The rating scheme for the strength of the recommendation for or against a preventive intervention follows the "Major Recommendations" field.
Note from the National Guideline Clearinghouse (NGC): The following recommendations were current as of May 1, 2009. However, because the American Academy of Family Physicians (AAFP) updates their guidance frequently, users may wish to consult the AAFP Web site for the most recent version of the Summary of Recommendations for Clinical Preventive Services.
Summary of Recommendations for Clinical Preventive Services
Abdominal Aortic Aneurysm
The American Academy of Family Physicians (AAFP) recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 years who have ever smoked. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm#clinical)
The AAFP makes no recommendation for or against screening for abdominal aortic aneurysm in men aged 65 to 75 years who have never smoked. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm#clinical)
The AAFP recommends against routine screening for abdominal aortic aneurysm in women. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm#clinical)
Accidental Injury
The AAFP recommends counseling all parents and patients more than 2 years old regarding accidental injury prevention including, as appropriate: child safety seats, lap and shoulder belt use, bicycle safety, motorcycle helmet use, smoke detectors, poison control center number, and driving while intoxicated.
Alcohol Misuse
The AAFP recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings. (Clinical Consideration: http://www.ahrq.gov/clinic/uspstf/uspsdrin.htm)
The AAFP recognizes avoidance of alcohol products by adolescents is desirable. The effectiveness of physician's advice and counseling in this area is uncertain. (Clinical Consideration: http://www.ahrq.gov/clinic/uspstf/uspsdrin.htm)
Bacteriuria, Asymptomatic
The AAFP strongly recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks' gestation or at first prenatal visit, if later. (Clinical Consideration: http://www.ahrq.gov/clinic/uspstf/uspsbact.htm)
The AAFP recommends against the routine screening for asymptomatic bacteriuria in men and nonpregnant women. (Clinical Consideration: http://www.ahrq.gov/clinic/uspstf/uspsbact.htm)
Bacterial Vaginosis
The AAFP recommends against screening for bacterial vaginosis in asymptomatic pregnant women at low risk for preterm delivery. (Clinical Considerations: www.ahrq.gov/clinic/uspstf08/bv/bvrs.htm#clinical)
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for bacterial vaginosis in asymptomatic pregnant women at high-risk for preterm delivery. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/bv/bvrs.htm#clinical)
Behavioral Counseling to Prevent Sexually Transmitted Infections
The AAFP recommends high-intensity behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs. (Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/sti/stirs.htm#clinical)
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/sti/stirs.htm#clinical)
Bladder Cancer
The AAFP recommends against routine screening for bladder cancer in adults. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf/uspsblad.htm)
Breast Cancer
The AAFP recommends women age 40 years and older be screened for breast cancer with mammography every 1 to 2 years after counseling by their family physician regarding the potential risks and benefits of the procedure (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsbrca.htm)
The AAFP concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE). (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsbrca.htm)
Breast Cancer/Breast Cancer Susceptibility Gene (BRCA) Mutation Testing
The AAFP recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm#clinical)
The AAFP recommends against routine referral for genetic counseling or routine BRCA testing for women whose family history is not associated with increased risk for deleterious mutations in BRCA1 or BRCA2. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm#clinical)
Breastfeeding
The AAFP recommends interventions during pregnancy and after birth to promote and support breastfeeding. (Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/breastfeeding/brfeedrs.htm#clinical)
(For Definition of Interventions: http://www.ahrq.gov/clinic/uspstf/gradespost.htm)
Cardiac Disease
The AAFP recommends against the use of routine electrocardiogram (ECG) as part of a periodic health or preparticipation physical exam for cardiac disease in asymptomatic children and adults.
