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USPSTF changes stance on routine pelvic exams
After years of treating the screening pelvic exam as a routine part of well care, the USPSTF says the evidence is insufficient to assess the...
Screening tests to avoid
TABLE 416,17 lists screening tests the Task Force recommends against. While chronic obstructive pulmonary disease afflicts 14% of US adults ages 40 to 79 years and is the third leading cause of death in the country, the Task Force found that early detection in asymptomatic adults does not affect the course of the illness and is of no benefit.16
Genital herpes, also prevalent, infects an estimated one out of 6 individuals, ages 14 to 49. It causes little mortality, except in neonates, but those infected can have recurrent flares and suffer psychological harms from stigmatization. Most genital herpes is caused by herpes simplex virus-2, and there is a serological test to detect it. However, the Task Force recommends against using the test to screen asymptomatic adults and adolescents, including those who are pregnant. This recommendation is based on the test’s high false-positive rate, which can cause emotional harm, and on the lack of evidence that detection through screening improves outcomes.17
The evidence is lacking for these practices
The Task Force is one of only a few organizations that will not make a recommendation if evidence is lacking on benefits and harms. In addition to the ‘I’ statements regarding CVD and CRC mentioned earlier, the Task Force found insufficient evidence to recommend screening for lipid disorders in individuals ages 20 years or younger,10 performing a visual skin exam as a screening tool for skin cancer,11 screening for celiac disease,12 performing a periodic pelvic examination in asymptomatic women,13 and screening for obstructive sleep apnea using screening questionnaires14 (TABLE 33,4,10-14).
SIDEBAR
A change for prostate cancer screening?The USPSTF recently issued new draft recommendations regarding prostate cancer screening in asymptomatic men (available at: https://screeningforprostatecancer.org/).
The draft now divides men into 2 age groups, stating that the decision to screen for prostate cancer using a prostate specific antigen (PSA) test should be individualized for men ages 55 to 69 years (a C recommendation, meaning that there is at least moderate certainty that the net benefit is small), and that men ages 70 and older (lowered from age 75 in the previous 2012 recommendation1) should not be screened (a D recommendation, meaning that there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits).
The USPSTF believes that clinicians should explain to men ages 55 to 69 years that screening offers a small potential benefit of reducing the chance of dying from prostate cancer, but also comes with potential harms, including false-positive results requiring additional testing/procedures, overdiagnosis and overtreatment, and treatment complications such as incontinence and impotence. In this way, each man has the chance to incorporate his values and preferences into the decision.
For men ages 70 and older, the potential benefits simply do not outweigh the potential harms, according to the USPSTF.
1. USPSTF. Final recommendation statement. Prostate cancer: screening. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/prostate-cancer-screening#Pod1. Accessed April 11, 2017.
