By Lisa Zamosky
The United States Preventive Services Task Force (USPSTF) has been in the news quite a bit over the past few years due to positions it’s taken on a number of cancer screening tests that have caused dissent within the medical community and concern on the part of the public.
Most recently, it recommended changes in the frequency with which women aged 40-50 undergo mammography and Pap smear tests to detect cervical cancer, and stated that men should no longer be routinely screened for prostate cancer.
To gain a greater understanding of its mission and influence, I talked with Virginia A. Moyer, MD, MPH, chair of the USPSTF and professor of pediatrics at the Baylor College of Medicine.
Who is the USPSTF?
The Task Force is a 16-member volunteer committee that serves a four-year term. It’s an independent, diverse panel of experts in primary care and preventive medicine appointed by the Department of Health and Human Services.
“We have pediatricians, internists, family physicians, advanced practice nurses and people in behavioral sciences, all of whom have expertise in primary care and prevention,” Moyer explains.
Members can’t just be practicing clinicians, however, though most are. According to Moyer, it’s critical that each has significant understanding of scientific evidence and the ability to expertly evaluate research studies.
Understanding the USPSTF‘s Mission
In criticizing the Task Forces’ recent recommendation that healthy men no longer undergo routine screening for prostate cancer, presidential candidate Newt Gingrich chided the panel for including no urologists.
But according to Moyer, concern over the absence of an urologist misses the point entirely. The panel’s area of focus is the identification of effective screening methods for disease in a population that exhibits no clinical symptoms.
“We’re not telling urologists what to do,” Moyer says. “The point at which we’re looking is in the primary care setting with someone who has no urologic complaints. Once the patient is referred to an urologist, that is simply not our area,” she says.
What Issues Will USPSTF Take On?
Anyone can recommend a topic for the Task Force to evaluate, a process you can learn more about here.
“We ask for some background information; some reasons why the topic is one we ought to consider. Then we have a sub-committee that looks at all the topic suggestions and makes sure they’re within our scope,” Moyer says.
With limited resources, the USPSTF attempts to address issues that are important, which is determined by how much burden the disease places on the population at large and where the Task Force has the potential to have the greatest impact.
What the Task Force Recommends
The recommendations of the USPSTF are based on rigorous review of existing peer-reviewed research and whether the evidence of the benefits provided by the preventive service outweighs the potential harms.
A letter grade is assigned to every recommendation the Task Force makes. Here’s what they mean:
|A||The USPSTF recommends the service. There is high certainty that the net benefit is substantial.|
|B||The USPSTF recommends the service. There is high certainty that the net benefit is moderate, or there is moderate certainty that the net benefit is moderate to substantial.|
|C||Note: The following statement is undergoing revision. Clinicians may provide this 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 from this service.|
|D||The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.|
|I Statement||The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service.|
The Task Force’s Impact
Although the panel’s work is independent, or perhaps precisely because of it, the medical recommendations it makes are weighted heavily not only by physician groups but also by insurance companies determining which services to pay for.
In fact, the USPSTF has played an important role in the Affordable Care Act (aka health reform). All insurance companies are now required by law to pay for preventive services assigned a rating of “A” or “B” by the USPSTF, with no cost-sharing for the consumer.
According to Moyer, insurance companies will also frequently pay for services with a “C” rating, although they are not included on the list of mandatory preventive services.
You can learn more about the USPSTF on its web site.
Virginia A. Moyer, MD, MPH, chair of the U.S. Preventive Services Task Force; professor of pediatrics, Baylor College of Medicine.
Understanding How the U.S. Preventive Services Task Force Works.