Carotid Artery Stenosis
The AAFP recommends against screening for asymptomatic carotid artery stenosis (CAS) in general adult populations. (Clinical Consideration: www.ahrq.gov/clinic/uspstf07/cas/casrs.htm#clinical)
Cervical Cancer
The AAFP concludes that there is insufficient evidence to recommend for or against routine use of new technologies to screen for cervical cancer. (Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical)
The AAFP concludes that there is insufficient evidence to recommend for or against routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer. (Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical)
The AAFP strongly recommends that a Pap smear be completed at least every 3 years to screen for cervical cancer for women who have ever had sex and have a cervix. (Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical)
Chlamydia
The AAFP strongly recommends screening for chlamydia infection for all sexually active non-pregnant young women aged 24 and younger and for older non-pregnant women who are at increased risk. (Clinical Considerations: www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm#clinicial)
The AAFP recommends against routinely providing screening for chlamydia infection for women aged 25 and older whether or not they are pregnant, if they are not at increased risk. (Clinical Considerations: www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm#clinicial)
The AAFP recommends screening for chlamydia infection for all pregnant women aged 24 younger and for older pregnant women who are at increased risk. (Clinical Considerations: www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm#clinicial)
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms screening for chlamydial infection for men. (Clinical Considerations: www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm#clinicial)
Colorectal Cancer
The AAFP strongly recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risk and benefits of these screening methods vary. (Go to Rationale and Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm)
The AAFP recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal cancer screening in an individual patient. (Go to Rationale and Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm)
The AAFP recommends against screening for colorectal cancer in adults older than age 85 years. (Go to Rationale and Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm)
The AAFP recommends against the routine use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer in individuals at average risk for colorectal cancer. (Clinical Considerations: www.ahrq.gov/clinic/uspstf07/aspcolo/aspcolors.htm#clinical)
The AAFP concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. (Go to Rationale and Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm)
Congenital Hypothyroidism
The AAFP strongly recommends screening for congenital hypothyroidism (CH) in newborns. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/conhypo/conhyprs.htm#clinical)
Congenital Rubella Syndrome
The AAFP recommends screening for congenital rubella syndrome by assuring rubella immunity by history, serology, or vaccination in women of childbearing potential.
Cardiovascular Disease, Aspirin for the Prevention of
The AAFP strongly recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical)
The AAFP strongly recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical)
The AAFP recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical)
The AAFP concludes that the evidence is insufficient to assess the benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical)
Coronary Heart Disease
The AAFP recommends against routine screening with resting electrocardiography (ECG), exercise treadmill test (ETT), or electron-beam computerized tomography (EBCT) scanning for coronary calcium for either the presence of severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD) events in adults at low risk for CHD events. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsacad.htm)
The AAFP found insufficient evidence to recommend for or against routine screening with ECG, ETT, EBCT scanning for coronary calcium for either the presence of severe CAS or the prediction of CHD events in adults at increased risk for CHD events. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsacad.htm)
Dental Caries
The AAFP strongly recommends ordering fluoride supplementation to prevent dental caries based on age and fluoride concentration of patient's water supply for infants and children age 6 months through 16 years residing in areas with inadequate fluoride in the water supply (less than 0.6 ppm).
Depression
The AAFP recommends screening adults for depression. (Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/depression/depressrr.htm#clinical)
The AAFP concludes that there is insufficient evidence on which to make a recommendation for or against routine screening of children or adolescents for depression. (Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/depression/depressrr.htm#clinical)
Diabetes, Type 2
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower. (Clinical Consideration: www.ahrq.gov/clinic/uspstf08/type2/type2rs.htm#clinical)
The AAFP recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg. (Clinical Consideration: www.ahrq.gov/clinic/uspstf08/type2/type2rs.htm#clinical)
Diphtheria
The AAFP strongly recommends immunizing all children for diphtheria using AAFP recommendations unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html
