Examples of Important Preventive Services Addressed by the U.S. Preventive Services Task Force in the 1995 Guide to Clinical Preventive Services


Examples of Preventive Services Recommended for Routine Use

Screening for Colorectal Cancer

Condition: Colorectal cancer causes 55,000 deaths each year and is the second most common form of cancer in the U.S.

1995 Recommendation: Screening for colorectal cancer is recommended for all persons aged 50 and older, using sigmoidoscopy, annual fecal occult blood testing, or both. The optimal interval between sigmoidoscopic examinations is not established; a 10-year interval may be adequate.

Change: The 1989 Guide to Clinical Preventive Services found insufficient evidence to recommend for or against routine screening for colorectal cancer.

Counseling To Prevent Tobacco Use

Condition: Tobacco use causes one of every five deaths in the U.S. each year, making it the most important preventable cause of premature death.

1995 Recommendation: Periodic counseling to stop tobacco use is recommended for all persons who use tobacco. Delivering anti-tobacco messages is recommended as part of health promotion counseling for children, adolescents, and young adults. The prescription of nicotine patches or gum is recommended as an adjunct to counseling to help selected patients quit tobacco use.

Change: The 1989 Guide also strongly recommended counseling to prevent tobacco use.

Screening for Breast Cancer

Condition: Breast cancer is the leading cause of cancer in women, accounting for 46,000 deaths annually.

1995 Recommendation: Screening for breast cancer with mammography every 1 or 2 years (with or without annual clinical breast examination) is recommended for all women ages 50 to 69 years of age. There is insufficient evidence to recommend for or against routine mammography or clinical breast examination for women aged less than 50 years or 70 years and older.

Change: In 1989 the Task Force recommended annual clinical breast examination for women aged 40 and older, and annual mammography for women ages 50 to 74.

Counseling To Prevent Injuries

Condition: Unintentional injuries account for about 89,000 deaths, 2.7 million hospitalizations, and 34 million emergency department visits each year, resulting in a lifetime economic cost of $182 billion. Almost half of unintentional injury deaths are due to motor vehicle crashes; the remainder are due to household, recreational, and other unintentional injuries.

1995 Recommendation: All patients should be counseled to use lap/shoulder belts and child safety seats (as appropriate for age) and to wear safety helmets when riding motorcycles. Adolescents and adults should refrain from driving or engaging in potentially dangerous activities such as swimming, boating, bicycling, or hunting while under the influence of alcohol or other drugs. Parents of young children should be counseled on measures to reduce the risk of unintentional household and recreational injuries, and such counseling may also be beneficial for adult patients. Examples of recommended preventive measures include smoke detectors, bicycle helmets, swimming pool isolation fences, and the safe storage or removal of firearms from the home.

Change: The new Guide makes a stronger recommendation for counseling parents of young children on measures to prevent household and recreational injuries.


Example of Preventive Service Recommended for Targeted Use

Screening for High Blood Cholesterol and Other Lipid Abnormalities

Condition: Elevated blood cholesterol is one of the major modifiable risk factors for coronary heart disease, which is the leading cause of death in the U.S.

1995 Recommendation: Periodic screening for high blood cholesterol is recommended for all men ages 35-65 and women ages 45-65. Screening may be recommended on other grounds for healthy persons ages 65-75, adolescents, and young adults, when they have major coronary risk factors (smoking, hypertension, diabetes). Recommendations against routinely screening children may be made based on potential risks and costs. There is insufficient evidence to recommend for or against routine screening for other lipid abnormalities.

Change: The new Guide makes a stronger recommendation for screening middle-aged women than did the 1989 edition, but recommends more targeted cholesterol screening in young adults and elderly persons based on coronary disease risk.


Examples of Preventive Services Not Recommended for Routine Use

Screening for Prostate Cancer

Condition: Prostate cancer causes 40,000 deaths in the U.S. each year. Many older men, however, harbor small, slow-growing prostate cancers that will not cause significant symptoms during their lifetime.

1995 Recommendation: Routine screening for prostate cancer by measurement of prostate-specific antigen (PSA) or performance of digital rectal examination (DRE) is not recommended.

Change: The Task Force also recommended against PSA testing in 1989, but at that time found insufficient evidence to recommend for or against DRE.

Intrapartum Electronic Fetal Monitoring

Condition: Abnormal fetal heart rate and other early signs of fetal distress, reported in 4% of pregnancies, may be detectable by electronic fetal monitoring (EFM). These abnormalities may indicate lack of oxygen to the fetus. Severe lack of oxygen (asphyxia) causes a total of 700 stillbirths and neonatal deaths each year. The use of EFM doubles the likelihood of having a cesarean delivery.

1995 Recommendation: Routine electronic fetal monitoring is not recommended for low-risk women in labor when adequate clinical monitoring by trained staff is available. There is insufficient evidence to recommend for or against intrapartum EFM over clinical monitoring in high-risk pregnancies.

Change: In 1989 the Task Force recommended EFM for high-risk pregnancies. The recommendation for low-risk pregnancies was similar.


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