- 1,018.7 KB]Section 2. Recommendations for Adults (continued)
Guide to Clinical Preventive Services, 2012
All clinical summaries in this Guide are abridged recommendations. To see the full recommendation statements and recommendations published after March 2012, go to http://www.uspreventiveservicestaskforce.org.
Behavioral Counseling to Prevent Sexually Transmitted Infections
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | All sexually active adolescents | Adults at increased risk for STIs | Non-sexually-active adolescents and adults not at increased risk for STIs |
|---|---|---|---|
| Recommendation | Offer high-intensity counseling Grade: B | Offer high-intensity counseling Grade: B | No recommendation Grade: I (Insufficient Evidence) |
| Risk Assessment | All sexually active adolescents are at increased risk for STIs and should be offered counseling. Adults should be considered at increased risk and offered counseling if they have:
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| Interventions | Characteristics of successful high-intensity counseling interventions:
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| Suggestions for Practice | High-intensity counseling may be delivered in primary care settings, or in other sectors of the health system and community settings after referral. Delivery of this service may be greatly improved by strong linkages between the primary care setting and community. | Evidence is limited regarding counseling for adolescents who are not sexually active. Intensive counseling for all adolescents in order to reach those who are at risk but have not been appropriately identified is not supported by current evidence. Evidence is lacking regarding the effectiveness of counseling for adults not at increased risk for STIs. | |
| Other Relevant USPSTF Recommendations | USPSTF recommendations on screening for chlamydial infection, gonorrhea, genital herpes, hepatitis B, hepatitis C, HIV, and syphilis, and on counseling for HIV, can be found at http://www.uspreventiveservicestaskforce.org. | ||
Abbreviation: STI = Sexually Transmitted Infection
For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
Screening for Skin Cancer1
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | Adult general population1 |
|---|---|
| Recommendation | No recommendation Grade: I (Insufficient Evidence) |
| Risk Assessment | Skin cancer risks: family history of skin cancer, considerable history of sun exposure and sunburn. Groups at increased risk for melanoma:
|
| Screening Tests | There is insufficient evidence to assess the balance of benefits and harms of whole body skin examination by a clinician or patient skin self-examination for the early detection of skin cancer. |
| Screening Intervals | Not applicable. |
| Suggestions for Practice | Clinicians should remain alert for skin lesions with malignant features that are noted while performing physical examinations for other purposes. Features associated with increased risk for malignancy include: asymmetry, border irregularity, color variability, diameter >6mm ("A," "B," "C," "D"), or rapidly changing lesions. Suspicious lesions should be biopsied. |
| Other Relevant Recommendations from the USPSTF and the Community Preventive Services Task Force | The USPSTF has reviewed the evidence for counseling to prevent skin cancer. The recommendation statement and supporting documents can be accessed at http://www.uspreventiveservicestaskforce.org. The Community Preventive Services Task Force has reviewed the evidence on public health interventions to reduce skin cancer. The recommendations can be accessed at http://www.thecommunityguide.org. |
1 The USPSTF does not examine outcomes related to surveillance of patients with familial syndromes, such as familial atypical mole and melanoma (FAM-M) syndrome.
