Grade	Grade definition	Suggestions for practice
A	The USPSTF recommends the service. There is high certainty that the net benefit is substantial	Offer/provide this service
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	Offer/provide this service
C	The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is moderate or high certainty that the net benefit is small	Offer/provide this service only if there are other considerations in support of offering/providing the service in an individual patient
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	Discourage the use of this service
I	The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality or conflicting, and the balance of benefits and harms cannot be determined	Read “Clinical Considerations” section of USPSTF Recommendation Statement. If this service offered, patients should understand the uncertainty about the balance of benefits and harms