Draft Recommendation Statement
#Cervical Cancer: #Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/cervical-cancer-screening2

-The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women ages 21 to 29 years. The USPSTF recommends either screening every 3 years with cervical cytology alone or every 5 years with high-risk human papillomavirus (hrHPV) testing alone in women ages 30 to 65 years.
See the Clinical Considerations section for the relative benefits and harms of alternative screening strategies for women age 30 years or older

- The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer.
See the Clinical Considerations section for a discussion of adequate prior screening and risk factors that support screening after age 65 years

- The USPSTF recommends against screening for cervical cancer in women younger than age 21 years

- The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion (i.e., cervical intraepithelial neoplasia CIN grade 2 or 3) or cervical cancer

The cost-effectiveness of one-time hepatitis #C #screening strategies among adolescents and young adults in primary care settings
https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/cix798/4108208/The-cost-effectiveness-of-one-time-hepatitis-C?redirectedFrom=fulltext

High hepatitis C virus (HCV) rates have been reported in young people who inject drugs (PWID). We evaluated the clinical benefit and cost-effectiveness of testing among youth seen in communities with a high overall number of reported HCV cases

.. Counselor-initiated routine rapid testing was associated with an ICER of $71,000/QALY gained. Results were sensitive to offer and result receipt rates. Counselor-initiated routine rapid testing was cost-effective (ICER <$100,000/QALY) unless the prevalence of PWID was < 0.59%, HCV prevalence among PWID <16%, reinfection rate >26 cases per 100 person-years, or reflex confirmatory testing followed all reactive venipuncture diagnostics. In PSA, routine rapid was the optimal strategy in 90% of simulations.

Conclusions
Routine rapid HCV testing among 15 to 30-year-olds may be cost-effective when the prevalence of PWID > 0.59%

Draft Recommendation Statement
#Osteoporosis to Prevent Fractures: #Screening
https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/osteoporosis-screening1

USPSTF Assessment
The USPSTF concludes with moderate certainty that the net benefit of screening for osteoporosis in women age 65 years and older is at least moderate.
The USPSTF concludes with moderate certainty that the net benefit of screening for osteoporosis in postmenopausal women younger than age 65 years who are at increased risk of osteoporosis is at least moderate.
The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men.

A simple #screening test to recognize #fibromyalgia in primary care patients with chronic pain
https://www.ncbi.nlm.nih.gov/pubmed/29063661

Primary care providers are increasingly expected to recognize and treat fibromyalgia (FM) without significant interaction with rheumatologists. The purpose of this study was to evaluate the potential usefulness of 3 simple measures (tenderness to digital pressure, BP cuff-evoked pain, and a single patient question , "I have a persistent deep aching over most of my body" (0-10) as a screening test for possible FM in a patient with chronic pain

FM patients endorsed the single deep ache question substantially more than those with chronic pain but without FM (7.4 ± 2.9 vs 3.2 ± 3.4; P < .0001) and exhibited greater bilateral digital evoked tenderness (6.1 ± 3.1 vs 2.4 ± 2.4, P < 0.0001), and BP-evoked pressure pain (132.6 mmHg ±45.5 vs 169.2 mmHg ±48.0, P < 0.0001). However, on multivariate logistic regressions, the BP cuff-evoked pain became non-significant. On further analyses, a useful screening test was provided by: (1) pain on pinching the Achilles tendon at 4 kg/pressure over 4 seconds, and (2) and positive endorsement of the question "I have a persistent deep aching over most of my body".

CONCLUSION:
These results suggest that 2 tests, taking less than 1 minute, can indicate a probable diagnosis of FM in a chronic pain patient. In the case of a positive screen, a follow-up examination is required for confirmation or refutation.

#Screening in the community to reduce #fractures in older women (SCOOP): a randomised controlled trial
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32640-5/fulltext

We did a two-arm randomised controlled trial in women aged 70–85 years to compare a screening programme using the Fracture Risk Assessment Tool (FRAX) with usual management

Treatment was recommended in 898 (14%) of 6233 women. Use of osteoporosis medication was higher at the end of year 1 in the screening group compared with controls (15% vs 4%), with uptake particularly high (78% at 6 months) in the screening high-risk subgroup. Screening did not reduce the primary outcome of incidence of all osteoporosis-related fractures (hazard ratio HR 0·94, 95% CI 0·85–1·03, p=0·178), nor the overall incidence of all clinical fractures (0·94, 0·86–1·03, p=0·183), but screening reduced the incidence of hip fractures (0·72, 0·59–0·89, p=0·002). There was no evidence of differences in mortality, anxiety levels, or quality of life.

