr
ams
that
incl
ude
diet
ary,
phy
sica
l act
ivity
, and
beh
avio
ral
coun
selin
g co
mpo
nent
s.
Bala
nce
of B
enefi
ts a
nd H
arm
sM
oder
ate-
to h
igh-
inte
nsity
pro
gram
s w
ere
foun
d to
yie
ld m
odes
t wei
ght c
hang
es.
Lim
ited
evid
ence
sug
gest
s th
at th
ese
impr
ovem
ents
can
be
sust
aine
d ov
er th
e ye
ar a
fter t
reat
men
t. H
arm
s of
scr
eeni
ng w
ere
judg
ed to
be
min
imal
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
ns
Rec
omm
enda
tions
on
othe
r ped
iatri
c an
d be
havi
oral
cou
nsel
ing
topi
cs c
an b
e fo
und
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
70
SCR
EEN
ING
FO
R P
HEN
YLK
ETO
NU
RIA
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll ne
wbo
rn in
fant
s
Rec
omm
enda
tion
Scre
en fo
r Phe
nyke
ltonu
ria (P
KU
).G
rade
: A
Scre
enin
g Te
sts
Scre
enin
g fo
r PKU
is m
anda
ted
in a
ll 50
sta
tes.
Met
hods
of s
cree
ning
var
y.
Thre
e m
ain
met
hods
are
use
d to
scr
een
for P
KU in
the
Uni
ted
Stat
es:
1. G
uthr
ie B
acte
rial I
nhib
ition
Ass
ay (B
IA)
2. A
utom
ated
fluo
rom
etric
ass
ay3.
Tan
dem
mas
s sp
ectro
met
ry
Tim
ing
of S
cree
ning
Infa
nts
who
are
test
ed w
ithin
the
first
24
hour
s af
ter b
irth
shou
ld re
ceiv
e a
repe
at s
cree
ning
test
by
2 w
eeks
of a
ge.
Opt
imal
tim
ing
of s
cree
ning
for p
rem
atur
e in
fant
s an
d in
fant
s w
ith il
lnes
ses
is a
t or n
ear 7
day
s of
age
, but
in a
ll ca
ses
befo
re
disc
harg
e fro
m th
e ne
wbo
rn n
urse
ry.
Trea
tmen
tIt
is e
ssen
tial t
hat p
heny
lala
nine
rest
rictio
ns b
e in
stitu
ted
shor
tly a
fter b
irth
to p
reve
nt th
e ne
urod
evel
opm
enta
l effe
cts
of P
KU.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsAd
ditio
nal U
SPST
F re
com
men
datio
ns re
gard
ing
scre
enin
g te
sts
for n
ewbo
rns
can
be a
cces
sed
at:
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/reco
mm
enda
tions
.htm
#ped
iatri
c
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
71
SCR
EEN
ING
FO
R ID
IOPA
THIC
SC
OLI
OSI
S IN
AD
OLE
SCEN
TS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
sym
ptom
atic
ado
lesc
ents
Rec
omm
enda
tion
Do
not s
cree
n fo
r idi
opat
hic
scol
iosi
s.
Gra
de: D
Scre
enin
g Te
sts
Ther
e is
no
evid
ence
that
scr
eeni
ng a
sym
ptom
atic
ado
lesc
ents
det
ects
idio
path
ic s
colio
sis
at a
n ea
rlier
sta
ge th
an d
etec
tion
with
out s
cree
ning
.
Scre
enin
g fo
r idi
opat
hic
scol
iosi
s is
usu
ally
don
e by
vis
ual i
nspe
ctio
n of
the
spin
e to
look
for a
sym
met
ry o
f the
sho
ulde
rs,
scap
ulae
, and
hip
s. If
idio
path
ic s
colio
sis
is s
uspe
cted
, rad
iogr
aphy
can
be
used
to c
onfir
m th
e di
agno
sis
and
to q
uant
ify th
e de
gree
of c
urva
ture
.
Tim
ing
of S
cree
ning
Alth
ough
rout
ine
scre
enin
g of
ado
lesc
ents
for i
diop
athi
c sc
olio
sis
is n
ot re
com
men
ded,
clin
icia
ns s
houl
d be
pre
pare
d to
ev
alua
te id
iopa
thic
sco
liosi
s w
hen
it is
dis
cove
red
inci
dent
ally
or w
hen
the
adol
esce
nt o
r par
ent e
xpre
sses
con
cern
abo
ut
scol
iosi
s.
Inte
rven
tions
Trea
tmen
t of i
diop
athi
c sc
olio
sis
durin
g ad
oles
cenc
e le
ads
to h
ealth
ben
efits
(dec
reas
ed p
ain
and
disa
bilit
y) in
onl
y a
smal
l pr
opor
tion
of p
eopl
e. M
ost c
ases
det
ecte
d th
roug
h sc
reen
ing
will
not p
rogr
ess
to a
clin
ical
ly s
igni
fican
t for
m o
f sco
liosi
s.
Bala
nce
of B
enefi
ts a
nd H
arm
sTr
eatm
ent o
f ado
lesc
ents
with
idio
path
ic s
colio
sis
dete
cted
thro
ugh
scre
enin
g le
ads
to m
oder
ate
harm
s, in
clud
ing
unne
cess
ary
brac
e w
ear a
nd u
nnec
essa
ry re
ferra
l for
spe
cial
ty c
are.
As
a re
sult,
the
harm
s of
scr
eeni
ng a
dole
scen
ts fo
r id
iopa
thic
sco
liosi
s ex
ceed
the
pote
ntia
l ben
efits
.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r dev
elop
men
tal d
yspl
asia
of t
he h
ip. T
hese
re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
72
SCR
EEN
ING
FO
R S
ICK
LE C
ELL
DIS
EASE
IN N
EWB
OR
NS
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nA
ll ne
wbo
rn in
fant
s
Rec
omm
enda
tion
Scre
en fo
r sic
kle
cell
dise
ase.
Gra
de: A
Scre
enin
g Te
sts
Scre
enin
g fo
r sic
kle
cell
dise
ase
in n
ewbo
rns
is m
anda
ted
in a
ll 50
sta
tes
and
the
Dis
trict
of C
olum
bia.
In
mos
t sta
tes,
one
of t
hese
test
s is
use
d fo
r the
initi
al s
cree
ning
:
●
Thin
-laye
r iso
elec
tric
focu
sing
(IEF
).
●H
igh
perfo
rman
ce li
quid
chr
omat
ogra
phy
(HPL
C).
Both
IEF
and
HPL
C h
ave
extre
mel
y hi
gh s
ensi
tivity
and
spe
cific
ity fo
r sic
kle
cell
anem
ia.
Tim
ing
of S
cree
ning
All n
ewbo
rns
shou
ld u
nder
go s
cree
ning
rega
rdle
ss o
f birt
h se
tting
. Bi
rth a
ttend
ants
sho
uld
mak
e ar
rang
emen
ts fo
r sam
ples
to b
e ob
tain
ed.
The
first
clin
icia
n to
see
the
infa
nt a
t an
offic
e vi
sit s
houl
d ve
rify
scre
enin
g re
sults
. C
onfir
mat
ory
test
ing
shou
ld o
ccur
no
late
r tha
n 2
mon
ths
of a
ge.
Trea
tmen
tIn
fant
s w
ith s
ickl
e ce
ll an
emia
sho
uld
rece
ive:
●
Prop
hyla
ctic
pen
icilli
n st
artin
g by
age
2 m
onth
s.