The AAFP strongly recommends immunizing adults for diphtheria by completing tetanus-diphtheria (Td) vaccine series if they haven't received primary series. Boosters every 10 years or at least at age 50. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html)
Dysplasia (Developmental) of the Hip in Infants
The AAFP concludes that the evidence is insufficient to recommend routine screening for developmental dysplasia of the hip in infants as a means to prevent adverse outcomes. (Clinical Considerations: www.ahrq.gov/clinic/uspstf06/hipdysp/hipdysrs.htm#clinical)
Family Violence and Intimate Partner Violence
The AAFP recognizes that all family physicians should be alert to physical and behavioral signs and symptoms associated with abuse or neglect. The AAFP concludes that the evidence is insufficient to recommend for or against screening of parents or guardians for the physical abuse or neglect of children, of adults or adolescents of either sex for intimate partner violence, or of older adults or their caregivers for elder abuse. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsfamv.htm)
Genital Herpes Simplex Virus Infection
The AAFP recommends against routine serological screening for herpes simplex virus (HSV) in asymptomatic pregnant women at any time during pregnancy to prevent neonatal HSV infection. (Clinical Considerations: www.ahrq.gov/clinic/uspstf05/herpes/herpesrs.htm#clinical)
The AAFP recommends against routine serological screening for herpes simplex virus in asymptomatic adolescents and adults. (Clinical Considerations: www.ahrq.gov/clinic/uspstf05/herpes/herpesrs.htm#clinical)
Glaucoma
The AAFP found insufficient evidence to recommend for or against screening adults for glaucoma. (Clinical Considerations:
www.ahrq.gov/clinic/uspstf05/glaucoma/glaucrs.htm#clinical)
Gonococcal Infection in Neonates
The AAFP strongly recommends prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorum. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/gonorrhea/gonrs.htm#clinical)
Gonorrhea
The AAFP recommends that clinicians screen all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk for infection (that is, if they are young or have other individual or population risk factors); see clinical consideration for further discussion of risk factors. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/gonorrhea/gonrs.htm#clinical)
The AAFP concludes there is insufficient evidence to recommend for or against routine screening for gonorrhea infection in men at increased risk for infection; see clinical consideration for further discussion of risk factors. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/gonorrhea/gonrs.htm#clinical)
The AAFP concludes there is insufficient evidence to recommend for or against screening for gonorrhea infection in pregnant women who are not at increased risk for infection; see clinical consideration for further discussion of risk factors. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/gonorrhea/gonrs.htm#clinical)
The AAFP recommends against routine screening for gonorrhea infection in men and women who are at low risk for infection; see clinical consideration for further discussion of risk factors. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/gonorrhea/gonrs.htm#clinical)
Haemophilus Influenza Type B Disease
The AAFP strongly recommends immunizing all children for Haemophilus influenzae type b disease using AAFP recommendations unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html
Healthy Diet
The AAFP recommends intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care physicians or by other qualified professionals including dietitians and nutritionists. (Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/diet/dietrr.htm#clinical)
Hearing Difficulties
The AAFP recommends screening for hearing difficulties by questioning elderly adults about hearing impairment and counsel regarding the availability of treatment when appropriate. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspshear.htm)
Hearing Loss Sensorineural (SNHL)
The AAFP recommends screening for hearing loss in all newborn infants. (Clinical Consideration: www.ahrq.gov/clinic/3rduspstf/newbornscreen/newhearrr.htm#section2)
Hemochromatosis
The AAFP recommends against routine genetic screening for hereditary hemochromatosis in the asymptomatic general population. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf06/hemochromatosis/hemochrs.htm)
Hemoglobinopathies
The AAFP strongly recommends ordering screening tests for phenylketonuria (PKU), hemoglobinopathies, and thyroid function abnormalities in neonates.
Hepatitis A
The AAFP recommends immunizing adults for hepatitis A who live, work, or travel in areas where hepatitis A is endemic and periodic outbreaks occur, or users of injection or street drugs, military personnel, men who have sex with men, and institutionalized persons and those working in those institutions. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing children for hepatitis A who are more than 2 years of age and all adolescents who are living in, traveling to, or working in areas where hepatitis A is endemic and periodic outbreaks occur. Immunize using AAFP recommendations. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Hepatitis B
