USPSTF: What’s recommended, what’s not

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Practice Alert

USPSTF: What’s recommended, what’s not

J Fam Pract. 2014 May;63(5):265-269

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References

1. Campos-Outcalt D. Vitamin D: when it helps, when it harms. J Fam Pract. 2013;62:368-370.

2. Campos-Outcalt D. Lung cancer screening: USPSTF revises its recommendation. J Fam Pract. 2013;62:733-740.

3. Campos-Outcalt D. HIV screening: what the USPSTF says now. [Audiocast]. Parsippany, NJ; The Journal of Family Practice: 2013. Available at: http://www.jfponline.com/multimedia/audio/article/hiv-screening-what-the-uspstf-says-now/a1c4bc0fc9405f18820bb19fe971f743.html. Accessed March 14, 2014.

4. Campos-Outcalt D. Does your patient really need a supplement? [Audiocast]. Parsippany, NJ: The Journal of Family Practice; 2013. Available at: http://www.jfponline.com/index.php?id=21643&cHash=071010&tx_ttnews[tt_news]=226385. Accessed March 14, 2014.

5. Campos-Outcalt D. Hepatitis C: new CDC screening recommendations. J Fam Pract. 2012;61:744-746.

6. US Preventive Services Task Force Web site. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm. Accessed March 14, 2014.

7. US Preventive Services Task Force Web site. Primary care interventions to prevent tobacco use in children and adolescents. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspstbac.htm. Accessed March 14, 2014.

8. US Preventive Services Task Force Web site. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrgen.htm. Accessed March 14, 2014.

9. US Preventive Services Task Force Web site. Medication for risk reduction of primary breast cancer in women. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrpv.htm. Accessed March 14, 2014.

10. US Preventive Services Task Force Web site. Screening for gestational diabetes mellitius. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsgdm.htm. Accessed March 14, 2014.

11. US Preventive Services Task Force Web site. Screening for intimate partner violence and abuse of elderly and vulnerable adults. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsipv.htm. Accessed March 14, 2014.

12. US Preventive Services Task Force Web site. Primary interventions to prevent child maltreatment. Available at: http://www.uspreventiveservicestaskforce.org/uspstf/uspsfamv.htm. Accessed March 14, 2014.

Intimate partner violence

Another change from a previous “I” statement pertains to intimate partner violence (IPV). The TF now recommends screening women of childbearing age for IPV and either providing intervention services for those who screen positive for IPV or referring for services. Reproductive age is defined as 14 to 46 years, although the TF admits that most studies have looked at women ≥18 years.¹¹ Most of the benefits from screening and counseling have been demonstrated in pregnant women.

While the USPSFT acknowledges that child and elder abuse are major problems, there isn't enough evidence to recommend interventions.IPV can include physical, sexual, or psychological harm by a current or former partner or spouse, and it is not limited to opposite sex couples.¹¹ Screening tools with the highest sensitivity and specificity include the Hurt, Insult, Threaten, and Scream (HITS) scale. Potential interventions include counseling, home visits, information cards, referrals to community services, and mentoring support.

While the TF acknowledges that both child abuse and elder abuse are prominent problems, there is not enough evidence to assess and recommend interventions.^11,12

D recommendations

There were 4 “D” recommendations (recommend against) in 2013: testing for BRCA or using tamoxifen or raloxifene in women at low risk of breast cancer; using β-carotene or vitamin E to prevent CVD and cancer; and using low doses of vitamin D and calcium to prevent fractures in noninstitutionalized postmenopausal women (TABLE 2). In each instance the harms of the intervention were deemed to exceed potential benefits.

I statements

The TF still finds little evidence to support some common practices (TABLE 3). Physicians who use these interventions should realize that the TF, after thorough systematic reviews of the available evidence, does not find enough evidence to assess their relative benefits and harms. A description of the evidence on each condition can be found in the recommendations section of the USPSTF Web site (http://www.uspreventiveservicestaskforce.org/uspstopics.htm).

USPSTF: What’s recommended, what’s not

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