●Pn
eum
ococ
cal i
mm
uniz
atio
ns a
t rec
omm
ende
d in
terv
als.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsAd
ditio
nal U
SPST
F re
com
men
datio
ns re
gard
ing
scre
enin
g te
sts
for n
ewbo
rns
can
be a
cces
sed
at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/reco
mm
enda
tions
.htm
#vis
ion.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
73
SCR
EEN
ING
FO
R S
PEEC
H A
ND
LA
NG
UA
GE
DEL
AY IN
PR
ESC
HO
OL
CH
ILD
REN
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nC
hild
ren
ages
5 y
ears
and
you
nger
who
hav
e no
t alre
ady
been
iden
tified
as
at in
crea
sed
risk
for s
peec
h an
d la
ngua
ge d
elay
s
Rec
omm
enda
tion
No
reco
mm
enda
tion.
G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Ris
k As
sess
men
tTh
e m
ost c
onsi
sten
tly re
porte
d ris
k fa
ctor
s in
clud
e a
fam
ily h
isto
ry o
f spe
ech
and
lang
uage
del
ay, m
ale
sex,
and
per
inat
al
fact
ors,
suc
h as
pre
mat
urity
and
low
birt
h-w
eigh
t. O
ther
risk
fact
ors
repo
rted
less
con
sist
ently
incl
ude
leve
ls o
f par
enta
l ed
ucat
ion,
spe
cific
chi
ldho
od il
lnes
ses,
birt
h or
der,
and
larg
er fa
mily
siz
e.
Scre
enin
g Te
sts
Ther
e is
insu
ffici
ent e
vide
nce
that
brie
f, fo
rmal
scr
eeni
ng in
stru
men
ts th
at a
re s
uita
ble
for u
se in
prim
ary
care
for a
sses
sing
sp
eech
and
lang
uage
dev
elop
men
t can
acc
urat
ely
iden
tify
child
ren
who
wou
ld b
enefi
t fro
m fu
rther
eva
luat
ion
and
inte
rven
tion.
Bala
nce
of B
enefi
ts a
nd H
arm
sTh
e U
SPST
F co
uld
not d
eter
min
e th
e ba
lanc
e of
ben
efits
and
har
ms
of u
sing
brie
f, fo
rmal
scr
eeni
ng in
stru
men
ts to
scr
een
for s
peec
h an
d la
ngua
ge d
elay
in th
e pr
imar
y ca
re s
ettin
g.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s al
so m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r hea
ring
loss
in n
ewbo
rns
and
visi
on im
pairm
ent i
n ch
ildre
n ag
es 1
to 5
yea
rs. T
hese
reco
mm
enda
tions
are
ava
ilabl
e at
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
/.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, pl
ease
go
to h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
74
SCR
EEN
ING
FO
R V
ISU
AL
IMPA
IRM
ENT
IN C
HIL
DR
EN A
GES
1 T
O 5
CLI
NIC
AL
SUM
MA
RY O
F U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
Popu
latio
nC
hild
ren
ages
3 to
5 y
ears
Chi
ldre
n yo
unge
r tha
n 3
year
s of
age
Rec
omm
enda
tion
Prov
ide
visi
on s
cree
ning
. G
rade
: BN
o re
com
men
datio
n.G
rade
: I (I
nsuf
ficie
nt E
vide
nce)
Scre
enin
g Te
sts
Vario
us s
cree
ning
test
s ar
e us
ed in
prim
ary
care
to id
entif
y vi
sual
impa
irmen
t in
child
ren,
incl
udin
g:
●
Visu
al a
cuity
test
●
Ster
eoac
uity
test
●
Cov
er-u
ncov
er te
st
●H
irsch
berg
ligh
t refl
ex te
st
●Au
tore
fract
ion
●
Phot
oscr
eeni
ng
Tim
ing
of S
cree
ning
No
evid
ence
was
foun
d re
gard
ing
appr
opria
te s
cree
ning
inte
rval
s.
Inte
rven
tions
Prim
ary
treat
men
t for
am
blyo
pia
incl
udes
the
use
of c
orre
ctiv
e le
nses
, pat
chin
g, o
r atro
pine
ther
apy
of th
e no
n-af
fect
ed
eye.
Tre
atm
ent m
ay a
lso
cons
ist o
f a c
ombi
natio
n of
inte
rven
tions
.
Bala
nce
of B
enefi
ts a
nd H
arm
s
Ther
e is
ade
quat
e ev
iden
ce th
at e
arly
trea
tmen
t of a
mbl
yopi
a in
chi
ldre
n ag
es 3
to 5
yea
rs le
ads
to im
prov
ed v
isua
l ou
tcom
es. T
here
is li
mite
d ev
iden
ce o
n ha
rms
of s
cree
ning
, inc
ludi
ng p
sych
osoc
ial e
ffect
s, in
chi
ldre
n ag
es 3
yea
rs a
nd
olde
r.
Ther
e is
inad
equa
te e
vide
nce
that
ear
ly tr
eatm
ent o
f am
blyo
pia
in c
hild
ren
youn
ger t
han
3 ye
ars
of a
ge le
ads
to
impr
oved
vis
ual o
utco
mes
.
Sugg
estio
ns fo
r Pra
ctic
e R
egar
ding
th
e I S
tate
men
t
In d
ecid
ing
whe
ther
to re
fer c
hild
ren
youn
ger t
han
3 ye
ars
of a
ge fo
r scr
eeni
ng, c
linic
ians
sho
uld
cons
ider
:
●P
oten
tial p
reve
ntab
le b
urde
n: s
cree
ning
late
r in
the
pres
choo
l yea
rs s
eem
s to
be
as e
ffect
ive
as s
cree
ning
ear
lier
●
Cos
ts: i
nitia
l hig
h co
sts
asso
ciat
ed w
ith a
utor
efra
ctor
s an
d ph
otos
cree
ners
●
Cur
rent
pra
ctic
e: ty
pica
l vis
ion
scre
enin
g in
clud
es a
sses
smen
t of v
isua
l acu
ity, s
trabi
smus
, and
ste
reoa
cuity
; ch
ildre
n w
ith p
ositi
ve fi
ndin
gs s
houl
d be
refe
rred
for a
com
preh
ensi
ve o
phth
alm
olog
ist e
xam
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
ese
reco
mm
enda
tions
, the
full
reco
mm
enda
tion
stat
emen
t, an
d su
ppor
ting
docu
men
ts,
plea
se g
o to
http
://w
ww.
uspr
even
tives
ervi
cest
askf
orce
.org
.
Immunizations
77
Immunizations for Adults and Children
The USPSTF recognizes the importance of immunizations in primary disease prevention. However, the USPSTF does not wish to duplicate the significant investment of resources made by others to review new evidence on immunizations in a timely fashion and make recommendations.
The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) publishes recommendations on immunizations for children and adults. The methods used by the ACIP to review evidence on immunizations may differ from the methods used by the USPSTF.
For the ACIP’s current recommendations on immunizations, please refer to the National Immunization Program Web site at www.cdc.gov/vaccines/recs/schedules/default.htm.
Topics in Progress
81
Topics in Progress
Each USPSTF recommendation goes through several stages of development. The review process takes into account input from the medical and research community, stakeholders, and the general public.
The length of time for the entire recommendation process varies depending on the amount and type of available evidence and the time required for compilation of data into a draft recommendation, public comment periods and consideration of comments, and in-depth review and discussions among USPSTF members.
