Updated: 8/16/2020

U.S. Preventive Services Task Force (USPSTF) Recommendations

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Snapshot
  • A 50-year-old woman visits her primary care physician for a routine check-up. Her last Pap smear was more than 5 years ago, and her physician recommends that she undergoes high-risk HPV testing in combination with cytology at the current visit. Her last mammogram was the previous year, so she is informed that she can wait until next year for repeat mammography. Her physician notes that colorectal cancer screening is recommended starting at age 50 years, and notes that she will receive a fecal occult blood test today. The patient is also counseled on the benefits of aspirin use for the prevention of heart attack and stroke in adults beginning at age 50.
Introduction
  • Overview
    • U.S. Preventive Services Task Force (USPSTF) recommendations are evidence-based guidelines for clinical disease prevention
  • Classification
    • USPSTF recommendations are classified into 5 ratings: A, B, C, D, and I
        • USPSTF recommends the service
        • high certainty that the net benefit is substantial
      • B
        • USPSTF recommends the service
        • high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
      • C
        • clinicians may provide this service to selected patients depending on individual circumstances; however, for most individuals without signs or symptoms there is likely to be only a small benefit from this service
      • D
        • USPSTF recommends against the service
        • moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits
      • I
        • USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service
        • evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined
USPSTF Recommendations (Grades A, B, and Others)
 
