November 2002 • Volume 8 • Number 11 |
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There is "fair evidence" that osteoporosis screening for women over age 65 years, or 60 to 65 and at high risk, provides a "moderate to substantial benefit," according to the U.S. Preventive Services Task Force. That is a "B" code recommendation based on the latest scientific data, recently upgraded from the previous "I" for insufficient evidence.
But the task force is not currently recommending osteoporosis screening for women under age 60 because evidence of benefit and harm is too closely balanced -- a "C" under the task force's new recommendation codes.
Rating preventive-intervention data as good, fair, bad or insufficient is not simply a matter of evaluating the science, says task force chair Alfred Berg, M.D.
"Science is the easy part," said Berg, professor and chair of the department of family medicine, University of Washington, Seattle. "The challenge is putting science into practice that benefits patients."
The task force evaluates evidence to determine whether an intervention is effective, whether it can work in practice and whether it can be cost-effective, he said in his Scientific Assembly lecture Oct. 17 titled "What's New From the U.S. Preventive Services Task Force." The session was offered as part of the 2003 Annual Clinical Focus on prevention.
Berg described some of the latest task force recommendations and also explained what the task force is not intended to do.
"It does not advocate for prevention, set clinical standards or make public policy," he said.
But it does tackle difficult topics.
The task force recently recommended against routine use of combination hormone replacement therapy, a "D" code, after it determined that evidence from the Women's Health Initiative study showed that potential harm from the therapy outweighed benefits.
"Hormone replacement is complicated -- it's the Rubik's Cube of prevention," Berg said. "We did find benefits to the combined therapy, but there were also significant harms. So our recommendation was that routine use to prevent chronic conditions is not a good deal for most women."
That leaves open the question of whether a woman who derives great benefit from HRT for perimenopausal symptoms might still want to stay on medication. The task force recognizes the importance of personal preference, Berg said, and in general advises physicians to discuss these questions as much as time permits with patients.
For example, the task force recognized that there is good evidence for a substantial benefit to aspirin in primary prevention of heart disease -- an "A" code. But it actually only recommends discussing aspirin therapy with the patient, not necessarily prescribing it. The recommendations are not the final answer for each individual patient, but they can be the stepping-off point to more patient and public education.
The task force publishes
recommendations in journals and news releases, and it will issue loose-leaf
binders later this year. It is also using the Web for immediate release of
recommendations.
The most important thing family physicians needed to know from his session was http://www.preventiveservices.ahrq.gov, Berg said.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.