The AAFP strongly recommends immunizing infants and children who are unimmunized at age 11 to 12 for hepatitis B using AAFP recommendations. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing persons for hepatitis B who are injection drug users and their sexual partners, have a history of multiple sexual partners in a previous 6 months, have recently acquired a sexually transmitted disease, are recipients of certain drug products, have a health related job with frequent exposure to blood or blood products, are travelers to countries where hepatitis B virus (HBV) is of high or intermediate endemicity, or who are men who have sex with men. Complete primary series. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP recommends immunizing for hepatitis B unimmunized persons age 12 to 24 years with no reliable history of hepatitis B infection or previous immunization. Discuss immunization using AAFP recommendations. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Hepatitis B Virus Infection
The AAFP strongly recommends screening for HBV infection in pregnant women at their first prenatal visit. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspshepb.htm)
The AAFP recommends against routinely screening the general asymptomatic population for chronic HBV infection. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspshepb.htm)
Hepatitis C Virus (HCV)
The AAFP recommends against routine screening for HCV infection in asymptomatic adults who are not at increased risk (general population) for infection. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspshepc.htm)
The AAFP found insufficient evidence to recommend for or against routine screening for HCV infection in adults at high risk for infection. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspshepc.htm)
High Blood Pressure
The AAFP strongly recommends screening for high blood pressure in adults aged 18 and older. (Clinical Consideration: www.ahrq.gov/clinic/uspstf07/hbp/hbprs.htm#clinical)
Human Immunodeficiency Virus (HIV) Infection
The AAFP strongly recommends that physicians screen for HIV infection all adolescents and adults at increased risk for HIV infection. (Go to Clinical Considerations for discussion of risk factors: http://www.ahrq.gov/clinic/uspstf05/hiv/hivrs.htm) Also See: HIV Policy Statement (August 2006)
The AAFP recommends that clinicians screen all pregnant women for HIV. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf05/hiv/hivrs.htm) Also See: HIV Policy Statement (August 2006)
The AAFP makes no recommendation for or against routinely screening for HIV in adolescents and adults who are not at increased risk for HIV infections. (Go to Clinical Considerations for discussion of risk factors: http://www.ahrq.gov/clinic/uspstf05/hiv/hivrs.htm) Also See: HIV Policy Statement (August 2006)
Hormone Replacement Therapy
The AAFP recommends against the routine use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. (Clinical Considerations: www.ahrq.gov/clinic/uspstf05/ht/htpostmenrs.htm#clinical)
The AAFP recommends against the routine use of unopposed estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (Clinical Considerations: www.ahrq.gov/clinic/uspstf05/ht/htpostmenrs.htm#clinical)
Hypertension
The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for high blood pressure in children and adolescents to reduce the risk of cardiovascular disease. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspshype.htm)
Illicit Drug Use
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening adolescents, adults, and pregnant women for illicit drug use. (Clinical Considerations: www.ahrq.gov/clinic/uspstf08/druguse/drugrs.htm#clinical)
Influenza
The AAFP recommends immunizing children and adolescents age 6 months or older for influenza who are residents of chronic care facilities, or who have chronic cardiopulmonary disorders, metabolic disease including diabetes mellitus, hemoglobinopathies, immunosuppression, or renal dysfunction for influenza. Discuss immunizing annually using AAFP recommendations. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP recommends immunizing adults for influenza who are residents of chronic care facilities, or suffer from chronic cardiopulmonary disorders, metabolic disease (including diabetes mellitus), hemoglobinopathies, immunosuppression, renal dysfunction, or are health care providers for the above. Discuss immunization annually using AAFP recommendations. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP recommends immunizing all persons age 50 years and older for influenza. Discuss immunization annually using AAFP recommendations. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Insulin Dependent Diabetes Mellitus
The AAFP recommends against the use of immune marker screening for insulin dependent diabetes mellitus in asymptomatic persons.
Iron Deficiency Anemia
The AAFP recommends routine screening for iron deficiency anemia in asymptomatic pregnant women. (Clinical Considerations: www.ahrq.gov/clinic/uspstf06/ironsc/ironrs.htm#clinical)
The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for iron deficiency anemia in asymptomatic children aged 6 to 12 months. (Clinical Considerations: www.ahrq.gov/clinic/uspstf06/ironsc/ironrs.htm#clinical)
Lead Poisoning
The AAFP concludes that evidence is insufficient to recommend for or against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at increased risk. (Clinical Considerations: www.ahrq.gov/clinic/uspstf06/lead/leadrs.htm#Clinical)
The AAFP recommends against routine screening for elevated blood levels in asymptomatic pregnant women. (Clinical Considerations: www.ahrq.gov/clinic/uspstf06/lead/leadrs.htm#Clinical)
