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A-E: Recommendations for Clinical Preventive Services

Abdominal Aortic Aneurysm, Men

The AAFP recommends one-time screening for abdominal aortic aneurysm (AAA) by ultrasonography in men aged 65 to 75 years who have ever smoked.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Consideration: www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm#clinical

Abdominal Aortic Aneurysm, Men

The AAFP makes no recommendation for or against screening for abdominal aortic aneurysm (AAA) in men aged 65 to 75 years who have never smoked.

(Grade: C recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Consideration: www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm#clinical

Abdominal Aortic Aneurysm, Women

The AAFP recommends against routine screening for abdominal aortic aneurysm (AAA) in women.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Consideration: www.ahrq.gov/clinic/uspstf05/aaascr/aaars.htm#clinical

Alcohol Misuse, Adults

The AAFP recommends screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspsdrin.htm

Alcohol Misuse, Adolescents

The AAFP recognizes avoidance of alcohol products by adolescents is desirable. The effectiveness of physician's advice and counseling in this area is uncertain.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Consideration: www.ahrq.gov/clinic/uspstf/uspsdrin.htm

Bacteriuria, Asymptomatic, Pregnant Women

The AAFP recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks’ gestation or at the first prenatal visit, if later.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/asymptbact/asbactrs.htm#clinical

Bacteriuria, Asymptomatic, Men, Non-Pregnant Women

The AAFP recommends against screening for asymptomatic bacteriuria in men and nonpregnant women.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/asymptbact/asbactrs.htm#clinical

Bacterial Vaginosis, Pregnant Women

The AAFP recommends against screening for bacterial vaginosis in asymptomatic pregnant women at low risk for preterm delivery.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf08/bv/bvrs.htm#clinical

Bacterial Vaginosis, Pregnant Women

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for bacterial vaginosis in asymptomatic pregnant women at high risk for preterm delivery.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/bv/bvrs.htm#clinical

Behavioral Counseling to Prevent Sexually Transmitted Infections

The AAFP recommends high-intensity behavioral counseling to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/sti/stirs.htm#clinical

Behavioral Counseling to Prevent Sexually Transmitted Infections

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of behavioral counseling to prevent STIs in non-sexually active adolescents and in adults not at increased risk for STIs.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/sti/stirs.htm#clinical

Bladder Cancer, Adults

The AAFP recommends against routine screening for bladder cancer in adults.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsblad.htm

Breast Cancer, Mammography

The AAFP recommends women age 40 years and older be screened for breast cancer with mammography every 1-2 years after counseling by their family physician regarding the potential risks and benefits of the procedure.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: http://www.ahrq.gov/clinic/pocketgd09/gcp09s2.htm#BreastScreening

Breast Cancer, Self BSE

The AAFP concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE).

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: http://www.ahrq.gov/clinic/pocketgd09/gcp09s2.htm#BreastScreening

Breast Cancer/BRCA Mutation Testing

The AAFP recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling and evaluation for BRCA testing.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Consideration: www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm#clinical

Breast Cancer/BRCA Mutation Testing

The AAFP recommends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2).

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Consideration: www.ahrq.gov/clinic/uspstf05/brcagen/brcagenrs.htm#clinical

Breastfeeding, Structured Education and Counseling

The AAFP recommends interventions during pregnancy and after birth to promote and support breastfeeding.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/breastfeeding/brfeedrs.htm#clinical


Cardiovascular Disease, Aspirin for Prevention of

The AAFP recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical

Cardiovascular Disease, Aspirin for Prevention of

The AAFP recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical

Cardiovascular Disease, Aspirin for Prevention of

The AAFP recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical

Cardiovascular Disease, Aspirin for Prevention of

The AAFP concludes that the evidence is insufficient to assess the benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf09/aspirincvd/aspcvdrs.htm#clinical

Carotid Artery Stenosis, Adults

The AAFP recommends against screening for asymptomatic carotid artery stenosis (CAS) in general adult populations.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
(Clinical Consideration: www.ahrq.gov/clinic/uspstf07/cas/casrs.htm#clinical

Cervical Cancer, New Technologies

The AAFP concludes that there is insufficient evidence to recommend for or against routine use of new technologies to screen for cervical cancer.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical

Cervical Cancer, HPV Testing

The AAFP concludes that there is insufficient evidence to recommend for or against routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical

Cervical Cancer, Pap Smear

The AAFP strongly recommends that a Pap smear be completed at least every 3 years to screen for cervical cancer for women who have ever had sex and have a cervix.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm#clinical

Chlamydia, Women

The AAFP recommends screening for chlamydial infection for all sexually active non-pregnant young women aged 24 and younger and for older non-pregnant women who are at increased risk.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm#clinicial

Chlamydia, Pregnant Women

AAFP recommends screening for chlamydial infection for all pregnant women aged 24 and younger and for older pregnant women who are at increased risk.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf07/chlamydia/chlamydiars.htm#clinicial

Chlamydia, Pregnant Women

The AAFP recommends against routinely providing screening for chlamydial infection for women aged 25 and older whether or not they are pregnant, if they are not at increased risk.

