‡For a more detailed discussion of cervical cytology screening, including the use of human papillomavirus DNA testing and screening after hysterectomy, see Cervical cytology screening. ACOG Practice Bulletin No. 109. American College of Obstetricians and Gynecologists. Obstet Gynecol 2009:114; 1409–20. §Other methods include: 1) fecal occult blood testing or fecal immunochemical test, annual patient-collected (fecal occult blood testing and fecal immunochemical testing require two or three samples of stool collected by the patient at home and returned for analysis. A single stool sample obtained by digital rectal examination is not adequate for the detection of colorectal cancer); 2) ﬂexible sigmoidoscopy every 5 years; 3) double contrast barium enema every 5 years; 4) computed tomography colonography every 5 years; and 5) stool DNA. More frequent testing is recommended for those with other risk factors. ||The recommendation for aspirin prophylaxis must weigh the benefits of stroke prevention against the harm of gastrointestinal bleeding. See Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. U.S. Preventive Services Task Force. Ann Intern Med 2009;150:396–404. ¶Despite a lack of definitive data for or against breast self-examination, breast self-examination has the potential to detect palpable breast cancer and can be recommended. #For a more detailed discussion of risk assessment and chemoprevention therapy, see Selective estrogen receptor modulators. ACOG Practice Bulletin No. 39. American College of Obstetricians and Gynecologists. Obstet Gynecol 2002;100:835–43. ∗∗Leading causes of mortality are provided by the Mortality Statistics Branch at the National Center for Health Statistics. Data are from 2004, the most recent year for which final data are available. The causes are ranked. From American College of Obstetricians and Gynecologists, Primary and preventive care: periodic assessments. ACOG Committee Opinion No. 452. Obstet Gynecol 2009;144:1444–1451.
The USPSTF is supported by an Evidence-Based Practice Center (EPC), which conducts systematic reviews of the evidence that serve as the scientific basis for USPSTF recommendations. These reviews analyze the effectiveness of various screening measures and tests. Preventive medicine and the discipline of evidence-based medicine have grown and evolved since the release of the first Guide to Clinical and Preventive Services in 1989. This document accelerated the trend to replace consensus or expert opinion in clinical recommendations with a more systematic and explicit review of the evidence. The USPSTF has recognized that scientific evidence, including evidence derived from a variety of research designs other than randomized clinical trials, does
Table 8.5 High-Risk Factors
Bone mineral density screening∗ Postmenopausal women younger than age 65 years: history of prior fracture as an adult; family history of osteoporosis; Caucasian; dementia; poor nutrition; smoking; low weight and BMI; estrogen deficiency caused by early (age younger than 45 years) menopause, bilateral oophorectomy, or prolonged (longer than 1 year) premenopausal amenorrhea; low lifelong calcium intake; alcoholism; impaired eyesight despite adequate correction; history of falls; inadequate physical activity All women: certain diseases or medical conditions and certain drugs associated with an increased risk of osteoporosis