ACPM 2009: New, Updated Screening Recommendations Released by Preventive Services Task Force

Norra MacReady

February 16, 2009

February 16, 2009 (Los Angeles, California) — The US Preventive Services Task Force (USPSTF) announced new or updated recommendations on screening for several conditions here at Preventive Medicine 2009: The Annual Meeting of the American College of Preventive Medicine.

Type 2 diabetes, congenital hearing loss, and chronic obstructive pulmonary disease (COPD) were among the conditions affected, said Mary Barton, MD, MPP, scientific director of the USPSTF.

Perhaps the task force's most controversial move was to tweak the recommendation for type 2 diabetes screening. Previously, screening candidates had to have hypertension plus hyperlipidemia. The updated recommendation advocates screening for patients with blood pressure readings of 135/80 or higher alone, whether or not they also have elevated lipids.

The task force gave the updated recommendation a grade of B on its rating scale, meaning that there is at least fair evidence that it improves health outcomes and that the benefits of screening outweigh the risks.

In explaining the task force's reasoning, Dr. Barton pointed out that aggressive treatment of cardiovascular risk factors is an established benefit of early diabetes detection. Therefore, the task force recommends screening for anyone near a risk threshold for whom the diagnosis of type 2 diabetes would make a difference in therapy. "The task force hoped that doctors would especially use this information for patients who were near the established threshold for other cardiovascular risk factors, such as aspirin use," she said.

In fact, Dr. Barton noted, the combination of diabetes and hypertension is a particularly strong risk factor for microvascular disease, and in future meetings, the task force plans to consider a recommendation of routine cardiovascular screening for anyone with these 2 conditions.

With this update, the task force panel is saying that there does not have to be an association "between cholesterol levels and evaluative screening for diabetes" if a patient has other risk factors, such as hypertension, that place them at high risk for cardiovascular disease, said Wayne Dysinger, MD, chairman of the department of preventive medicine at Loma Linda University, California.

However, Dr. Dysinger, who did not participate in the task force, said the updated recommendation probably would not induce him to change his own practice. Currently, he recommends diabetes testing for anyone who is obese, especially if they have metabolic syndrome, and for anyone with high serum triglycerides.

The task force also revised its recommendation for routine screening of newborns for bilateral congenital hearing loss, upgrading it from an I (insufficient evidence to recommend for or against) to a B.

The task force based this change on the findings of a large, controlled trial conducted in the United Kingdom that demonstrated better language and school performance outcomes among populations that underwent screening, Dr. Barton said. "This was very exciting for the task force. It's an important bit of progress in the preventive medicine world."

One new move was to assign screening of asymptomatic adults for COPD with spirometry a grade of D, meaning that the task force recommended against it. The evidence suggests that spirometry readings do not necessarily correlate with patients' subjective experience of symptoms. Screening with spirometry might also potentially harm patients, because the beta-agonist inhalers used to treat COPD raise heart rates and could produce an increase in the incidence of heart attacks "if you handed them out like water," Dr. Barton noted.

Preventive Medicine 2009: The Annual Meeting of the American College of Preventive Medicine (ACPM). Session 30. Presented February 13, 2009.


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