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In 2021, the US Preventive Services Task Force (USPSTF) considered 13 topics and made a total of 23 recommendations. They reviewed only 1 new topic. The other 12 were updates of topics previously addressed; no changes were made in 9 of them. In 3, the recommended age of screening or the criteria for screening were expanded. This Practice Alert will review the recommendations made and highlight new recommendations and any changes to previous ones. All complete recommendation statements, rationales, clinical considerations, and evidence reports can be found on the USPSTF website at https://uspreventiveservicestaskforce.org/uspstf/home.1
Dental caries in children
Dental caries affect about 23% of children between the ages of 2 and 5 years and are associated with multiple adverse social outcomes and medical conditions.2 The best way to prevent tooth decay, other than regular brushing with fluoride toothpaste, is to drink water with recommended amounts of fluoride (≥ 0.6 parts fluoride per million parts water).2 The USPSTF reaffirmed its recommendation from 2014 that stated when a local water supply lacks sufficient fluoride, primary care clinicians should prescribe oral supplementation for infants and children in the form of fluoride drops starting at age 6 months. The dosage of fluoride depends on patient age and fluoride concentration in the local water (TABLE 13). The USPSTF also recommends applying topical fluoride as 5% sodium fluoride varnish, every 6 months, starting when the primary teeth erupt.2
In addition to fluoride supplements and topical varnish, should clinicians perform screening examinations looking for dental caries? The USPSTF feels there is not enough evidence to assess this practice and gives it an “I” rating (insufficient evidence).
Preventive interventions in pregnancy
In 2021, the USPSTF assessed 3 topics related to pregnancy and prenatal care.
Screening for gestational diabetes. The USPSTF gave a “B” recommendation for screening at 24 weeks of pregnancy or after, but an “I” statement for screening prior to 24 weeks.4 Screening can involve a 1-step or 2-step protocol.
The 2-step protocol is most commonly used in the United States. It involves first measuring serum glucose after a nonfasting 50-g oral glucose challenge; if the resulting level is high, the second step is a 75- or 100-g oral glucose tolerance test lasting 3 hours. The 1-step protocol involves measuring a fasting glucose level, followed by a 75-g oral glucose challenge with glucose levels measured at 1 and 2 hours.
Healthy weight gain in pregnancy. This was the only new topic the USPSTF assessed last year. The resulting recommendation is to offer pregnant women behavioral counseling to promote healthy weight gain and to prevent excessive weight gain in pregnancy. The recommended weight gain depends on the mother’s prepregnancy weight status: 28 to 40 lbs if the mother is underweight; 25 to 35 lbs if she is not under- or overweight; 15 to 25 lbs if she is overweight; and 11 to 20 lbs if she is obese.5 Healthy weight gain contributes to preventing gestational diabetes, emergency cesarean sections, and infant macrosomia.
Continue to: Low-dose aspirin
Low-dose aspirin. Reaffirming a recommendation from 2014, the USPSTF advises low-dose aspirin (81 mg/d) starting after 12 weeks’ gestation for all pregnant women who are at high risk for preeclampsia. TABLE 26 lists high- and moderate-risk conditions for preeclampsia and the recommendation for the use of low-dose aspirin.
Sexually transmitted infections
Screening for both chlamydia and gonorrhea in sexually active females through age 24 years was given a “B” recommendation, reaffirming the 2014 recommendation.7 Screening for these 2 sexually transmitted infections (STIs) is also recommended for women 25 years and older who are at increased risk of STIs. Risk is defined as having a new sex partner, more than 1 sex partner, a sex partner who has other sex partners, or a sex partner who has an STI; not using condoms consistently; having a previous STI; exchanging sex for money or drugs; or having a history of incarceration.
Screen for both infections simultaneously using a nucleic acid amplification test, testing all sites of sexual exposure. Urine testing can replace cervical, vaginal, and urethral testing. Those found to be positive for either STI should be treated according to the most recent treatment guidelines from the Centers for Disease Control and Prevention (CDC). And sexual partners should be advised to undergo testing.8,9
The USPSTF could not find evidence for the benefits and harms of screening for STIs in men. Remember that screening applies to those who are asymptomatic. Male sex partners of those found to be infected should be tested, as should those who show any signs or symptoms of an STI. A recent Practice Alert described the most current CDC guidance for diagnosing and treating STIs.9
Type 2 diabetes and prediabetes
Screening for type 2 diabetes (T2D) and prediabetes is now recommended for adults ages 35 to 70 years who are overweight or obese.10 The age to start screening has been lowered to 35 years from the previous recommendation in 2015, which recommended starting at age 40. In addition, the recommendation states that patients with prediabetes should be referred for preventive interventions. It is important that referral is included in the statement because the Affordable Care Act mandates that USPSTF “A” and “B” recommendations must be covered by commercial health insurance with no copay or deductible.
