Medicine
Several recent publications have highlighted the strengths and limitations of U.S. Preventive Services Task Force recommendations on commonly provided preventive services.
- The Good News, At Last, In Prostate Cancer Screening
As I previously documented in a series of posts on this blog, the road to the U.S. Preventive Service Task Force's 2012 "don't do it" recommendation on PSA-based screening for prostate cancer was long, arduous, and full of political pitfalls....
- We Need To Know More About Psychological Harms Of Screening
Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with...
- Dissecting A Hepatitis C Screening Recommendation
After being banished from the public spotlight in 2010 and 2011 due to health reform politics, the evidence-generating operation known as the U.S. Preventive Services Task Force is finally making waves again. On Monday, the USPSTF got on board with...
- The End Of The Line On Psa Screening
In the summer of 2007, then-U.S. Preventive Services Task Force member Russ Harris, MD, MPH approached me about taking on what he suggested would be a fairly quick and straightfoward project: summarizing the small amount of medical literature on...
- "politics Trumped Science": Breast Cancer Chemoprevention
On November 17, 2009, in the same issue of the Annals of Internal Medicine that contained the U.S. Preventive Services Task Force's controversial new recommendations on screening for breast cancer, the journal also published a report on the comparative...
Medicine
Prevention potpourri
Several recent publications have highlighted the strengths and limitations of U.S. Preventive Services Task Force recommendations on commonly provided preventive services.
Screening and Interventions for Alcohol Misuse
Yesterday, the USPSTF released a draft recommendation statement on screening and behavioral counseling interventions for alcohol misuse, supported by a comprehensive systematic review published in the Annals of Internal Medicine. (Full disclosure: the lead author of the review is the son of family physician Pat Jonas, who blogs at Dr Synonymous and with whom I've given past presentations on social media.) Although the USPSTF review and statement affirm that brief behavioral counseling has positive effects on risky alcohol use, I believe that the Task Force missed an important opportunity to evaluate the effectiveness of medications such as acamprosate and naltrexone for alcohol-dependent patients in primary care settings. To expect, as the USPSTF appears to do, that alcohol-dependent patients identified by screening will all be referred to addiction specialists seems unreasonable, since the estimated lifetime prevalence of alcohol dependence in the U.S. is 12.5%.
Abdominal Aortic Aneurysm Screening
In 2005, the USPSTF recommended that men age 65 to 75 years who had ever smoked receive a one-time ultrasonography screening for abdominal aortic aneurysm (AAA), a condition that is usually causes no symptoms until the aneurysm ruptures, often leading to death. Previous studies had shown that identifying and repairing large (more than 5.5 centimeters in diameter) aneurysms could avert these deaths. However, a study published last week in the Archives of Internal Medicine found that despite Medicare coverage of AAA screening since 2007, few eligible men had undergone the test and there were no effects on rates of AAA rupture or death. I've always been uncomfortable with this Task Force recommendation because AAA repair surgery carries considerable risk to the patient even in the hands of the most skilled vascular surgeons, and many large AAAs that would not cause problems during men's lifetimes could potentially be overdiagnosed and unnecessarily treated. An accompanying editorial written by my friend and former USPSTF member Russ Harris and colleagues suggests that the population-level benefit of AAA screening may be declining, while the harms may be greater due to the increasing frequency of surgery for smaller AAAs that are even less likely to cause problems. It will be interesting to see if the USPSTF will reconsider its 2005 recommendation.
Counseling for Healthful Diet and Physical Activity
An ambitious project named Prescription for Health funded 22 primary care practice-based research networks between 2003 and 2007 to develop innovative, evidence-based strategies to address tobacco use, risky alcohol use, unhealthy diet, and physical inactivity in their patient populations. An analysis of a subset of 7 PBRNs published in the Journal of the American Board of Family Medicine reflects the mixed results that these interventions achieved and the numerous challenges of providing them in practice. Such considerations could be one reason that the USPSTF declined to endorse routine counseling for healthful diet and physical activity in the general adult population.
Screening for Prostate Cancer
Finally, a research letter in the Archives of Internal Medicine found a modest decline in PSA-based prostate cancer screening in Medicare recipients age 75 years and older (from 29.4% to 27.8%) associated with the USPSTF's 2008 recommendation to discontinue screening in this group. The screening rate remains much too high, especially since the Task Force now recommends against PSA-based screening in men of any age. I will share more of my thoughts about implementing this "don't do" guideline in primary care a future issue of the Journal of Lancaster General Hospital.
- The Good News, At Last, In Prostate Cancer Screening
As I previously documented in a series of posts on this blog, the road to the U.S. Preventive Service Task Force's 2012 "don't do it" recommendation on PSA-based screening for prostate cancer was long, arduous, and full of political pitfalls....
- We Need To Know More About Psychological Harms Of Screening
Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with...
- Dissecting A Hepatitis C Screening Recommendation
After being banished from the public spotlight in 2010 and 2011 due to health reform politics, the evidence-generating operation known as the U.S. Preventive Services Task Force is finally making waves again. On Monday, the USPSTF got on board with...
- The End Of The Line On Psa Screening
In the summer of 2007, then-U.S. Preventive Services Task Force member Russ Harris, MD, MPH approached me about taking on what he suggested would be a fairly quick and straightfoward project: summarizing the small amount of medical literature on...
- "politics Trumped Science": Breast Cancer Chemoprevention
On November 17, 2009, in the same issue of the Annals of Internal Medicine that contained the U.S. Preventive Services Task Force's controversial new recommendations on screening for breast cancer, the journal also published a report on the comparative...