screening

The results of this study suggest that patients with poorly controlled BP should be further evaluated for alcohol use disorders even if the brief screening questions are negative. James W. Mold, MD, MPH

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Background: This cross-sectional study aimed to describe proportions of patients with indications of alcohol consumption using phosphatidylethanol (PEth), the Alcohol Use Disorders Identification Test (AUDIT), and its consumption-focused version (AUDIT-C), in relation to blood pressure (BP) control, overall and by sex.

Methods: A total of 270 hypertensive primary care patients (ICD-10: I10.9) were stratified into BP control groups: controlled (<140/90 mmHg), uncontrolled (≥140/90 mmHg), and apparent treatment-resistant hypertension (aTRH; ≥140/90 mmHg with ≥3 antihypertensive drugs). A randomized sample from each stratum was invited, baseline data were collected. Alcohol consumption using predefined categories for PEth and AUDIT, and hazardous use (PEth ≥ 0.122 µmol/L; AUDIT ≥ 8; AUDIT-C ≥ 5 for men, ≥4 for women), were analyzed in relation to BP control groups.

Results: Mean age was 67 ± 11 years; 42% were women. PEth indicated high and regular alcohol consumption in 6.4% of controlled, 5.3% of uncontrolled, and 19.2% of aTRH patients (controlled vs. aTRH, P = .027; uncontrolled vs. aTRH, P = .013). AUDIT showed no significant differences in hazardous use between BP groups (P = .865). AUDIT-C identified slightly higher proportions of hazardous use than PEth, across BP groups and sexes. No significant differences were found between BP groups for hazardous use by PEth (P = .339) or AUDIT-C (P = .150).

Conclusions: PEth revealed significantly higher alcohol use in the aTRH group, undetected by AUDIT. AUDIT-C and PEth identified more hazardous use than AUDIT, suggesting their potential to prompt alcohol-related discussions and support evidence-based hypertension care. PEth correlated more strongly with AUDIT-C than with AUDIT.

Clinical trial registration: Retrospectively registered in Clinical Trials, SLSO2022-0143, 2022-12-10.

Keywords: alcohol use disorder; cardiovascular disorders (hypertension/DVT/atherosclerosis); hypertension (high blood pressure); prevention; primary care; screening.

Author/s:

Åsa Thurfjell, Maria Hagströmer, Charlotte Ivarsson, Anders Norrman, Johanna Adami, Lena Lundh, Jan Hasselström

Clinical Validation of a Vaginal Cervical Cancer Screening Self-Collection Method for At-Home Use: A Nonrandomized Clinical Trial

Alex Haga — Tue, 27 May 2025 13:21:18 +0000

Date Added:

May 27, 2025

Journal/Publication:

JAMA

Publication Date:

May 1, 2025

URL:

Clinical Validation of a Vaginal Cervical Cancer Screening Self-Collection Method for At-Home Use: A Nonrandomized Clinical Trial

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2025.11081

Keywords

Vaginal Cervical Cancer

Self-Collection

At-Home

screening

PMID (1):

40388167

MeSH

Early Detection of Cancer* / methods

Mass Screening* / methods

Papillomavirus Infections

Uterine Cervical Neoplasms* / diagnosis

An in-home, patient administered screening test for cervical cancer was highly accurate when compared with usual in-office testing. James W. Mold, MD, MPH

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Importance: One-quarter of US women who are at risk for cervical cancer delay screening. Self-collected (SC) cervical screening was recently US Food and Drug Administration (FDA)-approved in the US for use in a health care setting only; an at-home SC option is crucial to address clinic-related barriers to screening.

Objective: To clinically validate the use of an SC device that was designed for optimal at-home performance, safety, ease-of-use, and dry storage and transport.

Design, setting, and participants: This nonrandomized clinical trial used a prospective method comparison study design. Participants aged 25 to 65 years were recruited from 16 clinical sites in the US including community and academic practices from November 20, 2023, to April 5, 2024. Data analysis was conducted from April to August 2024.

Intervention: Eligible participants collected a sample with the SC method, followed by a clinician-collected (CC) sample. The SC sample was eluted into PreservCyt at the laboratory and both samples were tested on an FDA-approved high risk human papillomavirus (hrHPV) test approved for primary screening. Participants were followed up for safety and completed usability and screening preference surveys.

