USPSTF: All Pregnant Women Should Be Screened For Syphilis

MedicalResearch.com Interview with:

Melissa A. Simon, M.D., M.P.H. Member, U.S. Preventive Services Task Force George H. Gardner professor of clinical gynecology, Vice chair of clinical research Department of Obstetrics and Gynecology Professor of preventive medicine and medical social sciences Northwestern University Feinberg School of Medicine

Dr. Simon

Melissa A. Simon, M.D., M.P.H.
Member, U.S. Preventive Services Task Force
George H. Gardner professor of clinical gynecology, Vice chair of clinical research
Department of Obstetrics and Gynecology
Professor of preventive medicine and medical social sciences
Northwestern University Feinberg School of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The number of babies born with syphilis is increasing, mirroring the recent increase of syphilis among women. Syphilis infection passed from a pregnant woman to her baby, also known as congenital syphilis, can lead to serious health complications for the baby including premature birth, low birthweight, birth defects, and even death. The Task Force recommends that all pregnant women be screened for syphilis as early in pregnancy as possible to prevent congenital syphilis.  Continue reading

USPSTF and PAD: Uncertain if Nontraditional Risk Factors Can Predict Heart Disease or Stroke Risk

MedicalResearch.com Interview with:

Dr. Michael Barry MD Director of the Informed Medical Decisions Program Health Decision Sciences Center at Massachusetts General Hospital Physician at Massachusetts General Hospit Professor of Medicine,Harvard Medical School

Dr. Barry

Dr. Michael Barry MD
Director of the Informed Medical Decisions Program
Health Decision Sciences Center at Massachusetts General Hospital
Physician at Massachusetts General Hospit
Professor of Medicine,Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Peripheral artery disease—which is known as PAD—is a disease that reduces blood flow to a person’s limbs, especially the legs. PAD can cause leg and foot pain when resting or walking, wounds to not heal properly, and loss of limbs. Additionally, people with PAD are more likely to experience a cardiovascular disease event, such as heart attack and stroke.

The U.S. Preventive Services Task Force looked at the latest research to see if screening people without signs or symptoms of PAD using the ankle brachial index (ABI) can prevent heart attack, stroke, or other adverse health effects. We found that more research is needed to determine if screening with ABI can help to identify PAD and/or prevent heart attack or stroke in people without signs or symptoms.

Additionally, in a separate recommendation statement, we looked into the effectiveness of what we call nontraditional risk factors for assessing a person’s risk of cardiovascular disease. Clinicians typically check someone’s risk for cardiovascular disease using traditional risk factors, such as age, race, and smoking status. The Task Force looked at the current evidence to see if three additional, nontraditional risk factors can help prevent heart disease or stroke. The nontraditional factors considered were ABI measurements, an elevated amount of high-sensitivity C-reactive protein (hsCRP) in the blood, and an elevated amount of calcium in the coronary arteries (CAC score).

In this recommendation, we also found that there is insufficient evidence to recommend for or against using nontraditional risk factors in addition to those normally used to assess cardiovascular disease risk in people without signs or symptoms.  Continue reading

USPSTF: Women 65 and Older Should Be Screened for Osteoporosis to Prevent Fractures

MedicalResearch.com Interview with:

Chien-Wen Tseng, M.D., M.P.H., M.S.E.E. Hawaii Medical Service Association Endowed Chair in health services and quality research Associate professor, and the Associate research director Department of Family Medicine and Community Health University of Hawaii John A. Burns School of Medicine

Dr. Chien-Wen Tseng

Chien-Wen Tseng, M.D., M.P.H., M.S.E.E.
Hawaii Medical Service Association Endowed Chair in health services and quality research
Associate professor, and the Associate research director
Department of Family Medicine and Community Health
University of Hawaii John A. Burns School of Medicine 

MedicalResearch.com: What is the background for this recommendation statement? What are the main findings and recommendations?

Response: Osteoporosis is a condition where bones become weak and can break or fracture more easily. These fractures can happen at the spine, hip, and other locations, and can have serious health consequences such as pain, limited mobility, or even death. By 2020, more than 12 million Americans over the age of 50 are expected to have osteoporosis and two million fractures occur yearly.

Since people often may not know they have osteoporosis until they have a fracture, the U.S. Preventive Services Task Force looked at the evidence to see if screening for osteoporosis can help to prevent fractures. We found that screening for and treating osteoporosis can prevent fractures in women ages 65 and older and in younger women who have been through menopause and have additional factors that put them at increased risk for osteoporosis.

In men, more research is needed to know if routine screening and treatment for osteoporosis can prevent fractures. Continue reading

Government Agencies Provide Funding For Most USPSTF Evidence Reviews

MedicalResearch.com Interview with:

Jennifer Villani, PhD, MPH Office of Disease Prevention National Institutes of Health

Dr. Villani

Jennifer Villani, PhD, MPH
Office of Disease Prevention
National Institutes of Health

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The US Preventive Services Task Force (USPSTF) develops recommendations for the delivery of clinical preventive services based on the highest quality scientific evidence available. We performed a comprehensive assessment of the sources of funding for the research studies in this evidence base.

The results showed that government agencies supported the most articles (56%), with the remaining support coming from nonprofits or universities (32%), and industry (17%). The National Institutes of Health was the single largest funder of research articles underlying the USPSTF recommendations.  Continue reading

USPSTF: Men 70 and Older Should Not Be Screened for Prostate Cancer

MedicalResearch.com Interview with:

Alex Krist, M.D., M.P.H Professor of family medicine and population health Virginia Commonwealth University and Active clinician and teacher at the Fairfax Family Practice residency

Dr. Krist

Alex Krist, M.D., M.P.H
Professor of family medicine and population health
Virginia Commonwealth University and
Active clinician and teacher at the Fairfax Family Practice residency

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prostate cancer is one of the most common cancers to affect men. However, the decision about whether to be screened is complex and personal. The U.S. Preventive Services Task Force reviewed the latest research on the benefits and harms of screening for prostate cancer using PSA-based testing, as well as evidence on treatment.