Interpretation
Systematic, community-based screening programme of fracture risk in older women in the UK is feasible, and could be effective in reducing hip fractures

#Screening for Adolescent Idiopathic #Scoliosis
US Preventive Services Task Force Recommendation Statement
https://jamanetwork.com/journals/jama/fullarticle/2668355

Adolescent idiopathic scoliosis, a lateral curvature of the spine of unknown cause with a Cobb angle of at least 10°, occurs in children and adolescents aged 10 to 18 years. Idiopathic scoliosis is the most common form and usually worsens during adolescence before skeletal maturity. Severe spinal curvature may be associated with adverse long-term health outcomes (eg, pulmonary disorders, disability, back pain, psychological effects, cosmetic issues, and reduced quality of life). Early identification and effective treatment of mild scoliosis could slow or stop curvature progression before skeletal maturity, thereby improving long-term outcomes in adulthood however, evidence on the association between reduction in spinal curvature in adolescence and long-term health outcomes in adulthood is inadequate. The USPSTF found inadequate evidence on the harms of treatment. Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for adolescent idiopathic scoliosis cannot be determined.

Conclusions and Recommendation The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents aged 10 to 18 years. (I statement)

!!
Performance of the 2015 US Preventive Services Task Force #Screening Criteria for Prediabetes and Undiagnosed #Diabetes

https://link.springer.com/article/10.1007%2Fs11606-018-4436-4


Dysglycemia was defined by A1c ≥ 5.7%, FPG ≥ 100 mg/dL, and/or 2-h PG ≥ 140 mg/dL.

Key results
Among the US adult population without diagnosed diabetes, 49.7% had dysglycemia. Screening based on the limited criteria demonstrated a sensitivity of 47.3% (95% CI, 44.7–50.0%) and specificity of 71.4% (95% CI, 67.3–75.2%). The expanded criteria yielded higher sensitivity 76.8% (95% CI, 73.5–79.8%) and lower specificity 33.8% (95% CI, 30.1–37.7%). Point estimates for the sensitivity of the limited criteria were lower in all minority groups and significantly different for Asians compared to non-Hispanic whites 29.9% (95% CI, 23.4–37.2%) vs. 49.8% (95% CI, 45.9–53.7%); P < .001.

Conclusions
Diabetes screening that follows the limited USPSTF criteria will identify approximately half of US adults with dysglycemia. Screening other high-risk subgroups defined in the USPSTF recommendation would improve detection of dysglycemia and may reduce associated racial/ethnic disparities

!!
#Colorectal cancer #screening for average‐risk adults: 2018 guideline update from the American Cancer Society

https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21457


The ACS Guideline Development Group applied the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria in developing and rating the recommendations. The ACS recommends that adults aged 45 years and older with an average risk of CRC undergo regular screening with either a high‐sensitivity stool‐based test or a structural (visual) examination, depending on patient preference and test availability. As a part of the screening process, all positive results on noncolonoscopy screening tests should be followed up with timely colonoscopy. The recommendation to begin screening at age 45 years is a qualified recommendation. The recommendation for regular screening in adults aged 50 years and older is a strong recommendation.

The ACS recommends (qualified recommendations) that: 1) average‐risk adults in good health with a life expectancy of more than 10 years continue CRC screening through the age of 75 years; 2) clinicians individualize CRC screening decisions for individuals aged 76 through 85 years based on patient preferences, life expectancy, health status, and prior screening history; and 3) clinicians discourage individuals older than 85 years from continuing CRC screening. The options for CRC screening are: fecal immunochemical test annually; high‐sensitivity, guaiac‐based fecal occult blood test annually; multitarget stool DNA test every 3 years; colonoscopy every 10 years; computed tomography colonography every 5 years; and flexible sigmoidoscopy every 5 years

!!
#Screening for Cardiovascular Disease Risk With #Electrocardiography
US Preventive Services Task Force Recommendation Statement

https://jamanetwork.com/journals/jama/fullarticle/2684613

For asymptomatic adults at low risk of CVD events (individuals with a 10-year CVD event risk less than 10%), it is very unlikely that the information from resting or exercise ECG (beyond that obtained with conventional CVD risk factors) will result in a change in the patient’s risk category as assessed by the Framingham Risk Score or Pooled Cohort Equations that would lead to a change in treatment and ultimately improve health outcomes. Possible harms are associated with screening with resting or exercise ECG, specifically the potential adverse effects of subsequent invasive testing. For asymptomatic adults at intermediate or high risk of CVD events, there is insufficient evidence to determine the extent to which information from resting or exercise ECG adds to current CVD risk assessment models and whether information from the ECG results in a change in risk management and ultimately reduces CVD events. As with low-risk adults, possible harms are associated with screening with resting or exercise ECG in asymptomatic adults at intermediate or high risk of CVD events.