Main outcome and measures: The primary outcome measures were positive percentage agreement (PPA) and negative percentage agreement for detection of hrHPV between the SC and CC samples. Other study measures included clinical sensitivity for high grade cervical dysplasia and usability.

Results: Of 609 screening-eligible participants, 599 (262 aged 30-39 years [43.7%]; 583 identified as female [97.3%]) had paired SC-CC samples, of which 582 had valid paired samples included in the end point analysis. Among the 582 evaluable paired samples, the PPA between SC compared with paired CC samples for detection of hrHPV was 95.2% (95% CI, 92.1%-97.1%; 278 of 292 participants). The absolute clinical sensitivity for detection of high-grade cervical dysplasia was 95.8% (95% CI, 86.0%-98.8%; 46 of 48 participants), equivalent to the CC (relative sensitivity, 1.00). Nearly all participants (555 of 601 participants [92.3%]) reported that the device instructions were easy or very easy to understand and also that they would choose SC if they knew the results were comparable to CC results (560 of 602 participants [93.0%]).

Conclusions and relevance: In this nonrandomized clinical trial, SC samples collected with the device showed equivalent clinical sensitivity and exceeded the PPA end point for cervical screening. This SC method was found to be easy to use and to be a preferred option with high clinical performance intended for use in an at-home setting.

Author/s:

Megan B Fitzpatrick, Catherine M Behrens, Karl Hibler, Courtney Parsons

Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement

Aubrey Delammermore — Sat, 24 Jun 2023 22:55:19 +0000

Date Added:

June 24, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

June 20, 2023

URL:

Screening for Anxiety Disorders in Adults: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.9301

Keywords

PMID (1):

37338866

MeSH

The USPSTF recommends screening all adults under 65 for anxiety disorders. James W. Mold, MD, MPH

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Importance: Anxiety disorders are commonly occurring mental health conditions. They are often unrecognized in primary care settings and substantial delays in treatment initiation occur.

Objective: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for anxiety disorders in asymptomatic adults.

Population: Asymptomatic adults 19 years or older, including pregnant and postpartum persons. Older adults are defined as those 65 years or older.

Evidence assessment: The USPSTF concludes with moderate certainty that screening for anxiety disorders in adults, including pregnant and postpartum persons, has a moderate net benefit. The USPSTF concludes that the evidence is insufficient on screening for anxiety disorders in older adults.

Recommendation: The USPSTF recommends screening for anxiety disorders in adults, including pregnant and postpartum persons. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for anxiety disorders in older adults. (I statement).

Author/s:

US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Li, L., Ogedegbe, G., Pbert, L., Roa, G., Ruiz, J. M., Stevermer, J., Tsevat, J., Underwood, S. M., Wong, J. B.

Screening for Depression and Suicide Risk in Adults US Preventive Services Task Force Recommendation Statement

Aubrey Delammermore — Sat, 24 Jun 2023 05:00:00 +0000

Date Added:

June 24, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

June 20, 2023

Issue:

Volume:

329

Pages:

2057-2067

URL:

Screening for Depression and Suicide Risk in Adults US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.9297

Keywords

PMID (1):

37338872

MeSH

Depression / diagnosis

Depressive Disorder, Major* / diagnosis

Mass Screening / adverse effects

Suicide*

pregnancy

Final recommendations from the USPSTF regarding screening adults for depression (just do it). However, there is still insufficient evidence to screen for suicide risk apparently. James W. Mold, MD, MPH

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IMPORTANCE Major depressive disorder (MDD), a common mental disorder in the US, may
have substantial impact on the lives of affected individuals. If left untreated, MDD can
interfere with daily functioning and can also be associated with an increased risk of
cardiovascular events, exacerbation of comorbid conditions, or increased mortality.

OBJECTIVE The US Preventive Services Task Force (USPSTF) commissioned a systematic
review to evaluate benefits and harms of screening, accuracy of screening, and benefits and
harms of treatment of MDD and suicide risk in asymptomatic adults that would be applicable
to primary care settings.

POPULATION Asymptomatic adults 19 years or older, including pregnant and postpartum
persons. Older adults are defined as those 65 years or older.

EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for
MDD in adults, including pregnant and postpartum persons and older adults, has a moderate
net benefit. The USPSTF concludes that the evidence is insufficient on the benefit and harms
of screening for suicide risk in adults, including pregnant and postpartum persons and older
adults.

RECOMMENDATION The USPSTF recommends screening for depression in the adult
population, including pregnant and postpartum persons and older adults. (B
recommendation) The USPSTF concludes that the current evidence is insufficient to assess
the balance of benefits and harms of screening for suicide risk in the adult population,
including pregnant and postpartum persons and older adults. (I statement)

Author/s:

US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Chelmow, D., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Li, L., Ogedegbe, G., Pbert, L., Rao, G., Ruiz, J. M., Stevermer, J. J., Tsevat, J., Underwood, S. M., Wong, J. B.

Screening for primary aldosteronism in primary care

Aubrey Delammermore — Thu, 30 Mar 2023 05:00:00 +0000

Date Added:

March 30, 2023

Journal/Publication:

Canadian Medical Association Journal

Publisher:

CMA Impact

Publication Date:

March 20, 2023

Issue:

Volume:

195

Pages:

E410

URL:

Screening for primary aldosteronism in primary care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.221466

Keywords

Hypokalemia

Aldosterone

primary aldosteronism

MeSH

Mineralocorticoid Receptor Antagonists

Aldosterone

Angiotensin-Converting Enzyme Inhibitors

A very concise review of the suspicion, detection, and management of hyperaldosteronism in patients with hypertension. James W. Mold, MD, MPH

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Primary aldosteronism (PA) is common among patients with hypokalemia and hypertension. Patients with PA are at an increased risk of chronic disease if undiagnosed or untreated. Expert consensus recommends screening for PA in high-risk populations. Most antihypertensive medications can be continued during the work-up for PA. An elevated aldosterone-to-renin ratio is suggestive of PA.

Author/s:

Dubrofsky, L., Hundemer, G. L.

Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years US Preventive Services Task Force Recommendation Statement

Saige Blanchard — Mon, 03 Jan 2022 06:00:00 +0000

Date Added:

January 3, 2022

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

December 7, 2021

Issue:

Volume:

326

Pages:

2172-2178

URL:

Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2021.20007

Keywords

MeSH

USPSTF recommendations regarding the role of primary care clinicians in the prevention of dental caries in children. James W. Mold, MD, MPH

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IMPORTANCE Dental caries is the most common chronic disease in children in the US.
According to the 2011-2016 National Health and Nutrition Examination Survey, approximately
23% of children aged 2 to 5 years had dental caries in their primary teeth. Prevalence is higher
in Mexican American children (33%) and non-Hispanic Black children (28%) than in
non-Hispanic White children (18%). Dental caries in early childhood is associated with pain,
loss of teeth, impaired growth, decreased weight gain, negative effects on quality of life, poor
school performance, and future dental caries.
OBJECTIVE To update its 2014 recommendation, the US Preventive Services Task Force
(USPSTF) commissioned a systematic review on screening and interventions to prevent
dental caries in children younger than 5 years.
POPULATION Asymptomatic children younger than 5 years.
EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that there is a
moderate net benefit of preventing future dental caries with oral fluoride supplementation at
recommended doses in children 6 months or older whose water supply is deficient in
fluoride. The USPSTF concludes with moderate certainty that there is a moderate net benefit
of preventing future dental caries with fluoride varnish application in all children younger
than 5 years. The USPSTF concludes that the evidence is insufficient on performing routine
oral screening examinations for dental caries by primary care clinicians in children younger
than 5 years and that the balance of benefits and harms of screening cannot be determined.
RECOMMENDATION The USPSTF recommends that primary care clinicians prescribe oral fluoride
supplementation starting at age 6 months for children whose water supply is deficient in
fluoride. (B recommendation) The USPSTF recommends that primary care clinicians apply
fluoride varnish to the primary teeth of all infants and children starting at the age of primary
tooth eruption. (B recommendation) The USPSTF concludes that the current evidence is
insufficient to assess the balance of benefits and harms of routine screening examinations for
dental caries performed by primary care clinicians in children younger than 5 years. (I statement)

Author/s:

US Preventative Services task Force

Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement

Saige Blanchard — Fri, 21 May 2021 05:00:00 +0000

Date Added:

May 21, 2021

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

May 18, 2021

Issue:

Volume:

325

Pages:

1965-1977

URL:

Screening for Colorectal Cancer US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2021.6238

Keywords

PMID (1):

34003218

MeSH

Colorectal Neoplasms

hereditary nonpolyposis

incidence

Mass Screening

intestinal polyposis

Updated USPSTF recommendations regarding CRC screening. James W. Mold, MD, MPH

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Abstract

Importance: Colorectal cancer is the third leading cause of cancer death for both men and women, with an estimated 52 980 persons in the US projected to die of colorectal cancer in 2021. Colorectal cancer is most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years. Incidence of colorectal cancer (specifically adenocarcinoma) in adults aged 40 to 49 years has increased by almost 15% from 2000-2002 to 2014-2016. In 2016, 26% of eligible adults in the US had never been screened for colorectal cancer and in 2018, 31% were not up to date with screening.

Objective: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for colorectal cancer in adults 40 years or older. The review also examined whether these findings varied by age, sex, or race/ethnicity. In addition, as in 2016, the USPSTF commissioned a report from the Cancer Intervention and Surveillance Modeling Network Colorectal Cancer Working Group to provide information from comparative modeling on how estimated life-years gained, colorectal cancer cases averted, and colorectal cancer deaths averted vary by different starting and stopping ages for various screening strategies.

Population: Asymptomatic adults 45 years or older at average risk of colorectal cancer (ie, no prior diagnosis of colorectal cancer, adenomatous polyps, or inflammatory bowel disease; no personal diagnosis or family history of known genetic disorders that predispose them to a high lifetime risk of colorectal cancer [such as Lynch syndrome or familial adenomatous polyposis]).

Evidence assessment: The USPSTF concludes with high certainty that screening for colorectal cancer in adults aged 50 to 75 years has substantial net benefit. The USPSTF concludes with moderate certainty that screening for colorectal cancer in adults aged 45 to 49 years has moderate net benefit. The USPSTF concludes with moderate certainty that screening for colorectal cancer in adults aged 76 to 85 years who have been previously screened has small net benefit. Adults who have never been screened for colorectal cancer are more likely to benefit.

Recommendation: The USPSTF recommends screening for colorectal cancer in all adults aged 50 to 75 years. (A recommendation) The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years. (B recommendation) The USPSTF recommends that clinicians selectively offer screening for colorectal cancer in adults aged 76 to 85 years. Evidence indicates that the net benefit of screening all persons in this age group is small. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the patient's overall health, prior screening history, and preferences. (C recommendation).

Author/s:

Davidson, K. W., Barry, M. J., Mangione, C. M., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Krist, A. H., Kubik, M., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C., Wong, J. B.

Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis

Devin Evans — Thu, 29 Apr 2021 05:00:00 +0000

Date Added:

April 29, 2021

Journal/Publication:

The Journal of Pediatrics

Publication Date:

April 26, 2021

URL:

Get SET Early to Identify and Treatment Refer Autism Spectrum Disorder at 1 Year and Discover Factors That Influence Early Diagnosis

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1016/j.jpeds.2021.04.041

Keywords

MeSH

A summary of the impact of screening all children at 12, 18, and 24 months for autism. James W. Mold, MD, MPH

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Objectives

To examine the impact of a new approach, Get SET Early, on the rates of early autism spectrum disorder (ASD) detection and factors that influence the screen-evaluate-treat chain.

Study design

Following Get SET Early training, 203 pediatricians administered 57,603 total screens using the Communication and Symbolic Behavior Scales Infant-Toddler Checklist at 12, 18, and 24-month well-baby examinations, and parents designated presence or absence of concern. For screen-positive toddlers, pediatricians specified if the child was being referred for evaluation, and if not, why not.

Results

Collapsed across ages, toddlers were evaluated and referred for treatment at a median age of 19 months, and those screened at 12 months (59.4% of sample) by 15 months. Pediatricians referred one-third of screen-positive toddlers for evaluation, citing lack of confidence in the accuracy of screen-positive results as the primary reason for non-referral. If a parent expressed concerns, referral probability doubled, and the rate of an ASD diagnosis increased 37%. Of 897 toddlers evaluated, almost half were diagnosed as ASD, translating into an ASD prevalence of 1%.