The following topics are in review and are likely to be issued as drafts for public comment during 2012:
■ Alcohol Misuse, Screening and Behavioral Counseling
■ Breast Cancer, Preventive Medications
■ Child Abuse and Neglect, Interventions to Prevent
■ Glaucoma, Screening
■ Hepatitis C Virus in Adults, Screening
■ HIV Infection, Screening
■ Thyroid Disease, Screening
■ Tobacco Use (Children and Adolescents), Interventions to Prevent
Recommendations on the following topics were published during the production of the 2012 Guide to Clinical Preventive Services or are in review and are likely to be published as final recommendations during 2012:
■ Chronic Kidney Disease, Screening
■ Coronary Heart Disease, Screening With Electrocardiography
■ Falls in Older Adults, Interventions to Prevent
■ Healthful Diet and Physical Activity for CVD Prevention, Counseling
■ Hearing Loss in Older Adults, Screening
■ Hormone Therapy in Postmenopausal Women, Preventive Medication
■ Intimate Partner Violence and Elderly Abuse, Screening
■ Obesity in Adults, Screening
■ Ovarian Cancer, Screening
■ Prostate Cancer, Screening
82
■ Skin Cancer, Counseling
■ Vitamin D and Calcium Supplementation to Prevent Cancer and Fractures
The following topics are in earlier stages of review and are likely to be issued as drafts or published as final recommendations sometime after 2012:
■ Abdominal Aortic Aneurysm, Screening
■ BRCA 1 & 2, Screening and Counseling
■ Dementia, Screening
■ Gestational Diabetes, Screening
■ High Blood Pressure (Children and Adolescents), Screening
■ Lung Cancer, Screening
■ Oral Cancer, Screening
■ Peripheral Artery Disease, Screening
■ Suicide Risk, Screening
■ Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease
Please visit the USPSTF Recommendations page at www.uspreventiveservices taskforce.org/recommendations.htm to find the most current recommendations, as well as information on the status of topics being updated.
Appendixes and Index
85
Appendix A
How the U.S. Preventive Services Task Force Grades Its RecommendationsThe U.S. Preventive Services Task Force (USPSTF) assigns one of five letter grades (A, B, C, D, or I) to each of its recommendations to describe the recommendation’s strength. In May 2007, the USPSTF changed its grade definitions based on a change in methods and, in July 2012, it updated the definition and suggestions for practice for the grade C recommendations.
Describing the strength of a recommendation is an important part of communicating its importance to clinicians and other users. Although most of the grade definitions have evolved since the Task Force first began, none has changed more noticeably than the definition for a C recommendation, which has undergone three major revisions since 1998. Despite these revisions, the essence of the C recommendation has remained consistent: At the population level, the balance of benefits and harms is very close, and the magnitude of net benefit is small. Given this small net benefit, the Task Force has either: not made a recommendation “for or against routinely” providing the service (1998); recommended “against routinely” providing the service (2007); or recommended “selectively” providing the service (2012). Grade C recommendations are particularly sensitive to patient values and circumstances. Determining whether or not the service should be offered or provided to an individual patient will typically require an informed conversation between clinician and patient.
Grade Definitions After May 2007
What the Grades Mean and Suggestions for PracticeWith the USPSTF’s 2007 updates to grade definitions, suggestions for practice are now associated with each grade. The USPSTF had also defined levels of certainty regarding net benefit. These definitions apply to USPSTF recommendations voted on or after May 2007.
86
Grade Definition Suggestions for Practice
AThe USPSTF recommends the service. There is high certainty that the net benefit is substantial.
Offer or provide this service.
B
The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
Offer or provide this service.
C*
The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.
Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.
D
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.
Discourage the use of this service.
I Statement
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.
*The USPSTF voted on the following definition of Grade C in July 2012. The new definition, voted while this Guide was in final production, does not apply to any of the recommendations in this Guide. Grade Definition: The USPSTF recommends selectively offering (or providing) this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Suggestions for Practice: Offer or provide this service for selected patients depending on individual circumstances.
87
Levels of Certainty Regarding Net Benefit
Level of Certainty* Description
High
The available evidence usually includes consistent results from well-designed, well-conducted studies in representative primary care populations. These studies assess the effects of the preventive service on health outcomes. This conclusion is therefore unlikely to be strongly affected by the results of future studies.
Moderate
The available evidence is sufficient to determine the effects of the preventive service on health outcomes, but confidence in the estimate is constrained by such factors as:
● The number, size, or quality of individual studies. ● Inconsistency of findings across individual studies. ● Limited generalizability of findings to routine primary care practice. ● Lack of coherence in the chain of evidence.
As more information becomes available, the magnitude or direction of the observed effect could change, and this change may be large enough to alter the conclusion.
Low
The available evidence is insufficient to assess effects on health outcomes. Evidence is insufficient because of:
● The limited number or size of studies. ● Important flaws in study design or methods. ● Inconsistency of findings across individual studies. ● Gaps in the chain of evidence. ● Findings not generalizable to routine primary care practice. ● Lack of information on important health outcomes.
More information may allow estimation of effects on health outcomes.
*The USPSTF defines certainty as “likelihood that the USPSTF assessment of the net benefit of a preventive service is correct.” The net benefit is defined as benefit minus harm of the preventive service as implemented in a general, primary care population. The USPSTF assigns a certainty level based on the nature of the overall evidence available to assess the net benefit of a preventive service.
88
Grade Definitions Prior to May 2007The definitions below (of USPSTF grades and quality of evidence ratings) were in use prior to the update and apply to recommendations voted on by the USPSTF prior to May 2007.
A — Strongly Recommended: The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B — Recommended: The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C — No Recommendation: The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D — Not Recommended: The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I — Insufficient Evidence to Make a Recommendation: The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that [the service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.
Quality of EvidenceThe USPSTF grades the quality of the overall evidence for a service on a 3-point scale (good, fair, poor):
Good: Evidence includes consistent results from well-designed, well-conducted studies in representative populations that directly assess effects on health outcomes.
Fair: Evidence is sufficient to determine effects on health outcomes, but the strength of the evidence is limited by the number, quality, or consistency of the individual studies, generalizability to routine practice, or indirect nature of the evidence on health outcomes.
Poor: Evidence is insufficient to assess the effects on health outcomes because of limited number or power of studies, important flaws in their design or conduct, gaps in the chain of evidence, or lack of information on important health outcomes.
