Summary of 2006 USPSTF Guide to Preventive Service

              Associates of Internal Medicine. Columbia University Medical Center

AIM Clinic

 
SCREENING

(USPSTF grade) age

Additional info

Breast CA

(B) rec mammo +/- clinical breast exam >40 every 1-2 yrs

(I) insufficient for clinical or self breast exam alone

Text Box:  CANCERDiscuss breast ca chemoprophylaxis

(B) discuss risk vs. benefits in high risk pts

(D) for primary prevention for low or average risk

Genetic risk assessment and BRCA testing

(B) women with family history associated with increased risk for BRCA1 or BRCA2 mutations

(D) not recommended in avg risk women

Cervical CA (pap)

(A) >21 or 3yrs after activity. Screen at least every 3 yrs. Most orgs say need 2-3 normal paps before extending screening interval.

(D) do not screen in >65 w/ hx of nl. pap

(D) do not screen if s/p TAH (confirm history of TAH) for benign reasons. ACS and ACOG rec continued screening if TAH for invasive cerv ca or DES.

(I) new technology incld HPV DNA

Text Box: CARDIOVASCULARColorectal CA

(A) over 50-75

(C) against routine screening in 76-85

(D) against screening in adults over 85

annual FOBT, colonoscopy, sigmoidoscoy

(Insufficiant) evidence for CT colonography or fecal DNA

 

High blood press.

(A)18 and over

 

Lipid Disorder

(A)-Female >45, Male >35

(B)>20 with CV risk factors

(B) test for  tot.chol and HDL

(I) insufficient evidence for checking Tg

(C) for checking lipids in over 20 -35 without risk factors

ASA - 1° prev of cardiovasc events

(A) for adults with 10 yr CHD risk >6%*

75mg daily effective

*Risk score calculator

Aortic aneurysm

(B) 65-75 male past or present smokers

(C) male non-smokers 65-75; (D) women

Counseling for Healthy Diet

(B) adults with dyslipidemia., other CV risk factors, diet related chronic diseases

(I) insufficient evidence for diet counseling in average risk population

Text Box: ENDOCRINEDiabetes Type 2

(B) pt with HTN/hyperlipidemia

ADA: screen all >45 or <45 at high risk*

*ADA high risk: bmi>25, htn, HDL<35 or TG>250, sedentary, FH of DM, AA/latino/asian american, h/o gestational DM,  

Obesity

(B) screening of all, and offer intensive counseling/behavioral mod for obese pts

(I) insufficient evidence for low or moderate intensity counseling in obese or intensive counseling works in overweight adults

Osteoporosis

(B) >65, for >60 with risk factors*

*risk factors: low BMI, white or asian, h/o fracture, FH of osteoporotic fracture, falls, sedentary, smoking, excessive etoh or caffeine use, low Ca or vit D intake

(C) no recommendation for <60

(C) no recommendation for 60-64 who aren’t at incr. risk.

-optimal rescreening interval unclear, but at least 2 yrs

PPD

(A) high risk

USPSTF directs us to the CDC/MMWR recommendations

Chlamydia/GC

Chlamydia: <25 F or  high risk (A) ; Gonorrhea: (B)

 

Text Box:   IDSyphilis

(A) at risk* population

* at risk: MSM, high risk sexual behavior, commercial sex workers, h/o correctional facilities

HIV

(A) high risk, or in high prevalence population

Being cared for in CPMC (??AIM) is considered to be high risk >1% prev.

Hep B screening

(A) pregnant women at first visit

(D) in general asymptomatic population

Text Box: SUBST/PSYCHRubella*

(B) all women of childbearing age screen by hx of vax or test serology (1996 report; update in progress)

(D) postmeno women, older men, and young men not at risk

Tobacco

(A) for all adults (screen/counsel/treat)

Specially tailored counseling for pregnant women works best for that population.

Alcohol

(B) screening and counseling. For all including pregnant women.

Screening can accurately identify and brief behavioral counseling interventions can reduce etoh consumption.

Depression

(B) screening

 

*other vaccinations see ADIP sheet     * OB recommendation are not included here

                     D - Not Recommended

§  Aspirin for colorectal cancer

§  Beta-carotene suppliments to prevent of Ca

§  Bladder Ca

§  Ovarian Ca

§  Pancreatic Ca

§  Testicular Ca (clinical or self exam)

§  Thyroid Ca (palpation or u/s); being updated

§  CAD screening (in low risk)

§  Peripheral arterial disease, routine screening

§  Hep C in asx. population

§  Hormone therapy in post-menopausal women

§  Bacteruria in asymptomatic men and nonpreg women

 

(I) insufficient evidence for or against

§  Vits (A,C,E, MVI, or antiox) to prevent Ca or CV dz

§  Lung Ca

§  Oral Ca

§  Prostate Ca

§  Skin Ca (exam or counseling)

§  CAD in high risk population

§  Increase physical activity

§  Hep C in hi risk population

§  Glaucoma

§  Scoliosis in adolescent

§  Low back pain prevention counseling

Insufficient (continued)

§  Domestic violence/abuse

§  Dementia in elderly

§  Suicide risk in gen. pop.

 

Grade A  USPSTF strongly recommends with good evidence that service improves impt. health outcomes and concludes that benefits                                          substantially outweighs harm. 

Grade B  USPSTF recommends to provide service to eligible pt, supported by at least fair evidence that service improves impt. Health outcomes and conclude and benefit outweighs harm.

Grade C  USPSTF makes no recommendation for or against. The USPSTF found at least fair evidence that service improves outcome, but conclude the balance of benefit and harm is too close to justify a general recommendation.

Grade D  USPSTF recommends against routinely providing service to asx patients. Found at least fair evidence that the services is ineffective or that harm outweigh benefits

Grade I   USPSTF conclude evidence is insufficient to recommend for or against routinely providing service. Evidence that the service is effective is lacking, or poor quality, or conflicting, and the balance of benefit and harms cannot be determined.