Should you screen—or not? The latest recommendations

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Practice Alert

Should you screen—or not? The latest recommendations

J Fam Pract. 2008 July;57(7):469-471

By

Doug Campos-Outcalt, MD, MPA

While USPSTF recommendations on hypertension and sickle cell disease have stayed the same, those for Chlamydia and carotid artery stenosis have changed.

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References

1. Agency for Healthcare Quality and Research. USPSTF. Available at: http://www.ahrq.gov/clinic/uspstfix.htm. Accessed May 5, 2008.

2. USPSTF. Screening for High Blood Pressure. Available at: http://www.ahrq.gov/clinic/uspstf/uspshype.htm. Accessed May 5, 2008.

3. USPSTF. Screening for Sickle Cell Disease in Newborns. Available at: http://www.ahrq.gov/clinic/uspstf/uspshemo.htm. Accessed May 5, 2008.

4. USPSTF. Screening for Chlamydia Infection. Available at: http://www.ahrq.gov/clinic/uspstf/uspschlm.htm. Accessed May 5, 2008.

5. USPSTF. Aspirin or Nonsteroidal Anti-inflamatory Drugs for the Primary Prevention of Colorectal Cancer. Available at: http://www.ahrq.gov/clinic/uspstf/uspsasco.htm. Accessed May 5, 2008.

6. USPSTF. Screening for Carotid Artery Stenosis. Available at: http://www.ahrq.gov/clinic/uspstf/uspsacas.htm. Accessed May 5, 2008.

7. USPSTF. Screening for Bacterial Vaginosis in Pregnancy. Available at: http://www.ahrq.gov/clinic/uspstf/uspsbvag.htm. Accessed May 5, 2008.

8. USPSTF. Screening for Lipid Disorders in Children. Available at: http://www.ahrq.gov/clinic/uspstf/uspschlip.htm. Accessed May 5, 2008.

9. USPSTF. Counseling About Proper Use of Motor Vehicle Occupant Restraints and Avoidance of Alcohol Use While Driving. Available at: http://www.ahrq.gov/clinic/uspstf/uspsmvin.htm. Accessed May 5, 2008.

10. USPSTF. Screening for Illicit Drug Use. Available at: http://www.ahrq.gov/clinic/uspstf/uspsdrug.htm. Accessed May 5, 2008.

Not enough time and too many potential tests to do. This is the problem faced daily by family physicians. We want to practice up-to-date preventive medicine, but there’s little time to analyze the latest studies. Thankfully, we can rely on the United States Preventive Services Task Force, the organization with the most rigorous evidence-based approach, to do the legwork for us.¹

Last year, and in the early part of this year, the Task Force issued a number of recommendations on topics ranging from hypertension screening to screening for illicit drug use. (See TABLE 1 for a breakdown of the 5 categories of recommendations.)

While some of these recommendations (TABLE 2) were reaffirmations of past recommendations, others included some changes.

The Task Force has:

dropped the age for routine screening for Chlamydia in sexually active women from 25 years and younger to 24 and younger.
added a recommendation against the use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer (CRC).
changed its recommendation on screening for carotid artery stenosis. In 1996, the Task Force noted that the evidence was insufficient to make a recommendation; in 2007 it recommended against such routine screening.
added recommendations on counseling patients about drinking and driving, as well as on screening for illicit drug use. In both cases, the Task Force says the evidence is insufficient to recommend for or against.

TABLE 1
USPSTF recommendation categories

A Recommendation: The Task Force recommends the service. There is a high certainty that the net benefit is substantial.
B Recommendation: The Task Force 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.
C Recommendation: The Task Force 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.
D Recommendation: The Task Force recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.
I Recommendation: The Task Force 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.

TABLE 2
Summary of new USPSTF recommendations

A RECOMMENDATIONS
*The USPSTF recommends* routinely:** screening for high blood pressure in adults =18 years of age screening for sickle cell disease in newborns screening for chlamydial infection for all sexually active nonpregnant young women =24 years of age and for older nonpregnant women who are at increased risk.
B RECOMMENDATIONS
*The USPSTF recommends* routinely:** screening for chlamydial infection for all pregnant women =24 years of age and for older pregnant women who are at increased risk.
C RECOMMENDATIONS
*The USPSTF recommends against* routine:** screening for chlamydial infection for women =25 years of age, whether or not they are pregnant, if they are not at increased risk.
D RECOMMENDATIONS
*The USPSTF recommends against* routine:** use of aspirin or other nonsteroidal anti-inflammatory drugs to prevent colorectal cancer in patients at average risk for colorectal cancer screening for asymptomatic carotid artery stenosis in the general adult population screening for bacterial vaginosis in asymptomatic pregnant women at low risk for preterm delivery.
I RECOMMENDATIONS
*The USPSTF concludes that the current evidence is insufficient* to recommend for or against routine:** screening for chlamydial infection in men screening for lipid disorders in infants, children, adolescents, or young adults (up to age 20) counseling in the primary care setting to improve rates of proper use of motor vehicle occupant restraints (child safety seats, booster seats, and lap-and-shoulder belts) beyond the efficacy of legislation and community-based interventions counseling of all patients in the primary care setting to reduce driving while under the influence of alcohol or riding with drivers who are alcoholimpaired screening for bacterial vaginosis in asymptomatic pregnant women at high risk for preterm delivery screening adolescents, adults, and pregnant women for illicit drug use.

Continue to screen for HTN, sickle cell, Chlamydia

The latest A and B recommendations from the Task Force largely reaffirm previous recommendations. These recommendations cover hypertension, sickle cell disease, and Chlamydia.

Hypertension. Screening and treatment of hypertension in adults leads to lower morbidity and mortality from cardiovascular disease and is still recommended.²

Sickle cell disease. Screening newborns for sickle cell disease and treating those affected with oral prophylactic penicillin prevents serious bacterial infections. It also remains a recommended service.³

Chlamydia. Following a review of the evidence, the Task Force reconfirms the benefits of screening for Chlamydia in sexually active young women, but it has changed the age cutoff. In 2001, the Task Force indicated that sexually active women who were 25 years of age and younger should be screened. In 2007, the Task Force dropped the age to 24 and younger.

Should you screen—or not? The latest recommendations

References

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