Continue to: Screening can be conducted...
Screening can be conducted using a fasting plasma glucose or A1C level, or with an oral glucose tolerance test. Interventions that can prevent or delay the onset of T2D in those with prediabetes include lifestyle interventions that focus on diet and physical activity, and the use of metformin (although metformin has not been approved for this by the US Food and Drug Administration).
Changes to cancer screening recommendations
In 2021, the USPSTF reviewed and modified its recommendations on screening for 2 types of cancer: colorectal and lung.
For colorectal cancer, the age at which to start screening was lowered from 50 years to 45 years.11 Screening at this earlier age is a “B” recommendation, because, while there is benefit from screening, it is less than for older age groups. Screening individuals ages 50 to 75 years remains an “A” recommendation, and for those ages 76 to 85 years it remains a “C” recommendation. A “C” recommendation means that the overall benefits are small but some individuals might benefit based on their overall health and prior screening results. In its clinical considerations, the USPSTF recommends against screening in those ages 85 and older but, curiously, does not list it as a “D” recommendation. The screening methods and recommended screening intervals for each appear in TABLE 3.11
For lung cancer, annual screening using low-dose computed tomography (CT) was first recommended by the USPSTF in 2013 for adults ages 55 to 80 years with a 30-pack-year smoking history. Screening could stop once 15 years had passed since smoking cessation. In 2021, the USPSTF lowered the age to initiate screening to 50 years, and the smoking history threshold to 20 pack-years.12 If these recommendations are followed, a current smoker who does not quit smoking could possibly receive 30 annual CT scans. The recommendation does state that screening should stop once a person develops a health condition that significantly affects life expectancy or ability to have lung surgery.
For primary prevention of lung cancer and other chronic diseases through smoking cessation, the USPSTF also reassessed its 2015 recommendations. It reaffirmed the “A” recommendation to ask adults about tobacco use and, for tobacco users, to recommend cessation and provide behavioral therapy and approved pharmacotherapy.13 The recommendation differed for pregnant adults in that the USPSTF is unsure about the potential harms of pharmacotherapy in pregnancy and gives that an “I” statement.13 An additional “I” statement was made about the use of electronic cigarettes for smoking cessation; the USPSTF recommends using behavioral and pharmacotherapy interventions with proven effectiveness and safety instead.
Continue to: 4 additional recommendation updates with no changes
4 additional recommendation updates with no changes
Screening for high blood pressure in adults ages 18 years and older continues to receive an “A” recommendation.14 Importantly, the recommendation states that confirmation of high blood pressure should be made in an out-of-office setting before initiating treatment. Screening for vitamin D deficiency in adults and hearing loss in older adults both continue with “I” statements,15,16 and screening for asymptomatic carotid artery stenosis continues to receive a “D” recommendation.17 The implications of the vitamin D “I” statement were discussed in a previous Practice Alert.18
Continuing value of the USPSTF
The USPSTF continues to set the gold standard for assessment of preventive interventions, and its decisions affect first-dollar coverage by commercial health insurance. The reaffirmation of past recommendations demonstrates the value of adhering to rigorous evidence-based methods (if they are done correctly, they rarely must be markedly changed). And the updating of screening criteria shows the need to constantly review the evolving evidence for current recommendations. Once again, however, funding and staffing limitations allowed the USPSTF to assess only 1 new topic. A listing of all the 2021 recommendations is in TABLE 4.1
1. USPSTF. Recommendation topics. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation-topics
2. USPSTF. Prevention of dental caries in children younger than 5 years: screening and interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1#bootstrap-panel—4
3. ADA. Dietary fluoride supplements: evidence-based clinical recommendations. Accessed April 14, 2022. www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/ada_evidence-based_fluoride_supplement_chairside_guide.pdf?rev=60850dca0dcc41038efda83d42b1c2e0&hash=FEC2BBEA0C892FB12C098E33344E48B4
4. USPSTF. Gestational diabetes: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening
5. USPSTF. Healthy weight and weight gain in pregnancy: behavioral counseling interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/healthy-weight-and-weight-gain-during-pregnancy-behavioral-counseling-interventions
6. USPSTF. Aspirin use to prevent preeclampsia and related morbidity and mortality: preventive medication. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication
7. USPSTF. Chlamydia and gonorrhea: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening
8. Workowski KA, Bauchman LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70:1-187.
9. Campos-Outcalt D. CDC guidelines on sexually transmitted infections. J Fam Pract. 2021;70:506-509.
10. USPSTF. Prediabetes and type 2 diabetes: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
11. USPSTF. Colorectal cancer: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
12. USPSTF. Lung cancer: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
13. USPSTF. Tobacco smoking cessation in adults, including pregnant persons: interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions
14. USPSTF. Hypertension in adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening
15. USPSTF. Vitamin D deficiency in adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/vitamin-d-deficiency-screening
16. USPSTF. Hearing loss in older adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/hearing-loss-in-older-adults-screening
17. USPSTF. Asymptomatic carotid artery stenosis: screening. Access April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/carotid-artery-stenosis-screening
18. Campos-Outcalt D. How to proceed when it comes to vitamin D. J Fam Pract. 2021;70:289-292.
In 2021, the US Preventive Services Task Force (USPSTF) considered 13 topics and made a total of 23 recommendations. They reviewed only 1 new topic. The other 12 were updates of topics previously addressed; no changes were made in 9 of them. In 3, the recommended age of screening or the criteria for screening were expanded. This Practice Alert will review the recommendations made and highlight new recommendations and any changes to previous ones. All complete recommendation statements, rationales, clinical considerations, and evidence reports can be found on the USPSTF website at https://uspreventiveservicestaskforce.org/uspstf/home.1
Dental caries in children
Dental caries affect about 23% of children between the ages of 2 and 5 years and are associated with multiple adverse social outcomes and medical conditions.2 The best way to prevent tooth decay, other than regular brushing with fluoride toothpaste, is to drink water with recommended amounts of fluoride (≥ 0.6 parts fluoride per million parts water).2 The USPSTF reaffirmed its recommendation from 2014 that stated when a local water supply lacks sufficient fluoride, primary care clinicians should prescribe oral supplementation for infants and children in the form of fluoride drops starting at age 6 months. The dosage of fluoride depends on patient age and fluoride concentration in the local water (TABLE 13). The USPSTF also recommends applying topical fluoride as 5% sodium fluoride varnish, every 6 months, starting when the primary teeth erupt.2
In addition to fluoride supplements and topical varnish, should clinicians perform screening examinations looking for dental caries? The USPSTF feels there is not enough evidence to assess this practice and gives it an “I” rating (insufficient evidence).
Preventive interventions in pregnancy
In 2021, the USPSTF assessed 3 topics related to pregnancy and prenatal care.
Screening for gestational diabetes. The USPSTF gave a “B” recommendation for screening at 24 weeks of pregnancy or after, but an “I” statement for screening prior to 24 weeks.4 Screening can involve a 1-step or 2-step protocol.
The 2-step protocol is most commonly used in the United States. It involves first measuring serum glucose after a nonfasting 50-g oral glucose challenge; if the resulting level is high, the second step is a 75- or 100-g oral glucose tolerance test lasting 3 hours. The 1-step protocol involves measuring a fasting glucose level, followed by a 75-g oral glucose challenge with glucose levels measured at 1 and 2 hours.
Healthy weight gain in pregnancy. This was the only new topic the USPSTF assessed last year. The resulting recommendation is to offer pregnant women behavioral counseling to promote healthy weight gain and to prevent excessive weight gain in pregnancy. The recommended weight gain depends on the mother’s prepregnancy weight status: 28 to 40 lbs if the mother is underweight; 25 to 35 lbs if she is not under- or overweight; 15 to 25 lbs if she is overweight; and 11 to 20 lbs if she is obese.5 Healthy weight gain contributes to preventing gestational diabetes, emergency cesarean sections, and infant macrosomia.
Continue to: Low-dose aspirin
Low-dose aspirin. Reaffirming a recommendation from 2014, the USPSTF advises low-dose aspirin (81 mg/d) starting after 12 weeks’ gestation for all pregnant women who are at high risk for preeclampsia. TABLE 26 lists high- and moderate-risk conditions for preeclampsia and the recommendation for the use of low-dose aspirin.