USPSTF Recommendations by Year
Grades A & B Recommendations Published in 2020
Topic Description
Unhealthy drug use: screening
  • Screen by asking questions about unhealthy drug use in adults age 18 years or older
  • Should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred
  • Note: screening refers to asking questions about unhealthy drug use not testing biological specimens
Prevention and cessation of tobacco use in children and adolescents: primary care interventions
  • Primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents
Hepatitis C virus infection in adolescents and adults: screening
  • Screen for hepatitis C virus (HCV) infection in adults aged 18-79 years
Grades A & B Recommendations Published in 2019
Topic Description
Abdominal aortic aneurysm: screening 
  • 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65-75 years who have ever smoked
Asymptomatic bacteriuria in adults: screening
  • Screening for asymptomatic bacteriuria using urine culture in pregnant persons
Breast cancer: medication use to reduce risk
  • Clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects
BRCA-related cancer: risk assessment, genetic counseling, and genetic testing
  • Screen for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit
Human immunodeficiency virus (HIV) infection: screening
  • Screen for HIV infection in adolescents and adults aged 15 to 65 years 
    • Younger adolescents and older adults who are at increased risk of infection should also be screened
  • Screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown
Prevention of human immunodeficiency virus (HIV) infection: preexposure prophylaxis
  • Offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition
Perinatal depression: preventive interventions
  • Provide or refer pregnant and postpartum persons who are at increased risk of perinatal depression to counseling interventions
Ocular prophylaxis for gonococcal ophthalmia neonatorum: preventive medication
  • Prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum.
Grades A & B Recommendations Published in 2018
Topic
Description
Unhealthy alcohol use in adolescents and adults: screening and behavioral counseling interventions
  • Screen for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use
Intimate partner violence, elder abuse, and abuse of vulnerable adults: screening
  • Screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services
Weight loss to prevent obesity-related morbidity and mortality in adults: behavioral interventions
  • Offer or refer adults with a body mass index (BMI) of 30 or higher (calculated as weight in kilograms divided by height in meters squared) to intensive, multicomponent behavioral interventions.
Syphilis infection in pregnant women: screening
  • Early screening for syphilis infection in all pregnant women
Cervical cancer: screening
  • Screen for cervical cancer every 3 years with cervical cytology alone in women aged 21-29 years
  • For women aged 30-65 years, screen every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting)
Osteoporosis to prevent fractures: screening
  • Screen for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older
  • Screen for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool
Falls prevention in community-dwelling older adults: interventions
  • Exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls
Skin cancer prevention: behavioral counseling
  • Counseling young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet (UV) radiation for persons aged 6 months- -24 years with fair skin types to reduce their risk of skin cancer
Grades A & B Recommendations Published in 2017
Topic
Description
Vision in children ages 6 months-5 years: screening
  • Vision screening at least once in all children aged 3-5 years to detect amblyopia or its risk factors.
Obesity in children and adolescents: screening
  • Screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status.
Preeclampsia: screening
  • Screen for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy.
Folic acid for the prevention of neural tube defects: preventive medication
  • All women who are planning or capable of pregnancy take a daily supplement containing 0.4-0.8 mg (400-800 µg) of folic acid
Grades A & B Recommendations Published in 2016
Topic Description
Aspirin use to prevent cardiovascular disease and colorectal cancer: preventative medicine 
  • Initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50-59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years
Depression in children and adolescents: screening
  • Screening for major depressive disorder (MDD) in adolescents aged 12-18 years
  • Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up
Depression in adults: screening
  • Screening for depression in the general adult population, including pregnant and postpartum women
  • Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up
Breast cancer: screening
  • Biennial screening mammography for women aged 50-74 years.
Statin use for the primary prevention of cardiovascular disease in adults: preventive medication 
  • Adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are aged 40-75 years; 2) they have 1 or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension, or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater
Breastfeeding: primary care interventions
  • Providing interventions during pregnancy and after birth to support breastfeeding
Latent tuberculosis infection: screening
  • Screening for latent tuberculosis infection (LTBI) in populations at increased risk
Colorectal cancer: screening
  • Screening for colorectal cancer starting at age 50 years and continuing until age 75 years
Syphilis infection in nonpregnant adults and adolescents: screening
  • Screening for syphilis infection in persons who are at increased risk for infection
Grades A & B Recommendations Published in 2015
Topic Description
Abnormal blood glucose and type 2 diabetes mellitus: screening
  • Screening for abnormal blood glucose as part of cardiovascular risk assessment in adults aged 40-70 years who are overweight or obese
  • Offer or refer patients with abnormal blood glucose to intensive behavioral counseling interventions to promote a healthful diet and physical activity
High blood pressure in adults: screening
  • Screening for high blood pressure in adults aged 18 years or older
  • Obtaining measurements outside of the clinical setting for diagnostic confirmation before starting treatment (see the Clinical Considerations section)
Tobacco smoking cessation in adults, including pregnant women: behavioral and pharmacotherapy interventions
  • Ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)-approved pharmacotherapy for cessation to adults who use tobacco
  • Ask all pregnant women about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant women who use tobacco.
Grades A & B Recommendations Published in 2014
Topic Description
Chlamydia and gonorrhea: screening
  • Screening for chlamydia and gonorrhea in sexually active women age 24 years and younger and in older women who are at increased risk for infection
Sexually transmitted infections: behavioral counseling
  • Recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs)
Healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: behavioral counseling
  • Offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention
Low-dose aspirin use for the prevention of morbidity and mortality from preeclampsia: preventive medication
  • Use of low-dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia
Dental caries in children from birth through age 5 years: screening
  • Primary care clinicians should prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride
  • Primary care clinicians should apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption
Gestational diabetes mellitus, screening
  • Screen for gestational diabetes mellitus (GDM) in asymptomatic pregnant women after 24 weeks of gestation
Hepatitis B virus infection: screening
  • Screen for hepatitis B virus (HBV) infection in persons at high risk for infection.
Grades A & B Recommendations Published in 2013 or earlier
Topic Description
Lung cancer: screening
  • Annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 -80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
  • Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery
Rh(D) incompatibility: screening
  • Rh(D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care
  • Repeated Rh(D) antibody testing for all unsensitized Rh(D)-negative women at 24 to 28 weeks' gestation, unless the biological father is known to be Rh(D)-negative
Grades C & D Recommendations 
Pregnant persons not at increased risk for preterm delivery: screening
  • Recommends against screening for bacterial vaginosis (BV) in pregnant persons who are not at increased risk for preterm delivery (Grade D)
Pancreatic cancer: screening
  • Recommends against screening for pancreatic cancer in asymptomatic adults (Grade D)
Cardiovascular disease risk: screening with electrocardiography
  • Recommends against screening with resting or exercise electrocardiography (ECG) to prevent cardiovascular disease (CVD) events in asymptomatic adults at low risk of CVD events
Prostate cancer: screening
  • Men between the ages of 55-69, the decision to undergo PSA testing is an individual decision and the clinician should discuss the possible benefits and harms (Grade C)
  • Men older than 70, should not undergo PSA testing (Grade D)
Vitamin D, calcium, or combined supplementation for the primary prevention of fractures in community-wwelling adults: prevention
  • Recommends against daily supplementation with 400 IU or less of vitamin D and 1000 mg or less of calcium for the primary prevention of fractures in community-dwelling, postmenopausal women (Grade D)
Ovarian cancer: screening
  • Recommends against screening for ovarian cancer in asymptomatic women (Grade D)
Hormone therapy in postmenopausal women: primary prevention of chronic conditions
  • Recommends against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal women, including those who have had a hysterectomy (Grade D)
Healthful diet and physical activity for cardiovascular disease drevention in adults without known risk factors: behavioral counseling
  • Primary care professionals should individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes to behavioral counseling to promote a healthful diet and physical activity (Grade C)
Thyroid cancer: screening
  • Recommends against screening for thyroid cancer in asymptomatic adults (Grade D)
Genital herpes infection: serologic screening
  • Recommends against routine serologic screening for genital herpes simplex virus (HSV) infection in asymptomatic adolescents and adults, including those who are pregnant (Grade D)
Chronic obstructive pulmonary disease: screening
  • Recommends against screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults (Grade D)
Vitamin supplementation to prevent cancer and CVD: preventive edication
  • Recommends against the use of ß-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer (Grade D)
Carotid artery stenosis: screening
  • Recommends against screening for asymptomatic carotid artery stenosis in the general adult population (Grade D)
Testicular cancer: screening
  • Recommends against screening for testicular cancer in adolescent or adult men (Grade D)

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