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Selected Preventative Screening Recommendations

Preventive screenings are an important part of health promotion efforts. Many preventive screenings have been recognized as a cost-effective way to identify and treat potential health problems before they develop or worsen. However, it can be challenging to keep up with the latest scientific thinking regarding screenings. Age- and gender-specific preventive screening recommendations exist for dozens of health concerns, but the recommendations may vary from organization to organization, and are frequently changed as new information becomes available. This can create confusion for workforce heath promotion (WHP) planners—when and how often should employees get a particular screening? This document is not intended to offer an opinion on which services WHP planners should promote at their workplace, but provides planners with the recommendations of the U.S. Preventive Services Task Force (USPSTF) and other organizations for selected health screenings. With this information, WHP planners can design and promote screenings to their employees as appropriate.

About this Document

The USPSTF was convened by the Public Health Service to rigorously evaluate clinical research in order to assess the merits of preventive measures, including screening tests, counseling, immunizations, and preventive medications. The following information identifies the health concern, provides the recommendation of the USPSTF as well as additional health screening information from the USPSTF, and provides links to recommendations from other agencies that are independent of the USPSTF recommendations. The USPSTF information is from their 2nd and 3rd edition of The Clinical Guide, but includes only those recommendations that are appropriate for a working-age audience, age 18-65. Recommendations from other organizations may or may not have been cited by the USPSTF and are included if the recommendation is accessible via Internet link.

The links to recommendations from other organizations is not intended to be exhaustive and does not constitute an endorsement of any organization by CDC or the federal government, and none should be inferred. CDC is not responsible for the content of Web pages found at non-federal links.

Information on the following screenings is provided:

Alcohol Misuse Breast Cancer Cervical Cancer Chlamydial Infection Colorectal Cancer Dental and Periodontal Disease Depression Diabetes Mellitus, Adult type 2 Glaucoma Hearing Impairment Hepatitis B Virus Hepatitis C Virus

Human Immunodeficiency Virus High Blood Pressure Lipid Disorders Obesity in Adults Oral Cancer Osteoporosis Prostate Cancer Skin Cancer Tobacco Use Visual Impairment

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Screening for Alcohol Misuse

USPSTF Recommendation

• The USPSTF recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings.
• USPSTF Additional Health Screening Information (PDF-137k)

Recommendations of other Organizations

• American Medical Association American* (PDF-55k)
• Society of Addiction Medicine*
• Canadian Task Force on Preventive Health Care*

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Screening for Breast Cancer

USPSTF Recommendation

• The USPSTF recommends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older.
• The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer.
• The USPSTF concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE).
• USPSTF Additional Health Screening Information (PDF-92k)
  The USPSTF found fair evidence that mammography screening every 12-33 months significantly reduces mortality from breast cancer. Evidence is strongest for women aged 50-69, the age group generally included in screening trials. For women aged 40-49, the evidence that screening mammography reduces mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller, than it is for older women.

Recommendations of other Organizations

• American Medical Association*
• American College of Obstetricians and Gynecologists*
• American Cancer Society*
• Canadian Task Force on Preventive Health Care*
• American College of Preventive Medicine*
• National Institutes of Health

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Screening for Cervical Cancer

USPSTF Recommendation

• The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix.
• The USPSTF recommends against routinely screening women older than age 65 if they have had adequate recent screening with normal Pap smears and are not otherwise at increased risk for cervical cancer.
• The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease.
• The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer.
• The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer.
• USPSTF Additional Health Screening Information (PDF-90k)
  Direct evidence to determine the optimal starting and stopping age and interval for screening is limited. Indirect evidence suggests most of the benefit can be obtained by beginning screening within 3 years of the onset of sexual activity or age 21 (whichever comes first) and screening at least every 3 years.