89
Appendix B
Members of the U.S. Preventive Services Task Force 2002-2012Janet D. Allan, Ph.D., R.N., C.S., F.A.A.N. School of Nursing University of Maryland, Baltimore Baltimore, MD
Linda Ciofu Baumann, Ph.D., R.N. School of Nursing and School of Medicine & Public Health University of Wisconsin Madison, WI
Alfred O. Berg, M.D., M.P.H. University of Washington Seattle, WA
Kirsten Bibbins-Domingo, Ph.D., M.D. San Francisco General Hospital University of California, San Francisco, CA
Adelita Gonzales Cantu, R.N., Ph.D. University of Texas Health Science Center San Antonio, TX
Ned Calonge, M.D., M.P.H. Colorado Department of Public Health and Environment Denver, CO
Susan J. Curry, Ph.D. College of Public Health University of Iowa Iowa City, IA
Thomas G. DeWitt, M.D. Department of Pediatrics Children’s Hospital Medical Center Cincinnati, OH
Allen J. Dietrich, M.D. Dartmouth Medical School Hanover, NH
Mark Ebell, M.D., M.S. The University of Georgia Athens, GA
Glenn Flores, M.D. University of Texas Southwestern Medical Center and Children’s Medical Center of Dallas Dallas, TX
Paul S. Frame, M.D. Tri-County Family Medicine Cohocton, MY
Joxel Garcia, M.D., M.B.A. Pan American Health Organization Washington, DC
Leon Gordis, M.D., Dr.P.H. Johns Hopkins Bloomberg School of Public Health Baltimore, MD
Kimberly D. Gregory, M.D., M.P.H. Cedars-Sinai Medical Center Los Angeles, CA
David Grossman, M.D., M.P.H. Center for Health Studies, Group Health Cooperative University of Washington Seattle, WA
Russell Harris, M.D., M.P.H. University of North Carolina School of Medicine Chapel Hill, NC
90
Jessica Herzstein, M.D., M.P.H. Air Products Allentown, PA
Charles J. Homer, M.D., M.P.H. National Initiative for Children’s Healthcare Quality Boston, MA
George Isham, M.D., M.S. HealthPartners Minneapolis, MN
Mark S. Johnson, M.D., M.P.H. New Jersey Medical School University of Medicine and Dentistry of New Jersey Newark, NJ
Kenneth Kizer, M.D., M.P.H. National Quality Forum Washington, DC
Jonathan D. Klein, M.D., M.P.H. University of Rochester Rochester, NY
Tracy A. Lieu, M.D., M.P.H. Harvard Pilgrim Health Care and Harvard Medical School Boston, MA
Michael L. LeFevre, M.D., M.S.P.H. University of Missouri School of Medicine Columbia, MO
Rosanne Leipzig, M.D., Ph.D. Mount Sinai School of Medicine New York, NY
Carol Loveland-Cherry, Ph.D., R.N., F.A.A.N. School of Nursing University of Michigan Ann Arbor, MI
Lucy N. Marion, Ph.D., R.N. School of Nursing Medical College of Georgia Augusta, GA
Joy Melnikow, M.D., M.P.H. University of California Davis Sacramento, CA
Bernadette Melnyk, Ph.D., R.N., C.P.N.P./N.P.P. College of Nursing & Healthcare Innovation Arizona State University Phoenix, AZ
Virginia A. Moyer, M.D., M.P.H. University of Texas Health Science Center Houston, TX
Cynthia D. Mulrow, M.D., M.Sc. University of Texas Health Science Center Audie L. Murphy Memorial Veterans Hospital San Antonio, TX
Wanda Nicholson, M.D., M.P.H., M.B.A. Johns Hopkins School of Medicine and Bloomberg School of Public Health Baltimore, MD
Judith K. Ockene, Ph.D., M.Ed. University of Massachusetts Medical School Worcester, MA
C. Tracy Orleans, Ph.D. The Robert Wood Johnson Foundation Princeton, NJ
91
Douglas K. Owens, M.D., M.S. VA Palo Alto Health Care System Freeman Spogli Institute for International Studies Stanford University Stanford, CA
Jeffrey F. Peipert, M.D., M.P.H. Women and Infants’ Hospital Providence, RI
Nola J. Pender, Ph.D., R.N. School of Nursing University of Michigan Ann Arbor, MI
Diana B. Petitti, M.D., M.P.H. Fulton School of Engineering Arizona State University Tempe, AZ
Carolina Reyes, M.D. University of Southern California, Los Angeles County/USC Medical Center Los Angeles, CA
George F. Sawaya, M.D. University of California, San Francisco San Francisco, CA
J. Sanford (Sandy) Schwartz, M.D. University of Pennsylvania School of Medicine and Wharton School Philadelphia, PA
Harold C. Sox, Jr., M.D. Dartmouth-Hitchcock Medical Center Lebanon, NH
Albert L. Siu, M.D. Mount Sinai Medical Center New York, NY
Steven M. Teutsch, M.D., M.P.H. Merck and Company, Inc. West Point, PA
Carolyn Westhoff, M.D., M.Sc. Columbia University New York, NY
Timothy Wilt, M.D., M.P.H. Minneapolis VA Medical Center University of Minnesota Minneapolis, MN
Steven H. Woolf, M.D., M.P.H. Virginia Commonwealth University Fairfax, VA
Barbara P. Yawn, M.D., M.S.P.H., M.Sc. Olmstead Medical Center Rochester, MN
92
Appendix C
AcknowledgementsAHRQ Staff Supporting the USPSTF 2012
Aileen Buckler, M.D., M.P.H. Joel Boches Robert Cosby, Ph.D. Jennifer Croswell, M.D., M.P.H. Sandra K. Cummings Farah Englert Saeed Fatemi Janice Genevro, Ph.D., M.S.W. Margi Grady Alison Hunt William Hyde, M.L.S. Kristie Kiser Biff LeVee Iris Mabry-Hernandez, M.D., M.P.H. Corey Mackison, M.S.A. Andrew Marshall Robert McNellis, M.P.H., P.A. David Meyers, M.D. Tess Miller, Dr.P.H. Emily Moser Lisa Nicolella Linwood Norman, M.S. Janine Payne, M.P.H. Kathryn Ramage Richard Ricciardi, Ph.D., N.P., F.A.A.N.P. Randie Siegel, M.S. Gloria Washington Rachel Weinstein Claire Weschler, M.S.Ed. Tracy Wolff, M.D., M.P.H.
93
Evidence-Based Practice Centers Supporting the USPSTF for Recommendations in the 2012 EditionThe following researchers, working through four AHRQ Evidence-Based Practice Centers, prepared systematic evidence reviews and evidence summaries as resources on topics under consideration by the USPSTF.
Oregon Evidence-Based Practice Center: Howard Balshem, M.S.; Tracy Beil, M.S.; Ian Blazina, M.P.H.; Christina Bougatsos, M.P.H.; Brittany Burda, M.P.H.; Amy Cantor, M.D., M.P.H.; Roger Chou, M.D.; Erika Cottrell, Ph.D., M.P.P.; Tracy Dana, M.L.S.; Mark Deffebach, M.D.; Elizabeth Eckstrom, M.D.; Michelle Eder, Ph.D.; Stephen Fortmann, M.D.; Rochelle Fu, Ph.D.; Jessica Griffin, M.A.; Jeanne-Marie Guise, M.D., M.P.H.; Andrew Hamilton, M.S., M.L.S.; Mark Helfand, M.D., M.P.H.; Linda Humphrey, M.D., M.P.H.; Tanya Kapka, M.D., M.P.H.; P. Todd Korthuis, M.D., M.P.H; Jennifer Lin, M.D.; Kevin W. Lutz, M.F.A.; Yvonne Michael, Sc.D.; Jennifer Mitchell, B.A.; Heidi D. Nelson, M.D., M.P.H.; Carrie Patnode, Ph.D., M.P.H.; Leslie Perdue, M.P.H; Daphne Plaut, M.L.S.; Elizabeth O’Connor, Ph.D.; Basmah Rahman, M.P.H.; Bruin Rugge, M.D., M.P.H.; Shelley Selph, M.D.; Caitlyn Senger, M.P.H.; Christopher Slatore, M.D., M.E.; Beth Smith, D.O.; Xin Sun, Ph.D.; Matthew Thompson, M.D., M.P.H., D.Phil.; Kimberly Vesco, M.D., M.P.H.; Miranda Walker, M.A.; Ngoc Wasson, M.P.H.; Evelyn P. Whitlock, M.D., M.P.H.; Clara Williams, M.P.A.; Bernadette Zakher, M.B.B.S.
