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The United States Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services".[1] The task force, a volunteer panel of primary care clinicians (including those from internal medicine, pediatrics, family medicine, obstetrics and gynecology, nursing, and psychology) with methodology experience including epidemiology, biostatistics, health services research, decision sciences, and health economics, is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality.[2][3]
The USPSTF evaluates scientific evidence to determine whether medical screenings, counseling, and preventive medications work for adults and children who have no symptoms.
The methods of evidence synthesis used by the Task Force have been described in detail.[4] In 2007, their methods were revised.[5][6]
No weight given to cost-effectiveness
The USPSTF explicitly does not consider cost as a factor in its recommendations, and it does not perform cost-effectiveness analyses.[7] American health insurance groups are required to cover, at no charge to the patient, any service that the USPSTF recommends, regardless of how much it costs or how small the benefit is.[8]
Grade definitions
The task force assigns the letter grades A, B, C, D, or I to each of its recommendations, and includes "suggestions for practice" for each grade. The Task Force also defined levels of certainty regarding net benefit.[9]
| Grade | Result | Meaning |
|---|---|---|
| Grade A | Recommended | There is high certainty that the net benefit is substantial. |
| Grade B | Recommended | There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. |
| Grade C | No recommendation | Clinicians may provide the 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. |
| Grade D | Recommended against | The Task Force recommends against this service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. |
| I statement | Insufficient evidence | The current evidence is insufficient to assess the balance of benefits and harms. |
Levels of certainty vary from high to low according to the evidence.
- High: Consistent results from well-designed studies in representative populations that assess the effect of the service on health outcomes.
- Moderate: The evidence is sufficient to determine the effects of the service, but confidence is limited. The conclusion might change as more information becomes available.
- Low: The evidence is insufficient to assess effects on health outcome.
The USPSTF has evaluated many interventions for prevention and found several have an expected net benefit in the general population.[10]
- Aspirin in men 45 to 79 and women 55 to 79 for cardiovascular disease
- Colon cancer screening by colonoscopy, occult blood testing, or sigmoidoscopy in adults 45 to 75.[11]
- Low-dose CT scans for adults 55 to 80 at increased risk of lung cancer
- Osteoporosis screening via bone dual-energy X-ray absorptiometry (DEXA) in women over 65
The USPSTF has changed its breast cancer screening recommendations over the years, including at what age women should begin routine screening. In 2009, the task force recommended women at average risk for developing breast cancer should be screened with mammograms every two years beginning at age 50.[12] Previously, they had recommended beginning screening at age 40. The recommendation to begin screening at an older age received significant attention, including proposed congressional intervention.[13] The 2016 recommendations maintained 50 as the age when routine screening should begin.[14]
In April 2024, The USPSTF lowered the recommended age to begin breast cancer screening. Citing rising rates of breast cancer diagnosis and substantially higher rates among Black women in the United States, the task force recommends screening mammograms every two years beginning at age 40. This recommendation applies to all cisgender women and all other people assigned female at birth who are at average risk for breast cancer. [15][16][17]
In the current recommendation published in 2018, the Task Force recommended that prostate-specific antigen (PSA)-based screening for prostate cancer screenings be an individual decision for men between the ages of 55 to 69.[18] In 2018 the Task Force gave PCa screening a C recommendation.[18]
A final statement published in 2018 recommends basing the decision to screen on shared decision making in those 55 to 69 years old.[19] It continues to recommend against screening in those 70 and older.[19]
The initial USPSTF was created in 1984 as a 5 year appointment to "develop recommendations for primary care clinicians on the appropriate content of periodic health examinations" and was modelled on the Canadian Task Force on Preventive Health Care, established in 1976.[20] This initial 5 year project concluded in 1989 with the release of their report, the Guide to Clinical Preventive Services. In July 1990, the Department of Health and Human Services reconstituted the Task Force to continue and update these scientific assessments of preventive services.[21]
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