Sexually transmitted infections
Screening for both chlamydia and gonorrhea in sexually active females through age 24 years was given a “B” recommendation, reaffirming the 2014 recommendation.7 Screening for these 2 sexually transmitted infections (STIs) is also recommended for women 25 years and older who are at increased risk of STIs. Risk is defined as having a new sex partner, more than 1 sex partner, a sex partner who has other sex partners, or a sex partner who has an STI; not using condoms consistently; having a previous STI; exchanging sex for money or drugs; or having a history of incarceration.
Screen for both infections simultaneously using a nucleic acid amplification test, testing all sites of sexual exposure. Urine testing can replace cervical, vaginal, and urethral testing. Those found to be positive for either STI should be treated according to the most recent treatment guidelines from the Centers for Disease Control and Prevention (CDC). And sexual partners should be advised to undergo testing.8,9
The USPSTF could not find evidence for the benefits and harms of screening for STIs in men. Remember that screening applies to those who are asymptomatic. Male sex partners of those found to be infected should be tested, as should those who show any signs or symptoms of an STI. A recent Practice Alert described the most current CDC guidance for diagnosing and treating STIs.9
Type 2 diabetes and prediabetes
Screening for type 2 diabetes (T2D) and prediabetes is now recommended for adults ages 35 to 70 years who are overweight or obese.10 The age to start screening has been lowered to 35 years from the previous recommendation in 2015, which recommended starting at age 40. In addition, the recommendation states that patients with prediabetes should be referred for preventive interventions. It is important that referral is included in the statement because the Affordable Care Act mandates that USPSTF “A” and “B” recommendations must be covered by commercial health insurance with no copay or deductible.
Continue to: Screening can be conducted...
Screening can be conducted using a fasting plasma glucose or A1C level, or with an oral glucose tolerance test. Interventions that can prevent or delay the onset of T2D in those with prediabetes include lifestyle interventions that focus on diet and physical activity, and the use of metformin (although metformin has not been approved for this by the US Food and Drug Administration).
Changes to cancer screening recommendations
In 2021, the USPSTF reviewed and modified its recommendations on screening for 2 types of cancer: colorectal and lung.
For colorectal cancer, the age at which to start screening was lowered from 50 years to 45 years.11 Screening at this earlier age is a “B” recommendation, because, while there is benefit from screening, it is less than for older age groups. Screening individuals ages 50 to 75 years remains an “A” recommendation, and for those ages 76 to 85 years it remains a “C” recommendation. A “C” recommendation means that the overall benefits are small but some individuals might benefit based on their overall health and prior screening results. In its clinical considerations, the USPSTF recommends against screening in those ages 85 and older but, curiously, does not list it as a “D” recommendation. The screening methods and recommended screening intervals for each appear in TABLE 3.11
For lung cancer, annual screening using low-dose computed tomography (CT) was first recommended by the USPSTF in 2013 for adults ages 55 to 80 years with a 30-pack-year smoking history. Screening could stop once 15 years had passed since smoking cessation. In 2021, the USPSTF lowered the age to initiate screening to 50 years, and the smoking history threshold to 20 pack-years.12 If these recommendations are followed, a current smoker who does not quit smoking could possibly receive 30 annual CT scans. The recommendation does state that screening should stop once a person develops a health condition that significantly affects life expectancy or ability to have lung surgery.
For primary prevention of lung cancer and other chronic diseases through smoking cessation, the USPSTF also reassessed its 2015 recommendations. It reaffirmed the “A” recommendation to ask adults about tobacco use and, for tobacco users, to recommend cessation and provide behavioral therapy and approved pharmacotherapy.13 The recommendation differed for pregnant adults in that the USPSTF is unsure about the potential harms of pharmacotherapy in pregnancy and gives that an “I” statement.13 An additional “I” statement was made about the use of electronic cigarettes for smoking cessation; the USPSTF recommends using behavioral and pharmacotherapy interventions with proven effectiveness and safety instead.