RTI International/University of North Carolina Evidence-Based Practice Center Alice Ammerman, Dr.P.H., R.D.; James D. Bader, D.D.S., M.P.H.; Rainer Beck, M.D.; John F. Boggess, M.D.; Malaz Boustani, M.D., M.P.H.; Seth Brody, M.D.; Audrina J. Bunton; Katrina Donahue, M.D., M.P.H.; Louise Fernandez, P.A.-C., R.D., M.P.H.; Kenneth Fink, M.D., M.G.A., M.P.H.; Carol Ford, M.D.; Angela Fowler-Brown, M.D.; Bradley N. Gaynes, M.D., M.P.H.; Paul Godley, M.D., M.P.H.; Susan A. Hall, M.S.; Laura Hanson, M.D., M.P.H.; Russell Harris, M.D., M.P.H.; Katherine E.Hartmann, M.D., Ph.D.; Michael Hayden, M.D.; M. Brian Hemphill, M.D.; Alissa Driscoll Jacobs, M.S., R.D.; Jana Johnson; Linda Kinsinger, M.D., M.P.H.; Carol Krasnov; Ramesh Krishnaraj; Carole M. Lannon, M.D., M.P.H.; Carmen Lewis, M.D., M.P.H.; Kathleen N. Lohr, Ph.D.; Linda J. Lux, M.P.A.; Kathleen McTigue, M.D., M.P.H.; Catherine Mills, M.A.; Kavita Nanda, M.D., M.H.S.; Carla Nester, M.D.; Britt Peterson, M.D., M.P.H.; Christopher J. Phillips, M.D., M.P.H.; Michael Pignone, M.D., M.P.H.; Mark Pletcher, M.D., M.P.H.; Saif S. Rathore; Melissa Rich, M.D.; Gary Rozier, D.D.S.; Jerry L. Rushton, M.D., M.P.H.; Lucy A. Savitz; Joe Scattoloni; Stacey Sheridan, M.D., M.P.H.; Sonya Sutton, B.S.P.H.; Jeffrey A. Tice, M.D.; Suzanne L. West, Ph.D.; B. Lynn Whitener, Dr.P.H., M.S.L.S.; Margaret Wooddell, M.A.; Dennis Zolnoun, M.D.
94
University of Ottawa Evidence-Based Practice Center Nicholas Barrowman, Ph.D.; Catherine Code, M.D., F.R.C.P.C.; Catherine Dubé, M.D., M.Sc., F.R.C.P.C.; Gabriela Lewin, M.D.; David Moher, Ph.D.; Alaa Rostom, M.D., M.Sc., F.R.C.P.C.; Margaret Sampson, M.I.L.S.; Alexander Tsertsvadze, M.D., M.Sc.
Tufts - New England Medical Center Evidence-Based Practice Center Priscilla Chew; Mei Chung, Ph.D., M.P.H.; Deirdre DeVine; Stanley Ip, M.D.; Joseph Lau, M.D.; Gowri Raman, M.D.; Thomas Trikalinos, M.D., Ph.D.
95
Liaisons to the USPSTFPrimary care partners include:
■ American Academy of Family Physicians (AAFP) ■ American Academy of Nurse Practitioners (AANP) ■ American Academy of Pediatrics (AAP) ■ American Academy of Physician Assistants (AAPA) ■ American College of Obstetricians and Gynecologists (ACOG) ■ American College of Physicians (ACP) ■ American College of Preventive Medicine (ACPM) ■ American Osteopathic Association (AOA) ■ National Association of Pediatric Nurse Practitioners (NAPNAP)
Policy, population, and quality improvement partners include: ■ America’s Health Insurance Plans (AHIP) ■ AARP ■ National Committee for Quality Assurance (NCQA)
Federal partners include: ■ Centers for Disease Control and Prevention (CDC) ■ Centers for Medicare & Medicaid Services (CMS) ■ U.S. Food and Drug Administration (FDA) ■ Health Resources and Services Administration (HRSA) ■ Indian Health Service (IHS) ■ National Institutes of Health (NIH) ■ Veteran’s Health Administration (VHA) ■ Department of Defense/Military Health System (DoD/MHS) ■ Office of Disease Prevention and Health Promotion (ODPHP)
■ Office of the Surgeon General
96
Appendix D
About the U.S. Preventive Services Task Force
OverviewCreated in 1984, the U.S. Preventive Services Task Force (USPSTF) is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as:
■ Screenings
■ Counseling services
■ Preventive medications
The Task Force is made up of 16 volunteer members who serve 4-year terms. Members come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. The Task Force is led by a chair and two vice-chairs. Members are appointed by the Director of AHRQ. Members must have no substantial conflicts of interest that could impair the integrity of the work of the Task Force. A list of current USPSTF members, including their biographical information, can be found on the USPSTF Web site (www.USPreventiveServicesTaskForce.org).
Since 1998, through acts of the U.S. Congress, the Agency for Healthcare Research and Quality (AHRQ) has been authorized to convene the Task Force and to provide ongoing scientific, administrative, and dissemination support to the Task Force.
Recommendations The Task Force makes recommendations to help primary care clinicians and patients decide together whether a preventive service is right for a patient’s needs. Its recommendations apply to people who have no signs or symptoms of the specific disease or condition to which a recommendation applies and are for services prescribed, ordered, or delivered in the primary care setting.
Task Force recommendations are based on a rigorous review of existing peer-reviewed evidence. The Task Force assesses the effectiveness of a clinical preventive service by evaluating and balancing the potential benefits and harms of the service. The potential benefits include early identification of disease and improvement in health. The potential harms can include adverse effects of the service itself or inaccurate test results that may lead to additional testing, additional risks or unneeded treatment. The Task Force does not explicitly consider costs in its assessment of the effectiveness
97
of a service. The Task Force assigns each recommendation a letter grade (A, B, C, or D grade or an I statement) based on the strength of the evidence and on the balance of benefits and harms of the preventive service. More information on USPSTF recommendation grades and a list of all current USPSTF recommendations can be found on the USPSTF Web site.
The Recommendation Making ProcessThe USPSTF is committed to making its work as transparent as possible. As part of this commitment, the Task Force provides opportunities for the public to provide input during each phase of the recommendation process.
The phases of the topic development process are described below and illustrated in “Steps the USPSTF Takes to Make a Recommendation” at the end of this appendix.
Topic NominationThe USPSTF considers a broad range of clinical preventive services for its recommendations, focusing on screenings, counseling, and preventive medications. Anyone can nominate a topic for consideration by the Task Force.
Research Plan DevelopmentOnce the USPSTF selects a topic for review, it works with an Evidence-based Practice Center (EPC) to develop a draft research plan, which guides the recommendation process and includes key questions and target populations. A draft research plan is posted for public comment, and feedback is incorporated into a final research plan.
Evidence Report DevelopmentUsing the final research plan as a guide, EPC researchers gather, review, and analyze evidence on the topic and summarize their findings in a detailed evidence report. The evidence report is sent to subject matter experts for review before it is shared with the Task Force. Beginning in 2013, draft evidence reports will also be posted for public comment.
Recommendation Statement DevelopmentTask Force members discuss the evidence report and use the information to determine the effectiveness of a service by weighing the benefits and harms. The USPSTF creates a draft recommendation based on this discussion. The Task Force posts its draft recommendations for public comment and solicits feedback from national stakeholder organizations. All comments are reviewed by the Task Force and used to inform the development of the final recommendation statement.
98
Final Recommendation StatementAfter the public comment period, the USPSTF finalizes the recommendation statement. The final recommendation statement is posted on the USPSTF Web site along with supporting materials and is also published in a peer-reviewed scientific journal.
Please visit the Task Force Web site (www.USPreventiveServicesTaskForce.org) to learn how and when to nominate topics for consideration by the Task Force or to comment on topics in development.
