The New US Preventive Services Task Force “C” Draft Recommendation for Prostate Cancer Screening

In 2016, the US Preventive Services Task Force concluded that there was "insufficient" ("I" statement) evidence to support universal primary care screening for autism spectrum disorder. The statement led to controversy among research and clinical communities. Although a number of papers have since been published arguing for the potential benefit of autism spectrum disorder screening, none adequately address the potential harms of autism spectrum disorder screening. This evidence gap may relate to confusion regarding how the US Preventive Services Task Force conceptualizes and evaluates potential harm. In this commentary, we explore how the US Preventive Services Task Force operationalizes harm and discuss how the potential for harm was described in the "I" statement on autism spectrum disorder screening. This information can serve as a guide for investigators working to study the benefits and harms of autism spectrum disorder screening in order to fill the research gaps cited by the US Preventive Services Task Force report. Finally, we recommend future research directions for exploring harms of autism spectrum disorder screening, filling cited research gaps, and ultimately ensuring that the benefits of autism spectrum disorder screening truly outweigh the harms for all children and their families.

Clinical Preventive Medicine in Primary Care: Background and Practice: 1. Rationale and Current Preventive Practices

ImportanceIn the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 13%, and the lifetime risk of dying of prostate cancer is 2.5%. The median age of death from prostate cancer is 80 years. Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease. African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men.ObjectiveTo update the 2012 US Preventive Services Task Force (USPSTF) recommendation on prostate-specific antigen (PSA)–based screening for prostate cancer.Evidence ReviewThe USPSTF reviewed the evidence on the benefits and harms of PSA-based screening for prostate cancer and subsequent treatment of screen-detected prostate cancer. The USPSTF also commissioned a review of existing decision analysis models and the overdiagnosis rate of PSA-based screening. The reviews also examined the benefits and harms of PSA-based screening in patient subpopulations at higher risk of prostate cancer, including older men, African American men, and men with a family history of prostate cancer.FindingsAdequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened. Potential harms of screening include frequent false-positive results and psychological harms. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence, and 2 in 3 men will experience long-term erectile dysfunction. Adequate evidence shows that the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment. The USPSTF concludes with moderate certainty that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men. How each man weighs specific benefits and harms will determine whether the overall net benefit is small. The USPSTF concludes with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harms.Conclusions and RecommendationFor men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. (C recommendation) The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. (D recommendation)

Colon Cancer Screening Models: Lessons and Challenges

Prevalence of preeclampsia risk factors: implications for low-dose aspirin prophylaxis

This is an update of the 2002 US Preventive Services Task Force recommendation on screening for child and adolescent major depressive disorder. The US Preventive Services Task Force weighed the benefits and harms of screening and treatment for major depressive disorder in children and adolescents, incorporating new evidence addressing gaps in the 2002 recommendation statement. Evidence examined included the benefits and harms of screening, the accuracy of primary care-feasible screening tests, and the benefits and risks of treating depression by using psychotherapy and/or medications in patients aged 7 to 18 years. Screen adolescents (12-18 years of age) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up (B recommendation). Evidence is insufficient to warrant a recommendation to screen children (7-11 years of age) for major depressive disorder (I statement).

Commentary on: Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2011;155:762–71.[OpenUrl][1][CrossRef][2][PubMed][3][Web...

Response to Weinstein’s “Reply of Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia.”

Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years. Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings. We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched the Cochrane Library from 1996 to April 2004. We searched Medline, PsycINFO, DARE, and CINAHL from 1966 to April 2004. One reviewer abstracted relevant information from each included article into standardized evidence tables, and a second reviewer checked key elements. Two reviewers quality-graded each article with US Preventive Services Task Force criteria. Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >or=1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m(2)) is >or=50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals. BMI measurements of overweight among older adolescents identify those at increased risk of developing adult obesity. Interventions to treat overweight adolescents in clinical settings have not been shown to have clinically significant benefits, and they are not widely available. Screening to categorize overweight among children under age 12 or 13 who are not clearly overweight may not provide reliable risk categorization for adult obesity. Screening in this age group is compromised by the fact that there is little generalizable evidence for primary care interventions. Because existing trials report modest short- to medium-term improvements (approximately 10-20% decrease in percentage of overweight or a few units of change in BMI), however, overweight improvements among children and adolescents seem possible.