(Grade: C recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/ajpmsuppl/chlarr.htm#section2

Chlamydia, Men

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms screening for chlamydial infection for men.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/ajpmsuppl/chlarr.htm#section2

Chronic Obstructive Pulmonary Disease, Adults

The AAFP recommends against screening asymptomatic adults for chronic obstructive pulmonary disease (COPD) using spiromtery.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/copd/copdrs.htm#clinical

Colorectal Cancer, Adults

The AAFP recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risk and benefits of these screening methods vary.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Go to Rationale and Clinical Consideration : www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm

Colorectal Cancer, Adults

The AAFP recommends against routine screening for colorectal cancer in adults age 76 to 85 years. There may be considerations that support colorectal caner screening in an individual patient.

(Grade: C recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec) Go to Rationale and Clinical Consideration : www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm

Colorectal Cancer, Adults

The AAFP recommends against screening for colorectal cancer in adults older than age 85 years.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec) Go to Rationale and Clinical Consideration : http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm

Colorectal Cancer, Chemo Prevention

The AAFP recommends against the routine use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) to prevent colorectal cancer in individuals at average risk for colorectal cancer.

(Grade: C recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec) Clinical Considerations: www.ahrq.gov/clinic/uspstf07/aspcolo/aspcolors.htm#clinical

Colorectal Cancer, Chemo Prevention, DNA Testing

The AAFP concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colongraphy and fecal DNA testing as screening modalities for colorectal cancer.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Go to Rationale and Clinical Consideration : www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm

Congenital Hypothyroidism

The AAFP recommends screening for congenital hypothyroidism (CH) in newborns.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec) Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/conhypo/conhyprs.htm#clinical

Congenital rubella syndrome

The AAFP recommends screening for congenital rubella syndrome by assuring rubella immunity by history, serology, or vaccination in women of childbearing potential.

(Grade: A recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
(Clinical Considerations: http://www.ahrq.gov/clinic/uspstf08/conhypo/conhyprs.htm#clinical)

Coronary Heart Disease, Adults

The AAFP recommends against routine screening with resting electrocardiography (ECG), exercise treadmill test (ETT), or electron-beam computerized tomography (EBCT) scanning for coronary calcium for either the presence of severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD) events in adults at low risk for CHD events.

(Grade: D recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsacad.htm

Coronary Heart Disease, Adults

The AAFP found insufficient evidence to recommend for or against routine screening with electrocardiography (ECG), exercise treadmill test (ETT), electronbeam computerized tomography (EBCT) scanning for coronary calcium for either the presence of severe coronary artery stenosis (CAS) or the prediction of coronary heart disease (CHD) events in adults at increased risk for CHD events.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsacad.htm

Dental Caries, Fluoride Supplementation

The AAFP strongly recommends ordering fluoride supplementation to prevent dental caries based on age and fluoride concentration of patient’s water supply for infants and children age 6 months through 16 years residing in areas with inadequate fluoride in the water supply (less than 0.6 ppm).

Clinical Considerations: www.ahrq.gov/clinic/uspstf/uspsdnch.htm

Depression, Adults

The AAFP recommends screening adults for depression.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/3rduspstf/depression/depressrr.htm#clinical

Depression, Children and Adolescents

The AAFP recommends screening of adolescents (12-18 years of age) for major depressive disorder (MDD) when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf09/depression/chdeprrs.htm#clinical

Depression, Children and Adolescents

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening of children (7-11 years of age).

(Grade: I statement)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf09/depression/chdeprrs.htm#clinical

Diabetes, Gestational

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for gestational diabetes mellitus (GDM), either before or after 24 weeks gestation.

(Grade: I statement)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Considerations: www.ahrq.gov/clinic/uspstf08/gestdiab/gdrs.htm#clinical

Diabetes, Type 2, Adults

The AAFP recommends screening for type 2 diabetes in asymptomatic adults with
sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg.

(Grade: B recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/type2/type2rs.htm#clinical

Diabetes, Type 2, Adults

The AAFP concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/gradespost.htm#arec)
Clinical Consideration: www.ahrq.gov/clinic/uspstf08/type2/type2rs.htm#clinical

Dysplasia (Developmental) of the Hip in Infants

The AAFP concludes that the evidence is insufficient to recommend routine screening for developmental dysplasia of the hip in infants as a means to prevent adverse outcomes.

(Grade: I recommendation)
(Grade Definition: http://www.ahrq.gov/clinic/uspstf/grades.htm#pre)
Clinical Considerations: www.ahrq.gov/clinic/uspstf06/hipdysp/hipdysrs.htm#clinical
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