Online Resources On the Task Force Web site, people can:
■ View all current USPSTF recommendations and supporting materials.
■ Learn more about the Task Force methods and processes.
■ Nominate a new USPSTF member or a topic for a consideration by the Task Force.
■ Provide input on specific draft materials during public comment periods.
■ Sign up for the USPSTF listserv to receive USPSTF updates.
■ Access the Electronic Preventive Services Selector (ePSS), a quick hands-on tool designed to help primary care clinicians and health care teams identify, prioritize, and offer the screening, counseling, and preventive medication services that are appropriate for their patients. The ePSS is available on the Web (epss.ahrq.gov) or as a mobile phone or PDA application.
■ Access MyHealthfinder. MyHealthfinder is a tool for consumers that provides personalized recommendations for preventive services based on the U.S. Preventive Services Task Force; the Bright Futures Guidelines; the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP); and the Institute of Medicine’s (IOM’s) Committee on Preventive Services for Women.
99
100
Appendix E
More Resources
AHRQ’s Prevention and Chronic Care Program AHRQ’s Prevention and Chronic Care Program Web site (www.preventiveservices.ahrq.gov) presents information that supports AHRQ’s mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans with a focus on evidence-based preventive and chronic care services. The Program’s Web site includes tools, resources, and materials to support health care organizations and engage the entire health care delivery system.
The Program includes two overall project areas with specific areas of focus:
■ Improving Primary Care Practice
– Care coordination
– Clinical-community linkages
– Health care/system redesign
– Health information technology integration
– Behavioral and mental health
– Self-management support
■ Evidence-Based Decisionmaking
– Clinical decision support
– Multiple chronic conditions
myhealthfinderA consumer-friendly resource, myhealthfinder (available at www.healthfinder.gov) helps people create a customized list of relevant recommendations for preventive services based on age, sex, and pregnancy status, along with explanations of each recommendation in plain language.
101
Stay Healthy BrochuresConsumers can use the information in this series of brochures to learn which screening tests they need and when to get them, which medicines may prevent diseases, and daily steps to take for good health. The series includes Men Stay Healthy at Any Age, Women Stay Healthy at Any Age, Men Stay Healthy at 50+ and Women Stay Healthy at 50+, all in English and Spanish. Go to www.ahrq.gov/clinic/ppipix.htm for the list and choose the title you are interested in.
Community Preventive Services Task Force: Established in 1996 by the U.S. Department of Health and Human Services, the Community Preventive Services Task Force (CPSTF) complements the work of the USPSTF, by addressing preventive services at the community level. The CPSTF assists agencies, organizations, and individuals at all levels (national, State, community, school, worksite, and health care system) by providing evidence-based recommendations about community prevention programs and policies that are effective in saving lives, increasing longevity, and improving Americans’ quality of life. The recommendations of the CPSTF are available at www.thecommunityguide.org.
Healthy People 2020Healthy People 2020 is an initiative from the U.S. Department of Health and Human Services that challenges individuals, communities, and professionals to take specific steps to ensure good health. Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. Read more at www.healthypeople.gov/2020/default.aspx.
National Guideline ClearinghouseTM A public resource for evidence-based clinical practice guidelines, NGC (guideline.gov/index.aspx) was originally created by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America’s Health Insurance Plans). The NGC mission is to provide physicians and other health professionals, health care providers, health plans, integrated delivery systems, purchasers, and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation, and use of this information.
102
Canadian Task Force on Preventive Health CareThe Task Force was established by the Public Health Agency of Canada to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the Task Force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of scientific evidence. Read more at www.canadiantaskforce.ca/.
Cancer Control P.L.A.N.E.T. A service of the National Cancer Institute, the Cancer Control P.L.A.N.E.T. portal provides access to Web-based resources that can help planners, program staff, and researchers to design, implement, and evaluate evidence-based cancer control programs. Read more at cancercontrolplanet.cancer.gov/index.html.
HealthCare.govThis Web site (www.healthcare.gov), managed by the U.S. Department of Health and Human Services, helps people take health care into their own hands. It provides information about insurance options, using insurance, the Affordable Care Act, comparing providers, and prevention and wellness—including which preventive services are covered under the Act.
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Appendix FSC
REE
NIN
G F
OR
BR
EAST
CA
NC
ER
CLI
NIC
AL
SUM
MA
RY O
F 20
02 U
.S. P
REV
ENTI
VE S
ERVI
CES
TA
SK F
OR
CE
REC
OM
MEN
DAT
ION
*Po
pula
tion
Wom
en a
ges
40 y
ears
and
old
er
Scre
enin
g Te
stM
amm
ogra
phy,
with
or w
ithou
t cl
inic
al b
reas
t exa
min
atio
nC
linic
al b
reas
t exa
min
atio
n al
one
Bre
ast s
elf-e
xam
inat
ion
alon
e
Rec
omm
enda
tion
Scre
en e
very
1 to
2 y
ears
.
Gra
de: B
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
No
reco
mm
enda
tion.
Gra
de: I
(Ins
uffic
ient
Evi
denc
e)
Ris
k As
sess
men
tW
omen
who
are
at i
ncre
ased
risk
for b
reas
t can
cer (
e.g.
, tho
se w
ith a
fam
ily h
isto
ry o
f bre
ast c
ance
r in
a m
othe
r or s
iste
r, a
prev
ious
bre
ast b
iops
y re
veal
ing
atyp
ical
hyp
erpl
asia
, or fi
rst c
hild
birth
afte
r age
30)
are
mor
e lik
ely
to b
enefi
t fro
m re
gula
r m
amm
ogra
phy
than
wom
en a
t low
er ri
sk.
Scre
enin
g Te
sts
Ther
e is
fair
evid
ence
that
mam
mog
raph
y sc
reen
ing
ever
y 12
to 3
3 m
onth
s si
gnifi
cant
ly re
duce
s m
orta
lity
from
bre
ast
canc
er. E
vide
nce
is s
trong
est f
or w
omen
age
s 50
to 6
9 ye
ars.
For
wom
en a
ges
40 to
49
year
s, th
e ev
iden
ce th
at s
cree
ning
m
amm
ogra
phy
redu
ces
mor
talit
y fro
m b
reas
t can
cer i
s w
eake
r, an
d th
e ab
solu
te b
enefi
t of m
amm
ogra
phy
is s
mal
ler,
than
it is
fo
r old
er w
omen
.
Clin
icia
ns s
houl
d re
fer p
atie
nts
to m
amm
ogra
phy
scre
enin
g ce
nter
s w
ith p
rope
r acc
redi
tatio
n an
d qu
ality
ass
uran
ce s
tand
ards
to
ensu
re a
ccur
ate
imag
ing
and
radi
ogra
phic
inte
rpre
tatio
n. C
linic
ians
sho
uld
adop
t offi
ce s
yste
ms
to e
nsur
e tim
ely
and
adeq
uate
fo
llow
-up
of a
bnor
mal
resu
lts.
Bala
nce
of B
enefi
ts a
nd H
arm
s
The
prec
ise
age
at w
hich
the
bene
fits
from
scr
eeni
ng m
amm
ogra
phy
just
ify th
e po
tent
ial h
arm
s is
a s
ubje
ctiv
e ju
dgm
ent a
nd
shou
ld ta
ke in
to a
ccou
nt p
atie
nt p
refe
renc
es. C
linic
ians
sho
uld
info
rm w
omen
abo
ut th
e po
tent
ial b
enefi
ts (r
educ
ed c
hanc
e of
dy
ing
from
bre
ast c
ance
r), p
oten
tial h
arm
s (fa
lse-
posi
tive
resu
lts, u
nnec
essa
ry b
iops
ies)
, and
lim
itatio
ns o
f the
test
that
app
ly to
w
omen
thei
r age
. The
bal
ance
of b
enefi
ts a
nd p
oten
tial h
arm
s of
mam
mog
raph
y im
prov
es w
ith in
crea
sing
age
for w
omen
age
s 40
to 7
0 ye
ars.