The AAFP recommends against routine screening for elevated blood levels in asymptomatic children aged 1 to 5 years who are at average risk. (Clinical Considerations: www.ahrq.gov/clinic/uspstf06/lead/leadrs.htm#Clinical)
Lipid Disorders
The AAFP strongly recommends screening men aged 35 and older for lipid disorders (Clinical Considerations: www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm#clinical)
The AAFP strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease. (Clinical Considerations: www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm#clinical)
The AAFP recommends screening men aged 20 to 35 for lipid disorders if they are at increased risk for coronary heart disease. (Clinical Considerations: www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm#clinical)
The AAFP recommends screening women aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease. (Clinical Considerations: www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm#clinical)
The AAFP makes no recommendation for or against routine screening for lipid disorders in men aged 20 to 35, or in women aged 20 and older who are not at increased risk for coronary heart disease. (Clinical Considerations: www.ahrq.gov/clinic/uspstf08/lipid/lipidrs.htm#clinical)
Lung Cancer
The AAFP recommends against the use of chest x-ray and/or sputum cytology in asymptomatic persons for lung cancer screening. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspslung.htm)
Measles
The AAFP strongly recommends immunizing all children for measles using AAFP recommendations unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Measles, Mumps, Rubella
The AAFP strongly recommends immunizing all persons born after 1956 who lack evidence of immunity to measles (receipt of live vaccine on or after the first birthday, laboratory evidence of immunity, or a history of physician-diagnosed measles) with a single dose for measles, mumps, and rubella. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing adolescents and young adults in settings where such individuals congregate (e.g., high schools, technical schools, and colleges), if they have not previously received a second dose for measles, mumps, and rubella. Give second dose at least 1 month after first dose. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Mumps
The AAFP strongly recommends immunizing all children for mumps using AAFP recommendations unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Meningococcus, Conjugate Vaccine (Adolescents)
The AAFP recommends routine vaccination of adolescents: young adolescents at a pre-adolescent visit (11 to 12 years old); adolescents at high school entry (15 years old) for those who have not previously received MCV4; and other adolescents who wish to decrease their risk of meningococcal disease. (AAFP Clinical Recommendations for Immunizations: www.aafp.org/online/en/home/clinical/immunizationres.html).
Meningococcus, Conjugate Vaccine
The AAFP recommends for routine vaccination of other populations at increased risk of meningococcal disease: college freshman living in dormitories; microbiologists who are routinely exposed to isolates of Neisseria meningitidis; military recruits; persons who travel to or reside in countries in which N. meningitidis is hyperendemic or epidemic, particularly if contact with local population will be prolonged; persons who have terminal complement component deficiencies, and those who have anatomic or functional asplenia; and other adolescents, college students, and HIV patients who wish to decrease their risk of meningococcal disease. (AAFP Clinical Recommendations for Immunizations: www.aafp.org/online/en/home/clinical/immunizationres.html).
Neural Tube Defects
The AAFP strongly recommends prescribing 0.4 to 0.8 mg/day of folic acid supplementation from at least 1 month prior to conception through the first trimester of pregnancy to women planning to become pregnant who have not had a previous pregnancy affected by a neural tube defect.
The AAFP recommends prescribing 0.4 mg folate supplementation to women not planning a pregnancy but of childbearing potential who have not previously had a baby with a neural tube defect.
The AAFP strongly recommends prescribing 4 mg/day of folic acid supplementation from 1 to 3 months prior to conception through the first trimester of pregnancy to women who are planning a pregnancy and had a previous pregnancy affected by a neural tube defect.
Obesity
The AAFP recommends that family physicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. Intensive counseling involves more than one session per month for at least 3 months. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspsobes.htm)
Optimal weight management in children and adolescents is desirable. The effectiveness of screening and counseling for overweight is uncertain. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf/uspsobch.htm)
Oral Cancer
The AAFP concludes that the evidence is insufficient to recommend for or against routinely screening adults for oral cancer. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspsoral.htm)
Osteoporosis
The AAFP recommends routinely screening women aged 65 and older for osteoporosis. (Clinical Considerations: http://www.ahrq.gov/clinic/3rduspstf/osteoporosis/osteorr.htm#clinical)
The AAFP recommends routinely screening women aged 60 and older at increased risk for osteoporotic fractures. (Clinical Considerations; http://www.ahrq.gov/clinic/3rduspstf/osteoporosis/osteorr.htm#clinical)
The AAFP recommends counseling females age 11 and older to maintain adequate calcium intake to prevent osteoporosis.