Conclusions and Recommendation The USPSTF recommends against screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at low risk of CVD events. (D recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening with resting or exercise ECG to prevent CVD events in asymptomatic adults at intermediate or high risk

!!
Benefits and harms of #screening men for abdominal aortic #aneurysm in Sweden: a registry-based cohort study


https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31031-6/fulltext

AAA mortality in Swedish men has decreased from 36 to ten deaths per 100 000 men aged 65–74 years between the early 2000s and 2015. Mortality decreased at similar rates in all Swedish counties, irrespective of whether AAA screening was offered. After 6 years with screening, we found a non-significant reduction in AAA mortality associated with screening (adjusted odds ratio aOR 0·76, 95% CI 0·38–1·51), which means that two men (95% CI −3 to 7) avoid death from AAA for every 10 000 men offered screening. Screening was associated with increased odds of AAA diagnosis (aOR 1·52, 95% CI 1·16–1·99; p=0·002) and an increased risk of elective surgery (aOR 1·59, 95% CI 1·20–2·10; p=0·001), such that for every 10 000 men offered screening, 49 men (95% CI 25–73) were likely to be overdiagnosed, 19 of whom (95% CI 1–37) had avoidable surgery that increased their risk of mortality and morbidity.

Interpretation
AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality. The reductions were mostly caused by other factors, probably reduced smoking. The small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question

!!
#Screening for #Osteoporosis to Prevent Fractures
US Preventive Services Task Force Recommendation Statement

https://jamanetwork.com/journals/jama/fullarticle/2685995


The USPSTF found convincing evidence that bone measurement tests are accurate for detecting osteoporosis and predicting osteoporotic fractures in women and men. The USPSTF found adequate evidence that clinical risk assessment tools are moderately accurate in identifying risk of osteoporosis and osteoporotic fractures. The USPSTF found convincing evidence that drug therapies reduce subsequent fracture rates in postmenopausal women. The USPSTF found that the evidence is inadequate to assess the effectiveness of drug therapies in reducing subsequent fracture rates in men without previous fractures.

Conclusions and Recommendation The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older. (B recommendation) The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men. (I statement)

!!
Commence #CRC #Screening at Age 45, ACS Recommends

https://www.aafp.org/news/health-of-the-public/20180605acscrcscreen.html


STORY HIGHLIGHTS
On May 30, the American Cancer Society released an updated guideline recommending that colorectal cancer (CRC) screening begin at age 45 for patients at average risk.

This guideline differs from the latest recommendation by the U.S. Preventive Services Task Force (USPSTF) -- released June 2016 -- which recommends that screening for CRC begin at age 50 and continue through age 75 -- an "A" recommendation.

The AAFP agrees with the USPSTF's recommended screening of patients ages 50-75, although the Academy graded its recommendation a "B" and differed from the task force by offering a preferential recommendation that specific screening tests be used

!!
#Screening for #Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians

https://annals.org/aim/fullarticle/2730520/screening-breast-cancer-average-risk-women-guidance-statement-from-american

Guidance Statement 1:
In average-risk women aged 40 to 49 years, clinicians should discuss whether to screen for breast cancer with mammography before age 50 years. Discussion should include the potential benefits and harms and a woman's preferences. The potential harms outweigh the benefits in most women aged 40 to 49 years.

Guidance Statement 2:
In average-risk women aged 50 to 74 years, clinicians should offer screening for breast cancer with biennial mammography.

Guidance Statement 3:
In average-risk women aged 75 years or older or in women with a life expectancy of 10 years or less, clinicians should discontinue screening for breast cancer.

Guidance Statement 4:
In average-risk women of all ages, clinicians should not use clinical breast examination to screen for breast cancer

!!
Draft Recommendation Statement
Hepatitis #C Virus Infection in Adolescents and Adults: #screening

https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/hepatitis-c-screening1

There is adequate evidence that HCV testing (screening for the anti-HCV antibody followed by confirmation of active infection by HCV RNA for persons who test positive) accurately detects HCV infection.

There is adequate evidence for one-time testing in all adults and periodic testing in persons at continued risk of new HCV infection.

There is inadequate evidence on the timing of repeat testing..

The USPSTF concludes with moderate certainty that screening for HCV infection in adults ages 18 to 79 years has substantial net benefit.