On April 16, the U.S. Preventive Services Task Force (USPSTF) published a final recommendation statement(www.uspreventiveservicestaskforce.org) and final evidence summary(www.uspreventiveservicestaskforce.org) on screening children and pregnant women for elevated blood lead levels.
Based on its review, the USPSTF said current evidence is insufficient to assess the balance of benefits and harms of screening for elevated blood lead levels in children and pregnant women who are asymptomatic; both are "I" statements.
"We are calling for more research so clinicians can have better ways to prevent and treat health problems that can result from lead exposure," said USPSTF member Michael Silverstein, M.D., M.P.H., in a news release.(www.uspreventiveservicestaskforce.org) "Clinicians should use their best judgement about if and when to screen children and pregnant women without signs or symptoms for lead exposure and keep up to date on any concerns about lead in their community."
The task force found that although blood tests can detect elevated serum lead levels, questionnaires to identify patients at risk are less effective, and available treatments cannot reverse many of the effects of exposure.
"There is no safe level of lead exposure, so finding and removing any source of lead is essential," said USPSTF Vice Chair Alex Krist, M.D., M.P.H., in the release.
Update of Previous Recommendations
This final recommendation statement is in line with the USPSTF's October 2018 draft recommendation(www.uspreventiveservicestaskforce.org) and updates its 2006 final recommendation,(www.uspreventiveservicestaskforce.org) which found that the evidence was insufficient to recommend for or against routine screening for lead exposure in children ages 1 to 5 who were at increased risk, but recommended against screening in average-risk children in this age group and asymptomatic pregnant women. That earlier recommendation statement also called for more research to determine the efficacy of screening.
The AAFP supported the task force's final recommendation at the time.
Response to Public Comment
A draft version of this final recommendation statement was posted for public comment on the USPSTF website from Oct. 30 to Dec. 3, 2018.
Many commenters expressed concerned about at-risk populations.
In response, the USPSTF added information about specific risk factors, including emerging risk factors, in the Clinical Considerations(www.uspreventiveservicestaskforce.org) section and under the Research Needs and Gaps(www.uspreventiveservicestaskforce.org) subhead in the Other Considerations section.
Additionally, some commenters requested clarification regarding the specific population covered by the recommendation, to which the task force responded in the Clinical Considerations section that the recommendation applied to asymptomatic children 5 and younger, as well as to pregnant women with no symptoms.
The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence summary and will determine the Academy's stance on the recommendation.
Related AAFP News Coverage
Draft Recommendation Statement
USPSTF: More Research Needed on Screening for Lead Exposure
More From AAFP
American Family Physician: Lead Poisoning in Children