View
33
Download
0
Category
Tags:
Preview:
DESCRIPTION
USPSTF Screening Recommendations: Implications for Adults at Higher Risk NYFAHC Roundtable, June 18, 2013. Robert A. Smith, PhD Senior Director, Cancer Control Science Cancer Control Sciences Department. Cancer Screening, the ACA, and the USPSTF. - PowerPoint PPT Presentation
Citation preview
USPSTF Screening Recommendations:Implications for Adults at Higher Risk
NYFAHC Roundtable, June 18, 2013
Robert A. Smith, PhDSenior Director, Cancer Control Science
Cancer Control Sciences Department
Cancer Screening, the ACA, and the USPSTF
• Under the ACA, preventive services that are given an A or B rating by the USPSTF must be provided without any co-pays or deductibles
• USPSTF screening recommendations specifically are targeted to average risk adults
Cancer Screening, the ACA, and the USPSTF
• The need for a different screening regimen for adults at higher risk typically is acknowledged, but recommendations are not issued due to lack of adequate evidence
• The USPSTF commonly acknowledges that other organizations have issued different and specific recommendations for adults at higher risk
Colorectal Cancer Screening
Colorectal Screening in Average Risk Adults: Update 2008
Recommendation ACS, USMSTF, ACR USPSTF
Age to begin and end screening
Begin screening at age 50
End screening at a point where curative therapy would not be offered due to life-limiting co-morbidity
Begin screening at age 50
Routine screening in adults aged 76-85 is not recommended. There may be considerations that support screening in an individual patient.
Screening after age 85 is not recommended
CRC Screening in Average Risk Adults: Update 2008
Recommendation ACS, USMSTF, ACR USPSTF
CRC screening between ages 76-85
Adults in good health who would be candidates for treatment should continue screening
Recommend against routine screening in adults 76-85. There may be considerations that support screening in an individual patient.
CRC screening in adults over age 85
Screening not recommended in adults > 85 years
USPSTF Clinical Considerations• “These recommendations apply to adults 50 years of age
and older, excluding those with specific inherited syndromes (the Lynch syndrome or familial adenomatous polyposis) and those with inflammatory bowel disease. The recommendations do apply to those with first-degree relatives who have had colorectal adenomas or cancer, although for those with first-degree relatives who developed cancer at a younger age or those with multiple affected first-degree relatives, an earlier start to screening may be reasonable.”
USPSTF Clinical Considerations
• “When the screening test results in the diagnosis of clinically significant colorectal adenomas or cancer, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable. The USPSTF did not address evidence for the effectiveness of any particular surveillance regimen after diagnosis and/or removal of adenomatous polyps.”
INCREASED RISK
HIGHEST RISK
AVERAGE RISK
Breast Cancer Screening Guidelines
Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)
Recommendation ACS USPSTF
Mammography Age 40+ - Annual Screening
The USPSTF recommends biennial screening mammographyfor women between the ages of 50 and 74 years. (Grade B recommendation)
Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)
Recommendation ACS USPSTF
Mammography End screening at a point where curative therapy would not be offered due to life-limiting co-morbidity
The USPSTF concludes that the current evidence is insufficient toassess the additional benefits and harms of screening mammographyin women 75 years or older. (I statement)
Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)
Recommendation ACS USPSTF
Age to begin and end screening
Begin screening at age 50
End screening at a point where curative therapy would not be offered due to life-limiting co-morbidity
Begin screening at age 50
Routine screening in adults aged 76-85 is not recommended. There may be considerations that support screening in an individual patient.
Screening after age 85 is not recommended
USPSTF Clinical Considerations
• “This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.”
ACS Guidelines for Breast MR in High Risk Women
Cervical, Prostate, and Lung Screening
• ACS and USPSTF cervical cancer screening guidelines are similar
• USPSTF recommends against prostate cancer screening. ACS recommendations accommodate men at average and high risk
• Lung cancer screening recommendations are expected in 2013
Thank you
Recommended