Continue to: 4 additional recommendation updates with no changes
4 additional recommendation updates with no changes
Screening for high blood pressure in adults ages 18 years and older continues to receive an “A” recommendation.14 Importantly, the recommendation states that confirmation of high blood pressure should be made in an out-of-office setting before initiating treatment. Screening for vitamin D deficiency in adults and hearing loss in older adults both continue with “I” statements,15,16 and screening for asymptomatic carotid artery stenosis continues to receive a “D” recommendation.17 The implications of the vitamin D “I” statement were discussed in a previous Practice Alert.18
Continuing value of the USPSTF
The USPSTF continues to set the gold standard for assessment of preventive interventions, and its decisions affect first-dollar coverage by commercial health insurance. The reaffirmation of past recommendations demonstrates the value of adhering to rigorous evidence-based methods (if they are done correctly, they rarely must be markedly changed). And the updating of screening criteria shows the need to constantly review the evolving evidence for current recommendations. Once again, however, funding and staffing limitations allowed the USPSTF to assess only 1 new topic. A listing of all the 2021 recommendations is in TABLE 4.1
In 2021, the US Preventive Services Task Force (USPSTF) considered 13 topics and made a total of 23 recommendations. They reviewed only 1 new topic. The other 12 were updates of topics previously addressed; no changes were made in 9 of them. In 3, the recommended age of screening or the criteria for screening were expanded. This Practice Alert will review the recommendations made and highlight new recommendations and any changes to previous ones. All complete recommendation statements, rationales, clinical considerations, and evidence reports can be found on the USPSTF website at https://uspreventiveservicestaskforce.org/uspstf/home.1
Dental caries in children
Dental caries affect about 23% of children between the ages of 2 and 5 years and are associated with multiple adverse social outcomes and medical conditions.2 The best way to prevent tooth decay, other than regular brushing with fluoride toothpaste, is to drink water with recommended amounts of fluoride (≥ 0.6 parts fluoride per million parts water).2 The USPSTF reaffirmed its recommendation from 2014 that stated when a local water supply lacks sufficient fluoride, primary care clinicians should prescribe oral supplementation for infants and children in the form of fluoride drops starting at age 6 months. The dosage of fluoride depends on patient age and fluoride concentration in the local water (TABLE 13). The USPSTF also recommends applying topical fluoride as 5% sodium fluoride varnish, every 6 months, starting when the primary teeth erupt.2
In addition to fluoride supplements and topical varnish, should clinicians perform screening examinations looking for dental caries? The USPSTF feels there is not enough evidence to assess this practice and gives it an “I” rating (insufficient evidence).
Preventive interventions in pregnancy
In 2021, the USPSTF assessed 3 topics related to pregnancy and prenatal care.
Screening for gestational diabetes. The USPSTF gave a “B” recommendation for screening at 24 weeks of pregnancy or after, but an “I” statement for screening prior to 24 weeks.4 Screening can involve a 1-step or 2-step protocol.
The 2-step protocol is most commonly used in the United States. It involves first measuring serum glucose after a nonfasting 50-g oral glucose challenge; if the resulting level is high, the second step is a 75- or 100-g oral glucose tolerance test lasting 3 hours. The 1-step protocol involves measuring a fasting glucose level, followed by a 75-g oral glucose challenge with glucose levels measured at 1 and 2 hours.
Healthy weight gain in pregnancy. This was the only new topic the USPSTF assessed last year. The resulting recommendation is to offer pregnant women behavioral counseling to promote healthy weight gain and to prevent excessive weight gain in pregnancy. The recommended weight gain depends on the mother’s prepregnancy weight status: 28 to 40 lbs if the mother is underweight; 25 to 35 lbs if she is not under- or overweight; 15 to 25 lbs if she is overweight; and 11 to 20 lbs if she is obese.5 Healthy weight gain contributes to preventing gestational diabetes, emergency cesarean sections, and infant macrosomia.
Continue to: Low-dose aspirin
Low-dose aspirin. Reaffirming a recommendation from 2014, the USPSTF advises low-dose aspirin (81 mg/d) starting after 12 weeks’ gestation for all pregnant women who are at high risk for preeclampsia. TABLE 26 lists high- and moderate-risk conditions for preeclampsia and the recommendation for the use of low-dose aspirin.
Sexually transmitted infections
Screening for both chlamydia and gonorrhea in sexually active females through age 24 years was given a “B” recommendation, reaffirming the 2014 recommendation.7 Screening for these 2 sexually transmitted infections (STIs) is also recommended for women 25 years and older who are at increased risk of STIs. Risk is defined as having a new sex partner, more than 1 sex partner, a sex partner who has other sex partners, or a sex partner who has an STI; not using condoms consistently; having a previous STI; exchanging sex for money or drugs; or having a history of incarceration.