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Data Needs for Economic Evaluations of Screening in Pediatric Primary Care: A Research Framework.

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In this issue of Pediatrics , readers will find the recommendation of the US Preventive Services Task Force (USPSTF) that all newborns be screened for hearing loss1; readers will also find a concise version of the systematic evidence report that was commissioned to help develop this recommendation.2 Over the last several years, Pediatrics has published 5 recommendations relevant to children from the USPSTF3–7 and plans to publish additional recommendations as they are released. Because many pediatricians know very little about the USPSTF,8 we would like to use this commentary to inform readers about this task force: what it is, who is involved, how it works, and what readers can expect from these publications. The USPSTF is an independent panel charged by the US Congress to review the scientific evidence for clinical preventive services and develop evidence-based recommendations for the health care community. It was first convened by the US Public Health Service in 1984 and, since 1998, has been sponsored by the Agency for Healthcare Research and Quality (AHRQ). The USPSTF comprises 16 private-sector experts in prevention and primary care, representing primary care specialties and nursing, who serve for terms of 4 to 6 years. Members of the USPSTF are nominated by federal agencies, partner organizations (such as the American Academy of Pediatrics [AAP]), and individuals in response to an announcement in the Federal Register . Members are chosen for their ability to make rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications, and synthesize these assessments into recommendations. Throughout its existence, the task force has had at least 2 pediatricians, as well as other pediatric health care providers, among its members. Currently, 3 of its 16 … Address correspondence to Virginia A. Moyer, MD, MPH, Baylor College of Medicine, Department of Pediatrics, 6621 Fannin St, #1540, Houston, TX 77030. E-mail: moyer{at}bcm.edu

The prevalence of childhood and adolescent overweight has tripled over the past 2 decades, and associations have been identified between dietary patterns, physical activity, sedentary behaviors, and overweight. Some believe that pediatricians can easily recognize an overweight or obese child or adolescent and that there are sufficient therapeutic options to offer these patients and their families.1 However, primary care clinicians face obese and overweight children, adolescents, and parents every day, and most clinicians rarely document overweight. The American Academy of Pediatrics and American Academy of Family Physicians endorse universal screening using body mass index (BMI) and use of BMI growth curves to identify obese and overweight children. Physicians also seem to take high BMI more seriously than weight and height measures2; when documentation of high BMI occurs, screening, counseling, and referral rates for obese and overweight children and adolescents increase.3 Why then, does the US Preventive Services Task Force (USPSTF), in this issue of Pediatrics ,4 find insufficient evidence to recommend for or against formally screening children and adolescents for obesity or overweight in the primary care setting? The answer is: the USPSTF adheres strongly to a policy of making recommendations (either for or against delivery of preventive services) only in the presence of sufficient evidence of adequate quality. The USPSTF cannot make a recommendation for or against screening even for a practice that may be supported by expert consensus or less rigorous evidence. It is important to note that the USPSTF did not recommend that primary care clinicians not weigh and measure children or ignore … Address correspondence to Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850. E-mail: uspstf{at}ahrq.gov

The US Preventive Services Task Force (USPSTF) is an independent body that makes evidence-based recommendations regarding preventive services to improve health for people nationwide. Here, we summarize current USPSTF methods, describe how methods are evolving to address preventive health equity, and define evidence gaps for future research. We summarize current USPSTF methods as well as ongoing methods development. The USPSTF prioritizes topics on the basis of disease burden, extent of new evidence, and whether the service can be provided in primary care and going forward will increasingly consider health equity. Analytic frameworks specify the key questions and linkages connecting the preventive service to health outcomes. Contextual questions provide information on natural history, current practice, health outcomes in high-risk groups, and health equity. The USPSTF assigns a level of certainty to the estimate of net benefit of a preventive service (high, moderate, or low). The magnitude of net benefit is also judged (substantial, moderate, small, or zero/negative). The USPSTF uses these assessments to assign a letter grade from A (recommend) to D (recommend against). I statements are issued when evidence is insufficient. The USPSTF will continue to evolve its methods for simulation modeling and to use evidence to address conditions for which there are limited data for population groups who bear a disproportionate burden of disease. Additional pilot work is underway to better understand the relations of the social constructs of race, ethnicity, and gender with health outcomes to inform the development of a USPSTF health equity framework.