Conclusions

The Get SET Early model was effective at detecting ASD and initiating very early treatment. Results also underscored the need for change in early identification approaches to formally operationalize and incorporate pediatrician judgement and level of parent concern into the process.

Author/s:

Pierce, K., Gazestani, V., Bacon, E., Gyurjyan, G., Cook-Clark, T., Karins, K., Courchesne, E., Cheng, A., Barnes, C.C., Nalabolu, S., Cha, D., Arias, S., Lopez, L., Pham, C.

Existing methods of screening for substance abuse (standardized questionnaires or clinician’s simply asking) have proven difficult to initiate and maintain in primary care settings. This article reports on how predictive modeling can be used to screen for

Devin Evans — Wed, 03 Mar 2021 06:00:00 +0000

Date Added:

March 3, 2021

Journal/Publication:

Big Data

Publication Date:

September 1, 2018

Issue:

Volume:

Pages:

214-224

URL:

Existing methods of screening for substance abuse (standardized questionnaires or clinician’s simply asking) have proven difficult to initiate and maintain in primary care settings. This article reports on how predictive modeling can be used to screen for

Type:

Practice Management Research Results

Format:

Article

DOI (1):

10.1089/big.2018.0002

Keywords

PMID (1):

30283729

MeSH

Veterans

substance-related disorders

primary health care

outpatients

This article provides guidance on how to identify patients with substance use disorders from data available in the EMR. James W. Mold, MD, MPH

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Existing methods of screening for substance abuse (standardized questionnaires or clinician's simply asking) have proven difficult to initiate and maintain in primary care settings. This article reports on how predictive modeling can be used to screen for substance abuse using extant data in electronic health records (EHRs). We relied on data available through Veterans Affairs Informatics and Computing Infrastructure (VINCI) for the years 2006 through 2016. We focused on 4,681,809 veterans who had at least two primary care visits; 829,827 of whom had a hospitalization. Data included 699 million outpatient and 17 million inpatient records. The dependent variable was substance abuse as identified from 89 diagnostic codes using the Agency for Healthcare Quality and Research classification of diseases. In addition, we included the diagnostic codes used for identification of prescription abuse. The independent variables were 10,292 inpatient and 13,512 outpatient diagnoses, plus 71 dummy variables measuring age at different years between 20 and 90 years. A modified naive Bayes model was used to aggregate the risk across predictors. The accuracy of the predictions was examined using area under the receiver operating characteristic (AROC) curve in 20% of data, randomly set aside for the evaluation. Many physical/mental illnesses were associated with substance abuse. These associations supported findings reported in the literature regarding the impact of substance abuse on various diseases and vice versa. In randomly set-aside validation data, the model accurately predicted substance abuse for inpatient (AROC = 0.884), outpatient (AROC = 0.825), and combined inpatient and outpatient (AROC = 0.840) data. If one excludes information available after substance abuse is known, the cross-validated AROC remained high, 0.822 for inpatient and 0.817 for outpatient data. Data within EHRs can be used to detect existing or predict potential future substance abuse.

Author/s:

Alemi, Farrokh, Avramovic, Sanja, Schwartz, Mark D.

Forecasting Opioid Use Disorder at 25 Years of Age in 16-Year Old Adolescents

Brian Desmarais — Thu, 09 Jul 2020 21:14:01 +0000

Date Added:

July 9, 2020

Journal/Publication:

The Journal of Pediatrics

Publication Date:

July 8, 2020

URL:

Forecasting Opioid Use Disorder at 25 Years of Age in 16-Year Old Adolescents

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://www.jpeds.com

Keywords

People who, at 16, have a positive family history of substance abuse and are currently using addictive substances are very likely to develop a substance abuse disorder by age 25. Obvious but also important to remember when seeing adolescents for other reasons because addiction is really hard to cure and a major impediment to a long and happy life. James W. Mold, MD, MPH

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Objective

t To evaluate the accuracy of detecting 16 year old male (N=465) and female (N=162) youths who subsequently manifest opioid use disorder (OUD) at 25 years of age. We hypothesized that the combined measures of two components of etiology, heritable risk and substance use, accurately detect youths who develop OUD.