Screen for both infections simultaneously using a nucleic acid amplification test, testing all sites of sexual exposure. Urine testing can replace cervical, vaginal, and urethral testing. Those found to be positive for either STI should be treated according to the most recent treatment guidelines from the Centers for Disease Control and Prevention (CDC). And sexual partners should be advised to undergo testing.8,9
The USPSTF could not find evidence for the benefits and harms of screening for STIs in men. Remember that screening applies to those who are asymptomatic. Male sex partners of those found to be infected should be tested, as should those who show any signs or symptoms of an STI. A recent Practice Alert described the most current CDC guidance for diagnosing and treating STIs.9
Type 2 diabetes and prediabetes
Screening for type 2 diabetes (T2D) and prediabetes is now recommended for adults ages 35 to 70 years who are overweight or obese.10 The age to start screening has been lowered to 35 years from the previous recommendation in 2015, which recommended starting at age 40. In addition, the recommendation states that patients with prediabetes should be referred for preventive interventions. It is important that referral is included in the statement because the Affordable Care Act mandates that USPSTF “A” and “B” recommendations must be covered by commercial health insurance with no copay or deductible.
Continue to: Screening can be conducted...
Screening can be conducted using a fasting plasma glucose or A1C level, or with an oral glucose tolerance test. Interventions that can prevent or delay the onset of T2D in those with prediabetes include lifestyle interventions that focus on diet and physical activity, and the use of metformin (although metformin has not been approved for this by the US Food and Drug Administration).
Changes to cancer screening recommendations
In 2021, the USPSTF reviewed and modified its recommendations on screening for 2 types of cancer: colorectal and lung.
For colorectal cancer, the age at which to start screening was lowered from 50 years to 45 years.11 Screening at this earlier age is a “B” recommendation, because, while there is benefit from screening, it is less than for older age groups. Screening individuals ages 50 to 75 years remains an “A” recommendation, and for those ages 76 to 85 years it remains a “C” recommendation. A “C” recommendation means that the overall benefits are small but some individuals might benefit based on their overall health and prior screening results. In its clinical considerations, the USPSTF recommends against screening in those ages 85 and older but, curiously, does not list it as a “D” recommendation. The screening methods and recommended screening intervals for each appear in TABLE 3.11
For lung cancer, annual screening using low-dose computed tomography (CT) was first recommended by the USPSTF in 2013 for adults ages 55 to 80 years with a 30-pack-year smoking history. Screening could stop once 15 years had passed since smoking cessation. In 2021, the USPSTF lowered the age to initiate screening to 50 years, and the smoking history threshold to 20 pack-years.12 If these recommendations are followed, a current smoker who does not quit smoking could possibly receive 30 annual CT scans. The recommendation does state that screening should stop once a person develops a health condition that significantly affects life expectancy or ability to have lung surgery.
For primary prevention of lung cancer and other chronic diseases through smoking cessation, the USPSTF also reassessed its 2015 recommendations. It reaffirmed the “A” recommendation to ask adults about tobacco use and, for tobacco users, to recommend cessation and provide behavioral therapy and approved pharmacotherapy.13 The recommendation differed for pregnant adults in that the USPSTF is unsure about the potential harms of pharmacotherapy in pregnancy and gives that an “I” statement.13 An additional “I” statement was made about the use of electronic cigarettes for smoking cessation; the USPSTF recommends using behavioral and pharmacotherapy interventions with proven effectiveness and safety instead.