For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
Screening for Suicide Risk
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | General population |
|---|---|
| Recommendation | No recommendation Grade: I (Insufficient Evidence) |
| Risk Assessment | The strongest risk factors for attempted suicide include mood disorders or other mental disorders, comorbid substance abuse disorders, history of deliberate self-harm, and a history of suicide attempts. Deliberate self-harm refers to intentionally initiated acts of self-harm with a nonfatal outcome (including self-poisoning and self-injury). Suicide risk is assessed along a continuum ranging from suicidal ideation alone (relatively less severe) to suicidal ideation with a plan (more severe). Suicidal ideation with a specific plan of action is associated with a significant risk for attempted suicide. |
| Screening Tests | There is limited evidence on the accuracy of screening tools to identify suicide risk in the primary care setting, including tools to identify those at high risk. The characteristics of the most commonly used screening instruments (Scale for Suicide Ideation, Scale for Suicide Ideation–Worst, and the Suicidal Ideation Questionnaire) have not been validated to assess suicide risk in primary care settings. |
| Interventions | There is insufficient evidence to determine if treatment of persons at high risk for suicide reduces suicide attempts or mortality. |
| Balance of Benefits and Harms | There is no evidence that screening for suicide risk reduces suicide attempts or mortality. There is insufficient evidence to determine if treatment of persons at high risk reduces suicide attempts or mortality. There are no studies that directly address the harms of screening and treatment for suicide risk. As a result, the USPSTF could not determine the balance of benefits and harms of screening for suicide risk in the primary care setting. |
| Other Relevant USPSTF Recommendations | The USPSTF has also made recommendations on screening for alcohol misuse, depression, and illicit drug use. These recommendations are available at http://www.uspreventiveservicestaskforce.org. |
For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
Screening for Syphilis Infection
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | Persons at increased risk for syphilis infection | Asymptomatic persons who are not at increased risk for syphilis infection |
|---|---|---|
| Recommendation | Screen for syphilis infection. Grade: A | Do not screen for syphilis infection. Grade: D |
| Risk Assessment | Populations at increased risk for syphilis infection include men who have sex with men and engage in high-risk sexual behavior, commercial sex workers, persons who exchange sex for drugs, and those in adult correctional facilities. Persons diagnosed with other sexually transmitted diseases may be more likely than others to engage in high-risk behavior, placing them at increased risk. | |
| Screening Tests | Screening for syphilis infection is a two-step process that involves an initial nontreponemal test (Venereal Disease Research Laboratory or Rapid Plasma Reagin), followed by a confirmatory treponemal test (fluorescent treponemal antibody absorbed or T. pallidum particle agglutination). | |
| Timing of Screening | The optimal screening interval in average- and high-risk persons has not been determined. | |
| Interventions | Preferred treatment consists of antibiotic therapy with parenterally administered penicillin G. | |
| Balance of Benefits and Harms | Screening may result in potential harms (such as false-positive results, unnecessary anxiety to the patient, and harms of antibiotic use). However, the benefits of screening persons at increased risk for syphilis infection substantially outweigh the potential harms. | Given the low incidence of infection in the general population and the consequent low yield of such screening, the potential harms of screening (i.e., opportunity costs, false-positive tests, and labeling) in a low-incident population outweigh the benefits. |
| Other Relevant USPSTF Recommendations | The USPSTF has made other recommendations on screening for sexually transmitted infections, including screening for syphilis infection in pregnant women. These recommendations are available at http://www.uspreventiveservicestaskforce.org/. | |
For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
Screening for Syphilis Infection in Pregnancy
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | All pregnant women |
|---|---|
| Recommendation | Screen for syphilis infection. Grade: A |
| Screening Tests | Nontreponemal tests commonly used for initial screening include:
Confirmatory tests include:
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| Timing of Screening | Test all pregnant women at the first prenatal visit. |
| Other Clinical Considerations | Most organizations recommend testing high-risk women again during the third trimester and at delivery. Groups at increased risk include:
Prevalence is higher in southern U.S. and in metropolitan areas and in Hispanic and African American populations. |