Recommendations of other Organizations

• American Cancer Society (ACS)*
• American College of Preventive Medicine (ACPM)*
• American Medical Association (AMA)*
• American College of Obstetricians and Gynecologists*
• Canadian Task Force on Preventive Health Care*

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Screening for Chlamydial Infection

USPSTF Recommendation

• The USPSTF strongly recommends that clinicians routinely screen all sexually active women aged 25 years and younger, and other asymptomatic women at increased risk for infection, for chlamydial infection.
• The USPSTF makes no recommendation for or against routinely screening asymptomatic low-risk women in the general population for chlamydial infection.
• The USPSTF recommends that clinicians routinely screen all asymptomatic pregnant women aged 25 years and younger and others at increased risk for infection for chlamydial infection.
• The USPSTF makes no recommendation for or against routine screening of asymptomatic, low-risk pregnant women aged 26 years and older for chlamydial infection.
• The USPSTF concludes that the evidence is insufficient to recommend for or against routinely screening asymptomatic men for chlamydial infection.
• USPSTF Additional Health Screening Information (PDF-68k)
  The USPSTF found good evidence that screening women at risk for chlamydial infection reduces the incidence of pelvic inflammatory disease and fair evidence that community-based screening reduces prevalence of chlamydial infection. The USPSTF concludes that the benefits of screening substantially outweigh the potential harms.

Recommendations of other Organizations

• Centers for Disease Control and Prevention
• American College of Preventive Medicine* (PDF-99K)
• Canadian Task Force on Preventive Health Care*

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Screening for Colorectal Cancer

USPSTF Recommendation

• The USPSTF strongly recommends that clinicians screen men and women 50 years of age or older for colorectal cancer.
• USPSTF Additional Health Screening Information (PDF-62K)
  The USPSTF found fair to good evidence that several screening methods are effective in reducing mortality from colorectal cancer. In persons at higher risk (for example, those with a first-degree relative who receives a diagnosis with colorectal cancer before 60 years of age), initiating screening at an earlier age is reasonable.

Recommendations of other Organizations

• American Cancer Society*
• American Society of Colon and Rectal Surgeons*
• American Gastroenterological Association*
• Canadian Task Force on Preventive Health Care*

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Screening for Dental and Periodontal Disease

USPSTF Recommendation

• The USPSTF makes no recommendations on this screening.

Recommendations of other Organizations

• American Dental Association*

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Screening for Depression

USPSTF Recommendation

• The U.S. Preventive Services Task Force (USPSTF) recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up.
• USPSTF Additional Health Screening Information (PDF-78k)

Recommendations of other Organizations

• Canadian Task Force on Preventive Health Care*

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Screening for Diabetes Mellitus, Adult type 2

USPSTF Recommendation

• The USPSTF concludes the evidence is insufficient to recommend for or against routinely screening asymptomatic adults for type 2 diabetes, impaired glucose tolerance, or impaired fasting glucose.
• The USPSTF recommends screening for type 2 diabetes in adults with hypertension or hyperlipidemia.
• USPSTF Additional Health Screening Information (PDF-98k)
  The USPSTF found good evidence that available screening tests can accurately detect type 2 diabetes during an early, asymptomatic phase.

Recommendations of other Organizations

• American Diabetes Association*
• Canadian Task Force for Preventive Health Care*

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Screening for Glaucoma

USPSTF Recommendation

• The U.S. Preventive Services Task Force (USPSTF) found insufficient evidence to recommend for or against screening adults for glaucoma.
• USPSTF Additional Health Screening Information (PDF-90k)
  The USPSTF found good evidence that screening can detect increased intraocular pressure and early primary open-angle glaucoma in adults. The evidence, however, is insufficient to determine the extent to which screening would reduce impairment in vision-related function or quality of life.