Clin
icia
ns w
ho a
dvis
e w
omen
to p
erfo
rm b
reas
t sel
f-exa
min
atio
n or
who
per
form
rout
ine
clin
ical
bre
ast e
xam
inat
ion
to s
cree
n fo
r br
east
can
cer s
houl
d un
ders
tand
that
ther
e is
cur
rent
ly in
suffi
cien
t evi
denc
e to
det
erm
ine
whe
ther
thes
e pr
actic
es a
ffect
bre
ast
canc
er m
orta
lity,
and
that
they
are
like
ly to
incr
ease
the
inci
denc
e of
clin
ical
ass
essm
ents
and
bio
psie
s.
Oth
er R
elev
ant U
SPST
F R
ecom
men
datio
nsTh
e U
SPST
F ha
s m
ade
reco
mm
enda
tions
on
scre
enin
g fo
r gen
etic
sus
cept
ibilit
y fo
r bre
ast c
ance
r and
che
mop
reve
ntio
n of
br
east
can
cer.
Thes
e re
com
men
datio
ns a
re a
vaila
ble
at h
ttp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
*The
U.S
. Dep
artm
ent o
f Hea
lth a
nd H
uman
Ser
vice
s, in
impl
emen
ting
the
Affo
rdab
le C
are
Act,
unde
r the
sta
ndar
d it
sets
out
in re
vise
d Se
ctio
n 27
13(a
)(5) o
f the
Pub
lic H
ealth
Ser
vice
Act
, util
izes
the
2002
reco
mm
enda
tion
on b
reas
t can
cer s
cree
ning
of t
he U
.S. P
reve
ntiv
e Se
rvic
es T
ask
Forc
e.
For a
sum
mar
y of
the
evid
ence
sys
tem
atic
ally
revi
ewed
in m
akin
g th
is re
com
men
datio
n, th
e fu
ll re
com
men
datio
n st
atem
ent,
and
supp
ortin
g do
cum
ents
, ple
ase
go to
ht
tp://
ww
w.us
prev
entiv
eser
vice
stas
kfor
ce.o
rg/.
105
Index
5-A Approach (see Alcohol Misuse, Screening and Behavioral Counseling)AAA (see Abdominal Aortic Aneurysm, Screening)Abdominal Aortic Aneurysm, Screening….....................................................7, 82Alcohol, Avoidance While Driving (see Motor Vehicle Occupant Restraints,
Counseling)Alcohol Misuse, Screening and Behavioral Counseling ..................................8, 81Anemia, Iron Deficiency (see Iron Deficiency Anemia, Screening)Ankle Brachial Index (see Peripheral Arterial Disease, Screening)Aspirin for the Prevention of Cardiovascular Disease, Preventive Medication… .9Aspirin or Nonsteroidal Anti-inflammatory Drugs for Prevention of Colorectal
Cancer, Preventive Medication .....................................................................10Asymptomatic Bacteriuria (see Bacteriuria, Screening)Autorefraction (see Visual Impairment in Children Ages 1-5, Screening)Bacterial Vaginosis in Pregnancy, Screening ......................................................11Bacteriuria, Screening .......................................................................................12Basal Cell Cancer (see Skin Cancer, Screening)*Bladder Cancer, Screening...............................................................................13Blood Lead Levels in Childhood and Pregnancy, Screening ..............................59Blood Pressure, High (see High Blood Pressure in Adults, Screening)BMI Screening, Children and Adolescents (see Obesity in Children and Adolescents,
Screening)Bone Mineral Density (see Osteoporosis, Screening)BRCA Mutation Testing (see Breast and Ovarian Cancer, BRCA Testing, Screening)Breast and Ovarian Cancer, BRCA Testing, Screening ................................14, 82Breast Cancer, Screening .............................................................................15, 16Breast Cancer, Preventive Medications ......................................................................81Breast Self Examination [BSE] (see Breast Cancer, Screening)Breastfeeding, Counseling ................................................................................17CA-125 Screening for Ovarian Cancer (see Breast and Ovarian Cancer, BRCA
Testing, Screening)
106
Cancer (see Aspirin or Nonsteroidal Anti-inflammatory Drugs for Prevention of
Colorectal Cancer, Preventive Medication) (see Bladder Cancer, Screening) (see Breast and Ovarian Cancer, BRCA Testing, Screening) (see Breast Cancer, Screening) (see Cervical Cancer, Screening) (see Colorectal Cancer, Screening) (see Lung Cancer Screening) (see Oral Cancer, Screening) (see Ovarian Cancer, Screening) (see Pancreatic Cancer, Screening) (see Skin Cancer, Screening) (see Testicular Cancer, Screening)Carotid Artery Stenosis, Screening....................................................................18*Cervical Cancer, Screening ..............................................................................19Chest X-Ray (see Lung Cancer, Screening)Child Abuse and Neglect, Interventions to Prevent .....................................................81Chlamydial Infection, Screening .......................................................................20Chronic Bilirubin Encephalopathy (see Hyperbilirubinemia in Infants, Screening)Chronic Kidney Disease, Screening ...........................................................................81Chronic Obstructive Pulmonary Disease, Screening .........................................21Clinical Breast Examination [CBE] (see Breast Cancer, Screening)Colonoscopy (see Colorectal Cancer, Screening)Colorectal Cancer, Aspirin/NSAIDS (see Aspirin or Nonsteroidal Anti-inflammatory
Drugs for Prevention of Colorectal Cancer, Preventive Medication)Colorectal Cancer, Screening ............................................................................22Congenital Hypothyroidism, Screening ............................................................60Coronary Heart Disease Prevention (see Aspirin for the Prevention of Cardiovascular
Disease)Coronary Heart Disease (Risk Assessment, Nontraditional Risk Factors),
Screening......................................................................................................23Coronary Heart Disease, Screening With Electrocardiography .....................................81COPD (see Chronic Obstructive Pulmonary Disease, Screening)
107
Cover-Uncover Test (see Visual Impairment in Children Ages 1-5, Screening)Dementia, Screening ................................................................................................82Depression in Adults, Screening .......................................................................24Depression or Depressive Disorders in Children and Adolescents (see Major
Depressive Disorders in Children and Adolescents, Screening)Developmental Dysplasia of the Hip, Screening ...............................................61Diabetes Mellitus, Screening .............................................................................25Drug Use, Illicit (see Illicit Drug Use, Screening)Drug Abuse (see Illicit Drug Use, Screening)Dysplasia, Hip (see Developmental Dysplasia of the Hip, Screening)Elevated Blood Lead Levels (see Blood Lead Levels in Childhood and Pregnancy,
Screening)Estrogen Therapy (see Hormone Replacement Therapy, Preventive Medication)Falls in Older Adults, Counseling .............................................................................81Fecal Occult Blood Testing [FOBT] (see Colorectal Cancer, Screening)Folic Acid to Prevent Neural Tube Defects ........................................................26Genetic Risk Assessment and BRCA Mutation Testing (see Breast and Ovarian
Cancer, BRCA Testing, Screening)Genital Herpes, Screening ................................................................................27Gestational Diabetes Mellitus, Screening ....................................................28, 82Glaucoma, Screening ..................................................................................29, 81*Gonococcal Ophthalmia Neonatorum, Preventive Medication .......................62Gonorrhea, Screening .......................................................................................30 Healthful Diet and Physical Activity, Counseling .......................................................81Hearing Loss in Newborns, Screening ..............................................................63Hearing Loss in Older Adults, Screening ...................................................................81Heart Disease (see Coronary Heart Disease, Nontraditional Risk Factors)Hemochromatosis, Screening ...........................................................................31Hepatitis B Virus, Screening .............................................................................32Hepatitis B Virus in Pregnant Women, Screening .............................................33Hepatitis C Virus in Adults, Screening ........................................................34, 81Hereditary Hemochromatosis (see Hemochromatosis, Screening)Herpes Simplex Virus (see Genital Herpes, Screening)