| Interventions | The Centers for Disease Control and Prevention (CDC) recommends treatment with parenteral benzathine penicillin G. Women with penicillin allergies should be desensitized and treated with penicillin. Consult the CDC for the most up-to-date recommendations: http://www.cdc.gov/std/treatment/ |
| Other Relevant USPSTF Recommendations | Recommendations on screening for other STDs, and on counseling for STDs, can be found at http://www.uspreventiveservicestaskforce.org. |
Screening for Testicular Cancer
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | Adolescent and adult males |
|---|---|
| Recommendation | Do not screen Grade: D |
| Screening Tests | There is inadequate evidence that screening asymptomatic patients by means of self-examination or clinician examination has greater yield or accuracy for detecting testicular cancer at more curable stages. |
| Interventions | Management of testicular cancer consists of orchiectomy and may include other surgery, radiation therapy, or chemotherapy, depending on stage and tumor type. Regardless of disease stage, over 90% of all newly diagnosed cases of testicular cancer will be cured. |
| Balance of Benefits and Harms | Screening by self-examination or clinician examination is unlikely to offer meaningful health benefits, given the very low incidence and high cure rate of even advanced testicular cancer. Potential harms include false-positive results, anxiety, and harms from diagnostic tests or procedures. |
| Other Relevant USPSTF Recommendations | Recommendations on screening for other types of cancer can be found at http://www.uspreventiveservicestaskforce.org. |
For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
Screening for Thyroid Disease
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | Asymptomatic adults |
|---|---|
| Recommendation | No recommendation Grade: I (Insufficient Evidence) |
| Risk Assessment | People at higher risk for thyroid dysfunction include the elderly, postpartum women, persons with high levels of radiation exposure (>20 mGy), and patients with Down syndrome. |
| Screening Tests | Screening for thyroid dysfunction can be performed using the medical history, physical examination, or any of several serum thyroid function tests. Thyroid stimulating hormone (TSH) is usually recommended because it can detect abnormalities before other tests become abnormal. |
| Interventions | A potential benefit of treating subclinical thyroid disease is to prevent the spontaneous development of overt hypothyroidism or hyperthyroidism, but this potential benefit has not been well studied in clinical trials as of 2004. |
| Balance of Benefits and Harms | There is fair evidence that the TSH test can detect subclinical thyroid disease in persons without symptoms of thyroid dysfunction, but poor evidence that treatment improves clinically important outcomes in adults with screen-detected thyroid disease. There is the potential for harm caused by false-positive screening tests; however, the magnitude of harm is not known. There is good evidence that overtreatment with levothyroxine occurs in a substantial proportion of patients, but the long-term harmful effects of overtreatment are not known. As a result, the USPSTF could not determine the balance of benefits and harms of screening asymptomatic adults for thyroid disease. |
| Other Relevant USPSTF Recommendations | The USPSTF has also made recommendations on screening for diabetes, hemochromatosis, iron deficiency anemia, and obesity. These recommendations are available at http://www.uspreventiveservicestaskforce.org/. |
For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
Counseling and Interventions to Prevent Tobacco Use and Tobacco-Caused Disease in Adults and Pregnant Women
Clinical Summary of U.S. Preventive Services Task Force Recommendation
| Population | Adults age ≥ 18 years | Pregnant women of any age |
|---|---|---|
| Recommendation | Ask about tobacco use. Provide tobacco cessation interventions to those who use tobacco products. Grade: A | Ask about tobacco use. Provide augmented pregnancy-tailored counseling for women who smoke. Grade: A |
| Counseling | The “5-A” framework provides a useful counseling strategy:
Intensity of counseling matters: brief one-time counseling works; however, longer sessions or multiple sessions are more effective. Telephone counseling “quit lines” also improve cessation rates. | |
| Pharmacotherapy | Combination therapy with counseling and medications is more effective than either component alone. FDA-approved pharmacotherapy includes nicotine replacement therapy, sustained-release bupropion, and varenicline. | The USPSTF found inadequate evidence to evaluate the safety or efficacy of pharmacotherapy during pregnancy |
| Implementation | Successful implementation strategies for primary care practice include:
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| Other Relevant USPSTF Recommendations | Recommendations on other behavioral counseling topics are available at http://www.uspreventiveservicestaskforce.org/ | |
Abbreviations: FDA = U.S. Food and Drug Administration; USPSTF = U.S. Preventive Services Task Force
For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org/.
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