Study design

Heritable risk was measured by the transmissible liability index (TLI). Severity of the prodrome presaging OUD was quantified by the revised Drug Use Screening Inventory (DUSI-R) containing the consumption frequency index (CFI) documenting substance use events during the past month and the overall problem density (OPD) score indicating co-occurring biopsychosocial problems. Diagnosis of OUD was formulated by a clinical committee based on results of the Structured Clinical Interview for DSM-IV in conjunction with medical and social history records.

Results

Bivariate analysis shows that the TLI, CFI, and OPD scores at 16 years of age predict OUD at 25 years. Multivariate modeling indicates that the TLI combined with the CFI predict OUD with 86% accuracy (sensitivity = 87%; specificity = 62%). The TLI and CFI at 16 years of age mediate the association between parental substance use disorder and OUD in offspring at 25 years of age, indicating that these measures respectively evaluate risk and prodrome.

Conclusion

These results demonstrate the feasibility of identifying youths requiring intervention to prevent OUD.

Author/s:

Tarter, R.E., Kirisci, L., Reynolds, M., Seybert, A., Cochran, C., Vanyukov, M.

Osteoporosis Screening in Younger Postmenopausal Women

Brian Desmarais — Sat, 11 Jan 2020 20:19:49 +0000

Date Added:

January 11, 2020

Journal/Publication:

Journal of the American Medical Association

Publication Date:

January 9, 2020

URL:

Osteoporosis Screening in Younger Postmenopausal Women

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jama.2019.18343

Keywords

MeSH

osteoporotic fractures

This is a nice review of when to consider screening for osteoporosis in postmenopausal women younger than 65. James W. Mold, MD, MPH

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Osteoporotic fractures, especially hip fractures, are associated with mobility limitations, chronic disability, loss of independence, and reduced quality of life.

Several randomized trials have demonstrated the benefit of drug treatment in reducing clinical fractures among postmenopausal women with existing vertebral fractures or bone mineral density (BMD) T-scores of −2.5 or lower and among adults aged 50 years and older with recent hip fracture.

Thus, osteoporosis in the clinical setting should be diagnosed in patients with a history of hip or clinical vertebral fracture not due to excessive trauma, those with existing radiographic vertebral fractures, and those with a BMD T-score of −2.5 or lower at the hip (femoral neck or total hip) or lumbar spine. In the absence of a history of hip or vertebral fracture, osteoporosis screening is aimed at identifying individuals with a BMD T-score of −2.5 or lower because those individuals may be candidates for osteoporosis pharmacotherapy. The BMD T-score quantifies the difference (expressed in standard deviations) between a patient’s BMD and the average BMD of young adult white women (reference group).

Author/s:

Crandall, C.J., Ensrud, Kristine E.

Final Recommendation Statement: Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening

Tracy Ashby — Tue, 23 Oct 2018 05:00:00 +0000

Date Added:

October 23, 2018

Journal/Publication:

U. S. Preventive Services Task Force

Publication Date:

October 1, 2018

URL:

Final Recommendation Statement Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults: Screening

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

Keywords

intimate partner violence

screening

reproduction

MeSH

intimate partner violence

reproduction

The US Preventive Services Task Force recommends routinely screening women for intimate partner violence using one of the validated instruments.

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Intimate partner violence and abuse of older or vulnerable adults are common in the United States but often remain undetected. Although estimates vary, IPV (including sexual violence, physical violence, and stalking) is experienced by approximately 36% of US women and 33% of US men during their lifetime. Severe physical violence is experienced by 21% of US women and 15% of US men during their lifetime.1 Prevalence rates vary by age, race/ethnicity, and income. Estimates also vary for prevalence of elder abuse and abuse of vulnerable adults. A 2008 nationwide survey of US adults 60 years or older found that the prevalence of any abuse or neglect in the past year was 10%.2 A 2004 survey of Adult Protective Services (APS) agencies found 40,848 substantiated reports of vulnerable adult abuse (in those aged 18 to 59 years) in 19 states.3