Recommendations of other Organizations

• American Academy of Ophthalmology*
  http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZC6A6EIVC&sub_cat=2012

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Screening for Hearing Impairment

USPSTF Recommendation

• There is insufficient evidence to recommend for or against routinely screening asymptomatic adolescents and working-age adults for hearing impairment. Recommendations against such screening, except for those exposed to excessive occupational noise levels, may be made on other grounds.
• USPSTF Additional Health Screening Information (PDF-131K)
  Screening for older adults for hearing impairment is recommended through:
  • Periodically questioning them about their hearing
  • Counseling them about the availability of hearing aid devices
  • Making referrals for abnormalities when appropriate

Recommendations of other Organizations

• Speech-Language-Hearing Association*
• Canadian Task Force on Preventive Health Care*

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Screening for Hepatitis B Virus

USPSTF Recommendation

• The USPSTF strongly recommends screening for HBV infection in pregnant women at their first prenatal visit.
• The USPSTF recommends against routinely screening the general asymptomatic population for chronic HBV infection.
• USPSTF Additional Health Screening Information (PDF-130k)

Recommendations of other Organizations

• Advisory Committee on Immunization Practices

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Screening for Hepatitis C Virus

USPSTF Recommendation

• The USPSTF recommends against routine screening for HCV infection in asymptomatic adults who are not at increased risk for infection.
• The USPSTF found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk for infection.
• USPSTF Additional Health Screening Information (PDF-201K)

Recommendations of other Organizations

• National Institutes of Health Consensus Panel
• Centers for Disease Control and Prevention (PDF-490K)

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Screening for Human Immunodeficiency Virus

USPSTF Recommendation

• There is insufficient evidence to recommend for or against universal screening among low-risk pregnant women in low-prevalence areas, but recommendations to counsel and offer screening to all pregnant women may be made on other grounds.
• USPSTF Additional Health Screening Information (PDF-152k)
  Clinicians should assess risk factors for human immunodeficiency virus (HIV) infection by obtaining a careful sexual history and inquiring about injection drug use in all patients: Periodic screening for infection with HIV is recommended for all persons at increased risk of infection. Screening is recommended for all pregnant women at risk for HIV infection, including all women who live in states, counties, or cities with an increased prevalence of HIV infection. All patients should be counseled about effective means to avoid HIV infection.

Recommendations of other Organizations

• Joint National Committee (JNC)
• Canadian Task Force on Preventive Health Care*
• American Academy of Family Physicians* (PDF-318k)

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Screening for High Blood Pressure

USPSTF Recommendation

• The USPSTF strongly recommends that clinicians routinely screen men aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in people who are at increased risk of coronary heart disease.
• The USPSTF recommends that clinicians routinely screen younger adults (men aged 20 to 35 years and women aged 20 to 45 years) for lipid disorders if they have other risk factors for coronary heart disease.
• The USPSTF makes no recommendation for or against routine screening for lipid disorders in younger adults (men aged 20 to 35 or women aged 20 to 45) in the absence of known risk factors for coronary heart disease.
• The USPSTF recommends that screening for lipid disorders include measurement of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C).
• The USPSTF concludes that the evidence is insufficient to recommend for or against triglyceride measurement as a part of routine screening for lipd disorders.
• USPSTF Additional Health Screening Information (PDF-68k)
  The USPSTF found good evidence that lipid measurement can identify asymptomatic middle-aged people at increased risk of coronary heart disease and good evidence that lipid-lowering drug therapy substantially decreases the incidence of coronary heart disease in such people with abnormal lipids and causes few major harms.

Recommendations of other Organizations

• Canadian Task Force on Preventive Health Care*
• American Medical Association*
   

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Screening for Lipid Disorders

USPSTF Recommendation

• The USPSTF strongly recommends that clinicians routinely screen men aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in people who are at increased risk of coronary heart disease.
• The USPSTF recommends that clinicians routinely screen younger adults (men aged 20 to 35 years and women aged 20 to 45 years) for lipid disorders if they have other risk factors for coronary heart disease.
• The USPSTF makes no recommendation for or against routine screening for lipid disorders in younger adults (men aged 20 to 35 or women aged 20 to 45) in the absence of known risk factors for coronary heart disease.
• The USPSTF recommends that screening for lipid disorders include measurement of total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C).
• The USPSTG concludes that the evidence is insufficient to recommend for or against triglyceride measurement as a part of routine screening for lipd disorders.
• USPSTF Additional Health Screening Information (PDF-68K)
  The USPSTF found good evidence that lipid measurement can identify asymptomatic middle-aged people at increased risk of coronary heart disease and good evidence that lipid-lowering drug therapy substantially decreases the incidence of coronary heart disease in such people with abnormal lipids and causes few major harms.

