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JAMA,
1 the US Preventive Services Task Force (USPTF) has reaffirmed its 2014 recommendation, stating that “The USPTF recommends against screening for asymptomatic carotid artery stenosis in the general adult population (D recommendation),” based on evidence that the harms of screening for carotid artery stenosis in asymptomatic adults outweigh the benefits, with no new evidence that would change the previous recommendation. The rationale for this confirmation is based on a combination of considerations, including the effects of false-positive results when screening the general population with duplex ultrasonography; inadequate evidence that screening for asymptomatic carotid artery stenosis leads to a reduction in stroke or death; and the likelihoods of small to moderate harms of screening for and treatment of asymptomatic carotid artery stenosis. The restated recommendation is also consistent with that of the 2014 guidelines from the American Heart Association not to screen lo
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Carotid artery stenosis screening still can t be recommended in the absence of symptoms, the U.S. Preventive Services Task Force (USPSTF) concluded.
No substantial evidence has turned up in the years since its last D-grade recommendation against screening for asymptomatic adults in 2014, argued the group led by Alex H. Krist, MD, MPH, of Virginia Commonwealth University in Richmond. Using a reaffirmation process, the USPSTF concludes with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits, they wrote in
They pointed to false-positives with duplex ultrasonography in a general population with low prevalence, inadequate evidence that screening prevents stroke or death, and risk of small to moderate harms from screening for and treatment of asymptomatic cases.
Dr. Daniel Kopans.
The history of the U.S. Preventive Services Task Force (USPSTF) on breast screening is another case in point, in which decisions on mammography guidelines have been based on flawed analyses of scientific data.
When the USPSTF last week opened a new review of breast screening guidelines, it created the opportunity to revisit the group s flawed decision in 2009 to not recommend breast screening for women in their 40s. However, a number of factors need to be addressed for the 2021 review to present a fair and impartial review of the science and evidence in favor of breast screening.
Why? Because the emergency department is one of the few healthcare settings where people from traditionally underserved groups present for care, wrote a team led by Dr. Randy Miles of Massachusetts General Hospital in Boston. Limited access to a regular source of primary care, a hallmark of patients visiting the ED for nonemergent issues, has also been shown to represent one of the strongest predictors of nonadherence to cancer screening, the team noted. Thus, patient visits to the ED may represent an opportunity to engage hard-to-reach patient groups about cancer screening.
More than 600,000 breast, colorectal, and lung cancers are diagnosed each year, and although screening reduces the disease burden of these cancers, people of color and those with less financial resources often encounter barriers to screening, Miles and colleagues wrote. The team investigated whether the emergency department could mitigate these barriers by offering an opportunity for screening.