We found that men who are 55 to 69 years old should discuss the benefits and harms of screening with their doctor, so they can make the best choice for themselves based on their values and individual circumstances. Men age 70 and older should not be screened, as the benefits of screening diminish as men age and the harms are greater.

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USPSTF: Behavioral Counseling of Children and Teens to Prevent Skin Cancer Recommended

MedicalResearch.com Interview with:

John W. Epling, Jr., M.D.

Dr. Epling

John W. Epling, Jr., M.D., M.S.Ed., Task Force Member
Dr. Epling is is a professor of Family and Community Medicine at the Virginia Tech Carilion School of Medicine in Roanoke, VA. He is also the Medical Director of Research for Family and Community Medicine, Medical Director of Employee Health and Wellness for the Carilion Clinic, and maintains an active clinical primary care practice. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Skin cancer is the most common type of cancer in the U.S., affecting millions of people every year. The Task Force looked at the latest research to see if clinicians can help people prevent skin cancer by providing counseling about ways to reduce risk, including using sunscreen, wearing protective clothing, and avoiding sunlight during peak hours.

Sunburn damaged skin - wiki image

Sunburn damage – wiki image

Based on our review of the evidence, we found that counseling younger patients with a fair skin type and their parents is effective at encouraging these sun protective behaviors. By helping reduce their patients’ exposure to harmful UV rays, clinicians can decrease their risk for skin cancer. As such, we recommend that clinicians provide counseling to people who are six months to 24 years old and have a fair skin type. For adults over 24 with a fair skin type, clinicians should consider the individual’s risks for skin cancer when deciding whether or not to provide counseling.  Continue reading

Menopausal Hormone Replacement Should Not Be Used For Disease Prevention

MedicalResearch.com Interview with:

Dr-Suzanne Fenske.jpg

Dr. Fenske

Dr. Suzanne Fenske, MD
Assistant Professor of Obstetrics, Gynecology and Reproductive Science
Icahn School of Medicine at Mount Sinai

 MedicalResearch.com: What is the background for this study? What are the main findings?

Response: USPSTF recommendations are based off several studies, but is mainly based off of the Women’s Health Initiative.

The Women’s Health Initiative was a 15 year prevention study with a focus on death, disability and impaired quality of life in postmenopausal women. This study was originally performed in 1991.

The USPSTF reevaluated the data along with several other studies to assess the role of hormone replacement therapy in prevention of chronic diseases such as heart disease, stroke, blood clot, gallbladder disease, dementia.  The USPSTF has found that hormone replacement therapy has some benefit in reducing the risk of fractures, and, potentially, diabetes.  The USPSTF has found that hormone replacement therapy can increase the risk of coronary artery disease, stroke, blood clot, gall bladder disease, urinary incontinence and dementia.

With these risks, the USPSTF states that hormone replacement therapy should not be used as a preventative medicine, but, rather, used for treatment of symptomatic menopause and not prevention of osteoporosis or heart disease.

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USPSTF Recommends Men 70 or Older Not Be Screened for Prostate Cancer

MedicalResearch.com Interview with:

Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S.  Lee Goldman, MD, endowed chair in medicine and professor of medicine and of epidemiology and biostatistics University of California, San Francisco Chair of the U.S. Preventive Services Task Force

Dr. Bibbins-Domingo

Kirsten Bibbins-Domingo, Ph.D., M.D., M.A.S.
Lee Goldman, MD, endowed chair in medicine and professor of medicine and of epidemiology and biostatistics
University of California, San Francisco
Chair of the U.S. Preventive Services Task Force

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prostate cancer is one of the most common cancers to affect men, and the Task Force believes all men should be aware of the benefits and harms of screening for prostate cancer. Prostate cancer screening with PSA testing can help men reduce their chance of dying of prostate cancer or of having metastatic cancer. These are important benefits but occur in a small number of men. There are risks associated with screening, specifically overdiagnosis and overtreatment with surgery and radiation that can have important side effects like impotence and incontinence.

Since the release of our 2012 recommendation, new evidence has emerged that increased the Task Force’s confidence in the benefits of screening, which include reducing the risk of metastatic cancer (a cancer that spreads) and reducing the chance of dying from prostate cancer. This draft recommendation also reflects new evidence on the use of active surveillance in men with low-risk prostate cancers that may help mitigate some of the harms in these men by allowing some men with low risk cancer to delay or avoid surgery or radiation. Therefore, in our new 2017 draft recommendation, the Task Force encourages men ages 55 to 69 to make an individual decision about whether to be screened after a conversation with their clinician about the potential benefits and harms. For men age 70 years and older, the potential benefits do not outweigh the harms, and these men should not be screened for prostate cancer.

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Little Change in PSA Use After Taskforce Recommendation

MedicalResearch.com Interview with:
Dr Ryan Hutchinson MD and
Yair Lotan MD

Department of Urology
University of Texas Southwestern Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The United States Preventative Services Task Force recommendation against PSA screening generated significant controversy. Research since then has relied heavily on survey data to examine the impact of the recommendation on PSA screening practices. In a hotly charged issue such as this, such data can carry significant bias.

We examined a large, whole-institution data in the years before and after the USPSTF recommendations reflecting actual practice and found that the changes in PSA use at our institution, if any, were small. This is more consistent with behavior seen after the vast majority of practice recommendations.

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