In addition to the immediate effects of IPV, such as injury and death, there are other health consequences, many with long-term effects, including development of mental health conditions such as depression, posttraumatic stress disorder (PTSD), anxiety disorders, substance abuse, and suicidal behavior; sexually transmitted infections; unintended pregnancy; and chronic pain and other disabilities.4, 5 Violence during pregnancy is associated with preterm birth and low birth weight6 and adverse effects on maternal and infant health, including postpartum mental health problems7 and hospitalization during infancy.8

Long-term negative health effects from elder abuse include death,9 higher risk of nursing home placement10 among those referred to APS, and adverse psychological consequences (distress, anxiety, and depression).11

Author/s:

U. S. Preventive Services Task Force

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement.

Tracy Ashby — Tue, 04 Sep 2018 05:00:00 +0000

Date Added:

November 1, 2018

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

August 6, 2018

Issue:

Volume:

320

Pages:

674-686

URL:

Screening for Cervical Cancer: US Preventive Services Task Force Recommendation Statement.

Type:

Clinical Research Results, Public Health Announcements

Format:

Article

DOI (1):

10.1001/jama.2018.10897

Keywords

cervical cancer

screening

PMID (1):

30140884

MeSH

uterine cervical neoplasms

early detection of cancer

cohort studies

This new recommendation from the USPSTF suggests that it is not necessary to include HPV testing when doing pap tests, but if you do, the screening interval can be a little longer.

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IMPORTANCE:

The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100 000 women from 2000 to 2015.

OBJECTIVE:

To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on screening for cervical cancer, with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (cotesting) compared with cervical cytology alone. The USPSTF also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

FINDINGS:

Screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. The USPSTF concludes with moderate to high certainty that screening women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, screening women younger than 21 years, and screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer does not result in a positive net benefit.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. (A recommendation) The USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years. (A recommendation) The USPSTF recommends against screening for cervical cancer in women younger than 21 years. (D recommendation) The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D recommendation) The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer. (D recommendation).

Author/s:

US Preventive Services Task Force

Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement

Jeffrey Wilson — Thu, 23 Aug 2018 16:26:38 +0000

Date Added:

November 1, 2018

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

February 13, 2018

Issue:

Volume:

319

Pages:

588-594

URL:

Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2017.21926

Keywords

ovarian cancer

screening

PMID (1):

29450531

MeSH

ovarian neoplasms

unnecessary procedures

The USPSTF found good evidence that ovarian cancer screening causes more harm than good.

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IMPORTANCE:

With approximately 14 000 deaths per year, ovarian cancer is the fifth most common cause of cancer death among US women and the leading cause of death from gynecologic cancer. More than 95% of ovarian cancer deaths occur among women 45 years and older.

OBJECTIVE:

To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on screening for ovarian cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on the benefits and harms of screening for ovarian cancer in asymptomatic women not known to be at high risk for ovarian cancer (ie, high risk includes women with certain hereditary cancer syndromes that increase their risk for ovarian cancer). Outcomes of interest included ovarian cancer mortality, quality of life, false-positive rate, surgery and surgical complication rates, and psychological effects of screening.

FINDINGS:

The USPSTF found adequate evidence that screening for ovarian cancer does not reduce ovarian cancer mortality. The USPSTF found adequate evidence that the harms from screening for ovarian cancer are at least moderate and may be substantial in some cases, and include unnecessary surgery for women who do not have cancer. Given the lack of mortality benefit of screening, and the moderate to substantial harms that could result from false-positive screening test results and subsequent surgery, the USPSTF concludes with moderate certainty that the harms of screening for ovarian cancer outweigh the benefit, and the net balance of the benefit and harms of screening is negative.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends against screening for ovarian cancer in asymptomatic women. (D recommendation) This recommendation applies to asymptomatic women who are not known to have a high-risk hereditary cancer syndrome.

Author/s:

Grossman, David C., Curry, Susan J., Owens, Douglas K., Barry, Michael J., Davidson, Karina W., Doubeni, Chyke A., Epling, John W. Jr., Kemper, Alex R., Krist, Alex H., Kurth, Ann E., Landefeld, Seth, Mangione, Carol M., Phipps, Maureen G., Silverstein, Michael, Simon, Melissa A., Tseng, Chien-Wen