Recommendations of other Organizations

• Canadian Task Force on Preventive Health Care*
• American Medical Association*

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Screening for Obesity in Adults

USPSTF Recommendation

• The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults.
• The USPSTF concludes that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults.
• The USPSTF concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults.
• USPSTF Additional Health Screening Information (PDF-162k)
  The USPSTF found good evidence that body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, is reliable and valid for identifying adults at increased risk for mortality and morbidity due to overweight and obesity.

Recommendations of other Organizations

• Canadian Task Force on Preventive Health Care*
• American Academy of Family Physicians* (PDF-318K)
• National Institute on Health (PDF-127k)
• American College of Preventive Medicine* (PDF-138k)
• American Diabetes Association*

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Screening for Oral Cancer

USPSTF Recommendation

• The USPSTF concludes that the evidence is insufficient to recommend for or against routinely screening adults for oral cancer.
• USPSTF Additional Health Screening Information (PDF-63K)

Recommendations of other Organizations

• American Cancer Society*
• Canadian Task Force on Preventive Health Care*
• National Cancer Institute
• National Institute of Dental Research
• American Dental Association*

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Screening for Osteoporosis

USPSTF Recommendation

• The USPSTF recommends that women aged 65 and older be screened routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic.
• The USPSTF makes no recommendation for or against routine osteoporosis screening in postmenopausal women who are younger than 60 or in women aged 60-64 who are not at increased risk for osteoporotic fractures.
• USPSTF Additional Health Screening Information (PDF-86k)

Recommendations of other Organizations

• National Osteoporosis Foundation*
• U.S. National Institutes of Health
• Canadian Task Force on Preventive Health Care*

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Screening for Prostate Cancer

USPSTF Recommendation

• The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for prostate cancer using prostate specific antigen (PSA) testing or digital rectal examination (DRE).
• USPSTF Additional Health Screening Information (PDF-67k)
  The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes.

Recommendations of other Organizations

• American Cancer Society*
• American Medical Association*
• American Urologic Association* (PDF-247k)
• Canadian Task Force on Preventive Health Care*
• American College of Preventive Medicine* (PDF-75k)

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Screening for Skin Cancer

USPSTF Recommendation

•  The USPSTF concludes that the evidence is insufficient to recommend for or against routine screening for skin cancer using a total-body skin examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer.
• USPSTF Additional Health Screening Information (PDF-62K)

Recommendations of other Organizations

• Canadian Task Force on Preventive Health Care*
• American Cancer Society*
• American College of Preventive Medicine* (PDF-64k)
• National Cancer Institute

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Screening for Tobacco Use

USPSTF Recommendation

• The USPSTF strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products.
• The USPSTF strongly recommends that clinicians screen all pregnant women for tobacco use and provide augmented pregnancy-tailored counseling to those who smoke.
• USPSTF Additional Health Screening Information (PDF-196k)

Recommendations of other Organizations

• Canadian Task Force on Preventive Health Care*
• U.S. Public Health Service
• Guide to Community Preventive Services*

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Screening for Visual Impairment

USPSTF Recommendation

• Screening for diminished visual acuity with the Snellen visual acuity chart is recommended for elderly persons. There is insufficient evidence to recommend for or against screening for diminished visual acuity among other asymptomatic persons, but recommendations against routine screening may be made on other grounds.
• USPSTF Additional Health Screening Information (PDF-120k)

Recommendations of other Organizations

• American Academy of Ophthalmology*
  http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ08DZO3SC&sub_cat=118

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