Ovarian Cancer
The AAFP recommends against routine screening for ovarian cancer. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsovar.htm)
Ovarian Cancer/BRCA Mutation Testing
The AAFP recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing. (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm#clinical)
The AAFP recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2). (Clinical Consideration: www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm#clinical)
Pancreatic Cancer
The AAFP recommends against routine screening for pancreatic cancer in asymptomatic adults using abdominal palpation, ultrasonography, or serologic markers. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspspanc.htm)
Peripheral Arterial Disease
The AAFP recommends against routine screening for peripheral arterial disease (PAD). (Clinical Considerations: www.ahrq.gov/clinic/uspstf05/pad/padrs.htm#clinical)
Pertussis
The AAFP strongly recommends immunizing all children for pertussis using AAFP recommendations unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Phenylketonuria
The AAFP strongly recommends ordering screening test for phenylketonuria (PKU) in newborns. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/pku/pkurs.htm#clinical)
Physical Activity
The AAFP recognizes that regular physical activity is desirable. The effectiveness of physician's advice and counseling in this area is uncertain. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsphys.htm)
Pneumococcal Disease
The AAFP strongly recommends immunizing all children less than 24 months for pneumococcal disease using pneumococcal conjugate vaccine. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing healthy children living where pneumococcal disease is endemic using AAFP recommendations. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing children less than 60 months with sickle cell, HIV, functional or anatomic asplenia, immunocompromising conditions, and chronic illness, and children who are African Americans, Alaskan Natives, and American Indians using pneumococcal conjugate vaccine. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP recommends immunizing children and adolescents with chronic cardiac or pulmonary disease, diabetes mellitus, or anatomic asplenia or who live in special environments or social settings with an identified increased risk of pneumococcal disease. Discuss immunizing using AAFP recommendation. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP recommends immunizing institutionalized adults (age 50 years or older) or any adult with chronic cardiac or pulmonary disease, diabetes mellitus, anatomic asplenia, or who live in special environments or social settings with an increased risk of pneumococcal disease (e.g., certain Native American or Native Alaskan populations). Discuss immunization using AAFP recommendations. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP recommends immunizing adults age 65 years or older for pneumococcal disease. Discuss immunization using AAFP recommendations. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP makes no recommendation either for or against pneumococcal conjugate immunization in children aged 24 to 59 months, including those children who attend childcare settings and children who had frequent or complicated acute otitis media in the previous year. As a practice option, discuss pneumococcal conjugate immunization. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Poliomyelitis
The AAFP strongly recommends immunizing all children for poliomyelitis using AAFP recommendations unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Prostate Cancer
The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years. (Clinical Consideration: http://www.ahrq.gov/clinic/uspstf08/prostate/prostaters.htm#clinical)
The AAFP recommends against screening for prostate cancer in men age 75 years or older. (Clinical Consideration: www.ahrq.gov/clinic/uspstf08/prostate/prostaters.htm#clinical)
Pulmonary Chronic Obstructive Disease
The AAFP recommends against screening asymptomatic adults for chronic obstructive pulmonary disease (COPD) using spirometry. (Clinical Consideration: http://ahrq.gov/clinic/uspstf08/copd/copdrs.htm#clinical)
Rh (D) Incompatibility
The AAFP strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspsdrhi.htm)
The AAFP recommends repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24 to 28 weeks' gestation. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspsdrhi.htm)
Rubella
The AAFP strongly recommends immunizing all children for rubella using AAFP recommendation unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Scoliosis, Idiopathic in Adolescents
The AAFP recommends against the routine screening of asymptomatic adolescents for idiopathic scoliosis. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsaisc.htm)
Second Hand Smoke
The AAFP strongly recommends to counsel smoking parents with children in the house regarding the harmful effects of smoking and children's health.
Sickle Cell Disease
The AAFP strongly recommends screening for sickle cell disease in all newborns. (Clinical Considerations: www.ahrq.gov/clinic/uspstf07/sicklecell/sicklers.htm#clinical)
Skin Cancer
The AAFP concludes there is insufficient evidence on which to make a recommendation for or against routine screening for skin cancer in asymptomatic persons. (Clinical Considerations: http://www.ahrq.gov/clinic/uspstf/uspsskca.htm)
Speech and Language Delay in Preschool Children
The AAFP concludes that the evidence is insufficient to recommend for or against routine use of brief, formal screening instruments in primary care to detect speech and language delay in children up to 5 years of age. (Clinical Considerations: www.ahrq.gov/clinic/uspstf06/speech/speechrs.htm#clinical)
Syphilis
The AAFP strongly recommends that clinicians screen persons at increased risk for syphilis infection. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspssyph.htm)
The AAFP strongly recommends that clinicians screen all pregnant women for syphilis infection. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspssyph.htm)
The AAFP recommends against routine screening of asymptomatic persons who are not at increased risk for syphilis infection. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspssyph.htm)
Testicular Cancer
The AAFP recommends against routine screening for testicular cancer in asymptomatic adolescents and adult males. (Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspstest.htm)
Tetanus
The AAFP strongly recommends immunizing all children for tetanus using AAFP recommendation unless contraindicated. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing adults for tetanus by completing the Td vaccine series if primary series hasn't been received. Boosters should be given every 10 years or at least at age 50. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Thyroid Cancer
The AAFP recommends against the use of ultrasound screening for thyroid cancer in asymptomatic persons. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsthca.htm)
Thyroid Disease
The AAFP concludes that the evidence is insufficient to recommend for or against routine screening for thyroid disease in adults. (Clinical Consideration: ww.ahrq.gov/clinic/uspstf/uspsthyr.htm)
Thyroid Function Abnormalities
The AAFP strongly recommends ordering screening test for thyroid function abnormalities in neonates.
