Recommendations for 2005
So far in 2005, new recommendations have been added on 3 topics: abdominal aortic aneurisms, glaucoma, and herpes simplex.
Abdominal aortic aneurisms. The recommendations on screening for abdominal aortic aneurisms are contained in TABLE 3. Of special note is the recommendation to screen (using abdominal ultrasound) men over the age of 65 years who have ever smoked.
Glaucoma. The statement that evidence is insufficient to recommend for or against routinely screening for glaucoma reflects the uncertainty about the contribution of screening to improved outcomes, as well as the documented harms of treating elevated intraocular pressure, such as local eye irritation and an increased risk for cataracts.
Herpes simplex. The task force recommends against screening for herpes in pregnant women and asymptomatic adults and adolescents because of a lack of improved outcomes and documented potential harms.
TABLE 3
USPSTF 2005 recommendations for screening for abdominal aortic aneurisms
| The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 who have ever smoked. |
| RATING: B RECOMMENDATION |
| Rationale: The USPSTF found good evidence that screening for AAA and surgical repair of large AAAs (5.5 cm or more) in men aged 65 to 75 who have ever smoked (current and former smokers) leads to decreased AAA-specific mortality. There is good evidence that abdominal ultrasonography, performed in a setting with adequate quality assurance (ie, in an accredited facility with credentialed technologists), is an accurate screening test for AAA. There is also good evidence of important harms of screening and early treatment, including an increased number of surgeries with associated clinically-significant morbidity and mortality, and short-term psychological harms. Based on the moderate magnitude of net benefit, the USPSTF concluded that the benefits of screening for AAA in men aged 65 to 75 who have ever smoked outweigh the harms. |
| The USPSTF makes no recommendation for or against screening for AAA in men aged 65 to 75 who have never smoked. |
| RATING: C RECOMMENDATION. |
| Rationale: The USPSTF found good evidence that screening for AAA in men aged 65 to 75 who have never smoked leads to decreased AAA-specific mortality. There is, however, a lower prevalence of large AAAs in men who have never smoked compared with men who have ever smoked; thus, the potential benefit from screening men who have never smoked is small. There is good evidence that screening and early treatment leads to important harms, including an increased number of surgeries with associated clinically-significant morbidity and mortality, and short-term psychological harms. The USPSTF concluded that the balance between the benefits and harms of screening for AAA is too close to make a general recommendation in this population. |
| The USPSTF recommends against routine screening for AAA in women. |
| RATING: D RECOMMENDATION. |
| Rationale: Because of the low prevalence of large AAAs in women, the number of AAA-related deaths that can be prevented by screening this population is small. There is good evidence that screening and early treatment result in important harms, including an increased number of surgeries with associated morbidity and mortality, and psychological harms. The USPSTF concluded that the harms of screening women for AAA outweigh the benefits. |
USPSTF The Gold Standard
The USPSTF offers busy practicing physicians a valuable set of resources to assist in staying current on the ever changing field of clinical prevention and to guide clinical practice. Their recommendations often are at odds with common beliefs. But over time, their methodology and resulting recommendations have become the gold standard for evidence-based prevention practice.
CORRESPONDENCE
Doug Campos-Outcalt, MD, MPA, 4001 North Third Street #415, Phoenix, AZ 85012. E-mail: dougco@u.arizona.edu