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The evidence on cancer prevention from USPSTF.

March 5, 2009

Matthew Vasey, MD



U.S. Preventive Services Task Force recommendations for cancer.

The U.S. Preventive Services Task Force (USPSTF) is an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services. Recommendations are graded according to one of five classifications (A, B, C, D, I) reflecting the strength of evidence and magnitude of net benefit (benefits minus harms).

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.


Routine Aspirin or Nonsteroidal Anti-inflammatory Drugs for the Primary Prevention of Colorectal Cancer
The USPSTF recommends against the routine use of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer in individuals at average risk for colorectal cancer.
Grade: D Recommendation.

Screening for Bladder Cancer in Adults
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for bladder cancer in adults.
Grade: D Recommendation.

Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility
The U.S. Preventive Services Task Force (USPSTF) recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with an increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2).
Grade: D Recommendation.

The USPSTF recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing.
Grade: B Recommendation.

Screening for Breast Cancer

NOTE - The USPSTF has amended their breast cancer screening recommendations. This is a discussion to be brought up with your primary care doctor. Click to view

The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older.
Grade: B Recommendation.

The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer.
Grade: I Statement.

The USPSTF concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE).
Grade: I Statement.

Screening for Cervical Cancer
The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix.
Grade: A Recommendation.

The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer.
Grade: D Recommendation.

The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease.
Grade: D Recommendation.

The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer.
Grade: I Statement.

The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer.
Grade: I recommendation.

Screening for Colorectal Cancer
The USPSTF recommends screening for colorectal cancer (CRC) using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary.
Grade: A Recommendation.

The USPSTF recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient.
Grade: C Recommendation.

The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.
Grade: D Recommendation.

The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer.
Grade: I Statement.

Lung Cancer Screening
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against screening asymptomatic persons for lung cancer with either low dose computerized tomography (LDCT), chest x-ray (CXR), sputum cytology, or a combination of these tests.
Grade: I Statement.

Screening for Oral Cancer
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routinely screening adults for oral cancer.
Grade: I Statement.

Screening for Ovarian Cancer
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for ovarian cancer.
Grade: D Recommendation.

Screening for Prostate Cancer
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.
Grade: I Statement.
The USPSTF recommends against screening for prostate cancer in men age 75 years or older. Grade: D Recommendation.

Screening for Skin Cancer
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population.
Grade: I Statement.

Screening for Testicular Cancer
The U.S. Preventive Services Task Force (USPSTF) recommends against routine screening for testicular cancer in asymptomatic adolescent and adult males.
Grade: D Recommendation.

Counseling to Prevent Tobacco Use and Tobacco-Caused Disease
The USPSTF strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products.
Grade: A Recommendation.

The USPSTF strongly recommends that clinicians screen all pregnant women for tobacco use and provide augmented pregnancy-tailored counseling to those who smoke.
Grade: A Recommendation.

The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for tobacco use or interventions to prevent and treat tobacco use and dependence among children or adolescents.
Grade: I Statement.

Routine Vitamin Supplementation to Prevent Cancer and Cardiovascular Disease
The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against the use of supplements of vitamins A, C, or E; multivitamins with folic acid; or antioxidant combinations for the prevention of cancer or cardiovascular disease.
Grade: I Statement.

The USPSTF recommends against the use of beta-carotene supplements, either alone or in combination, for the prevention of cancer or cardiovascular disease.
Grade: D Recommendation.

Internet Citation:
http://www.ahrq.gov/clinic/uspstf/gradespre.htm
http://www.ahrq.gov/clinic/cps3dix.htm#cancer
http://www.ahrq.gov/clinic/uspstfix.htm
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