Continue to: 4 additional recommendation updates with no changes
4 additional recommendation updates with no changes
Screening for high blood pressure in adults ages 18 years and older continues to receive an “A” recommendation.14 Importantly, the recommendation states that confirmation of high blood pressure should be made in an out-of-office setting before initiating treatment. Screening for vitamin D deficiency in adults and hearing loss in older adults both continue with “I” statements,15,16 and screening for asymptomatic carotid artery stenosis continues to receive a “D” recommendation.17 The implications of the vitamin D “I” statement were discussed in a previous Practice Alert.18
Continuing value of the USPSTF
The USPSTF continues to set the gold standard for assessment of preventive interventions, and its decisions affect first-dollar coverage by commercial health insurance. The reaffirmation of past recommendations demonstrates the value of adhering to rigorous evidence-based methods (if they are done correctly, they rarely must be markedly changed). And the updating of screening criteria shows the need to constantly review the evolving evidence for current recommendations. Once again, however, funding and staffing limitations allowed the USPSTF to assess only 1 new topic. A listing of all the 2021 recommendations is in TABLE 4.1
1. USPSTF. Recommendation topics. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation-topics
2. USPSTF. Prevention of dental caries in children younger than 5 years: screening and interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1#bootstrap-panel—4
3. ADA. Dietary fluoride supplements: evidence-based clinical recommendations. Accessed April 14, 2022. www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/ada_evidence-based_fluoride_supplement_chairside_guide.pdf?rev=60850dca0dcc41038efda83d42b1c2e0&hash=FEC2BBEA0C892FB12C098E33344E48B4
4. USPSTF. Gestational diabetes: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening
5. USPSTF. Healthy weight and weight gain in pregnancy: behavioral counseling interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/healthy-weight-and-weight-gain-during-pregnancy-behavioral-counseling-interventions
6. USPSTF. Aspirin use to prevent preeclampsia and related morbidity and mortality: preventive medication. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication
7. USPSTF. Chlamydia and gonorrhea: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening
8. Workowski KA, Bauchman LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70:1-187.
9. Campos-Outcalt D. CDC guidelines on sexually transmitted infections. J Fam Pract. 2021;70:506-509.
10. USPSTF. Prediabetes and type 2 diabetes: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
11. USPSTF. Colorectal cancer: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
12. USPSTF. Lung cancer: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
13. USPSTF. Tobacco smoking cessation in adults, including pregnant persons: interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions
14. USPSTF. Hypertension in adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening
15. USPSTF. Vitamin D deficiency in adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/vitamin-d-deficiency-screening
16. USPSTF. Hearing loss in older adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/hearing-loss-in-older-adults-screening
17. USPSTF. Asymptomatic carotid artery stenosis: screening. Access April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/carotid-artery-stenosis-screening
18. Campos-Outcalt D. How to proceed when it comes to vitamin D. J Fam Pract. 2021;70:289-292.
1. USPSTF. Recommendation topics. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation-topics
2. USPSTF. Prevention of dental caries in children younger than 5 years: screening and interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/prevention-of-dental-caries-in-children-younger-than-age-5-years-screening-and-interventions1#bootstrap-panel—4
3. ADA. Dietary fluoride supplements: evidence-based clinical recommendations. Accessed April 14, 2022. www.ada.org/-/media/project/ada-organization/ada/ada-org/files/resources/research/ada_evidence-based_fluoride_supplement_chairside_guide.pdf?rev=60850dca0dcc41038efda83d42b1c2e0&hash=FEC2BBEA0C892FB12C098E33344E48B4
4. USPSTF. Gestational diabetes: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening
5. USPSTF. Healthy weight and weight gain in pregnancy: behavioral counseling interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/healthy-weight-and-weight-gain-during-pregnancy-behavioral-counseling-interventions
6. USPSTF. Aspirin use to prevent preeclampsia and related morbidity and mortality: preventive medication. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/low-dose-aspirin-use-for-the-prevention-of-morbidity-and-mortality-from-preeclampsia-preventive-medication
7. USPSTF. Chlamydia and gonorrhea: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/chlamydia-and-gonorrhea-screening
8. Workowski KA, Bauchman LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70:1-187.
9. Campos-Outcalt D. CDC guidelines on sexually transmitted infections. J Fam Pract. 2021;70:506-509.
10. USPSTF. Prediabetes and type 2 diabetes: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
11. USPSTF. Colorectal cancer: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
12. USPSTF. Lung cancer: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
13. USPSTF. Tobacco smoking cessation in adults, including pregnant persons: interventions. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions
14. USPSTF. Hypertension in adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/hypertension-in-adults-screening
15. USPSTF. Vitamin D deficiency in adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/vitamin-d-deficiency-screening
16. USPSTF. Hearing loss in older adults: screening. Accessed April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/hearing-loss-in-older-adults-screening
17. USPSTF. Asymptomatic carotid artery stenosis: screening. Access April 14, 2022. https://uspreventiveservicestaskforce.org/uspstf/recommendation/carotid-artery-stenosis-screening
18. Campos-Outcalt D. How to proceed when it comes to vitamin D. J Fam Pract. 2021;70:289-292.