108
High Blood Pressure (Adults), Screening ..........................................................35High Blood Pressure (Children), Screening ................................................................82High Cholesterol (see Lipid Disorders in Adults OR in Children, Screening)Hip Dysplasia (see Developmental Dysplasia of the Hip, Screening)HIV Infection, Screening ...................................................................................36Hirschberg Light Reflex Test (see Visual Impairment in Children Ages 1-5, Screening)Hormone Replacement Therapy, Preventive Medication..............................37, 81HPV Testing (see Cervical Cancer, Screening)HT or HRT (see Hormone Replacement Therapy, Preventive Medication)Human Immunodeficiency Virus (see HIV Infection, Screening)Hyperbilirubinemia in Infants, Screening ........................................................64Hyperlipidemia (see Lipid Disorders in Adults OR in Children, Screening)Hypertension (see High Blood Pressure, Screening)Hypothyroidism, Congenital (see Congenital Hypothyroidism, Screening)Idiopathic Scoliosis (see Scoliosis in Adolescence, Screening)Illicit Drug Use, Screening ................................................................................38Impaired Visual Acuity in Older Adults, Screening ...........................................39Intimate Partner Violence and Elderly Abuse, Screening .............................................81Iron Deficiency Anemia, Screening .............................................................65, 66 Iron Supplementation (see Iron Deficiency Anemia, Screening)Lead Levels in Blood, Elevated (see Blood Lead Levels in Childhood and Pregnancy,
Screening)Lipid Disorders in Adults, Screening ................................................................40Lipid Disorders in Children, Screening ............................................................67Low Dose Computerized Tomography (see Lung Cancer, Screening)Lung Cancer, Screening ...............................................................................41, 82Major Depressive Disorder in Children and Adolescents, Screening ................68Major Depressive Disorder in Adults (see Depression in Adults, Screening)Mammography (see Breast Cancer, Screening)Melanoma (see Skin Cancer, Screening)Motor Vehicle Occupant Restraints, Counseling ..............................................42Neural Tube Defects (see Folic Acid to Prevent Neural Tube Defects)Newborn Hearing Screening (see Hearing Loss (Newborns), Screening)
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Non-Steroidal Anti-Inflammatories [NSAIDS] (see Aspirin or NSAIDs for Primary Prevention of Colorectal Cancer, Preventive Medication)
Obesity in Adults, Screening .....................................................................................81Obesity in Children and Adolescents, Screening ...............................................69Oral Cancer, Screening ...............................................................................43, 82*Osteoporosis, Screening ..................................................................................44Ovarian Cancer, Screening .........................................................................45, 81Overweight (see Obesity in Children and Adolescents, Screening)Pancreatic Cancer, Screening ............................................................................46Pap Smear (see Cervical Cancer, Screening)Peripheral Arterial Disease, Screening ........................................................47, 82Phenylketonuria, Screening ..............................................................................70Photoscreening (see Visual Impairment in Children Ages 1-5, Screening)PKU (see Phenylketonuria, Screening)Postmenopausal Hormone Therapy (see Hormone Replacement Therapy, Preventive
Medication)Progestin Therapy (see Hormone Replacement Therapy, Preventive Medication)Prostate Cancer, Screening ........................................................................................81PSA Screening for Prostate Cancer (see Prostate Cancer, Screening)Rh (D) Incompatibility, Screening ....................................................................48Scoliosis in Adolescents (Idiopathic), Screening ...............................................71Sexually Transmitted Infections, Counseling ....................................................49Sickle Cell Disease, Screening ...........................................................................72Sigmoidoscopy (see Colorectal Cancer, Screening)Skin Cancer, Counseling ..........................................................................................82Skin Cancer, Screening .....................................................................................50Speech and Language Delay, Screening.............................................................73Squamous Cell Cancer (see Skin Cancer, Screening)Smoking Cessation (see Tobacco Use in Adults, Counseling and Interventions)Spirometry Screening for COPD (see Chronic Obstructive Pulmonary Disease,
Screening)Sputum Cytology (see Lung Cancer, Screening)Stereoacuity Test (see Visual Impairment in Children Ages 1-5, Screening)
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STI or STD (see Sexually Transmitted Infections, Counseling) (see Chlamydial Infection, Screening) (see Gonorrhea, Screening) (see Genital Herpes Simplex, Screening) (see HIV Infection, Screening) (see Syphilis (Pregnant Women), Screening)Suicide Risk, Screening ...............................................................................51, 82Syphilis Infection, Screening ............................................................................52Syphilis (Pregnant Women), Screening .............................................................53T3 (see Thyroid Disease, Screening)T4 (see Thyroid Disease, Screening) (see Congenital Hypothyroidism, Screening)*Testicular Cancer, Screening ............................................................................54Thyroid Disease, Screening ..........................................................................55, 81Tobacco (Children and Adolescents), Interventions to Prevent .....................................81Tobacco Use in Adults, Counseling and Interventions ......................................56TSH (see Thyroid Disease, Screening) (see Congenital Hypothyroidism, Screening)Ultrasonography (see Abdominal Aortic Aneurysm, Screening)Urinalysis (see Bladder Cancer, Screening)Urine Biomarkers (see Bladder Cancer, Screening)Urine Culture (see Bacteriuria in Adults, Screening)Urine Cytology (see Bladder Cancer, Screening)Vaginosis, Bacterial (see Bacterial Vaginosis in Pregnancy, Screening)Visual Acuity Test (see Visual Impairment in Children Ages 1-5, Screening)*Visual Impairment in Children Ages 1-5, Screening .......................................74Vitamin D and Calcium Supplementation to Prevent Cancer and Fractures ...............82Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease ...................82
*indicates new recommendations released March 2010 to March 2012.Bold text indicates topic of recommendation.Italic text indicates topic in progress.
AHRQ’s Electronic Preventive Services Selector (ePSS)
Bringing the prevention information clinicians need—recommendations, clinical considerations, and selected practice
tools—to the point of care.
The ePSS helps you identify and select screening, counseling, and preventive medication services based on specific patient
characteristics.
Available athttp://epss.ahrq.gov
on the Web and for mobile devices, including Android, BlackBerry, iPhone, Palm, and iPad.
The U.S. Preventive Services Task Force is always interested in making our resources and tools more useful to those implementing the recommendations in primary care, as well as educating health professions students and patients.
We would love to hear how well we are meeting your needs. Please take our 2-minute survey to give us your feedback on the 2012 Guide to Clinical Preventive Services at https://www.surveymonkey.com/s/ClinicalGuide.
U.S. Department of Health and Human Services Agency for Healthcare Research and Qualitywww.ahrq.govAHRQ Pub. No. 12-05154 October 2012 ISBN 978-58763-421-5