Tobacco Use
The AAFP strongly recommends that clinicians screen all adults for tobacco use and provide tobacco cessation interventions for those who use tobacco products. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspstbac.htm)
The AAFP strongly recommends that clinicians screen all pregnant women for tobacco use and provide 5 to 15 minutes of smoking cessation counseling using messages and self-help materials tailored for pregnant smokers. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspstbac.htm)
The AAFP recognizes avoidance of tobacco products by children and adolescents is desirable. The effectiveness of physician advice and counseling in this area is uncertain. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspstbac.htm)
Tuberculosis
The AAFP strongly recommends screening for tuberculosis (TB) by applying the Mantoux test to patients at high risk for tuberculosis, including those with close contacts to person with known or suspected TB, health care workers, immigrants from countries with high TB prevalence, HIV positive individuals, alcoholics, injection drug users, residents of long term care facilities, and medically underserved low income people.
Vaginal Cancer
The AAFP recommends against screening for vaginal cancer with the use of Pap smears in women who have had hysterectomies for reasons other than cancer.
Varicella
The AAFP strongly recommends immunizing healthy infants age 12 to 18 months for varicella using AAFP recommendation. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing for varicella unimmunized children and adolescents with no reliable history of varicella infection or previous immunization and to consider serologic testing instead of immediate immunization in history negative adolescents if able to comply if return visit needed using AAFP recommendations. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing children and adolescents for varicella who are unimmunized or have no history of prior infection and who have been exposed to varicella in the last 3 to 5 days. Immunize using AAFP recommendations. (Recommended Childhood and Adolescent Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP strongly recommends immunizing adults for varicella who are unimmunized or have no history of prior infection and who have been exposed to varicella in the last 3 to 5 days. Immunize using AAFP recommendations. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
The AAFP recommends immunizing adults for varicella with no history of varicella or previous vaccination. Discuss immunization using AAFP recommendations. (Recommended Adult Immunization Schedule: www.aafp.org/online/en/home/clinical/immunizationres.html).
Visual Impairment
The AAFP recommends screening to detect amblyopia, strabismus, and defects in visual acuity in children younger than age 5 years. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsvsch.htm)
Visual Difficulties
The AAFP recommends screening for visual difficulties in elderly adults by performing Snellen acuity testing. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsvisi.htm)
Vitamin Supplementation
The AAFP concludes that the evidence is insufficient to recommend for or against the use of supplements of vitamins A, C, or E; multivitamins with folic acid; or antioxidant combinations for the prevention of cancer or cardiovascular disease. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsvita.htm)
The AAFP recommends against the use of beta-carotene supplements, either alone or in combination, for the prevention of cancer or cardiovascular disease. (Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsvita.htm)
Definitions:
The strength of the recommendation for or against a preventive intervention was graded as follows:
Strongly Recommend: Good quality evidence exists which demonstrates substantial net benefit over harm; the intervention is perceived to be cost effective and acceptable to nearly all patients.
Recommend: Although evidence exists which demonstrates net benefit, either the benefit is only moderate in magnitude or the evidence supporting a substantial benefit is only fair. The intervention is perceived to be cost effective and acceptable to most patients.
No Recommendation Either For or Against: Either good or fair evidence exists of at least a small net benefit. Cost-effectiveness may not be known or patients may be divided about acceptability of the intervention.
Recommend Against: Good or fair evidence which demonstrates no net benefit over harm.
Insufficient Evidence to Recommend Either For or Against: No evidence of even fair quality exists or the existing evidence is conflicting.
Healthy Behavior is identified as desirable but the effectiveness of physician's advice and counseling is uncertain.
