UICC World Cancer Congress 2006

The US Preventive Services Task Force is an independent panel of nationally recognized, non-federal researchers experienced in primary care, prevention, evidence-based medicine, and research methods who are convened and supported by the Agency for Health Research and Quality (AHRQ). The Task Force is charged by Congress to review the scientific evidence for clinical preventive services and develop evidence-based recommendations for the health care community. Member disciplines include family medicine, internal medicine/geriatrics, preventive medicine, pediatrics/adolescent medicine, Ob/Gyn, nursing, counseling/behavioral medicine, public health, and health policy. Using explicit methods, the Task Force produces systematic evidence reviews of preventive services and based on these reviews releases structure evidence-based recommendations intended primarily for the practicing primary care clinician. Cancer prevention services are included in the Task Force's portfolio of evidence-based recommendations.

Methods:

Steps in the explicit process used by the Task Force to produce evidence-based recommendations include: 1) Defining the question regarding a service and the associated outcomes of interest within an analytic framework. The preference is to look at overarching evidence that would address whether the service has been shown, in an good quality study such as and RCT, to provide overall health benefit. Often these studies are not available, so the Task Force attempts to establish a chain of good quality evidence that allows a recommendation to be made. 2) Defining and retrieving the relevant evidence. 3) Evaluating the quality of individual studies. 4) Synthesizing and judging the strength of the available evidence. 5) Determining the balance of benefits and harms of providing the service. Outcome tables are often produced to assist in this determination. 6) Writing a recommendation linked to the judgment about net benefits. Recommendations receive a letter grade that relates to the judgment about strength of evidence and net benefit:

A: Strongly recommend, benefits substantially outweigh harms; B: Recommend, benefits outweigh harms; C: USPSTF makes no recommendation, benefits and harms too closely balanced; D: Recommend against routine use, ineffective interventions or harms outweigh potential benefits; and I: Insufficient evidence to recommend for or against the intervention

Results:

"A" recommendations for cancer in include screening for cervical and colorectal cancer; "B" recommendations include screening for breast cancer and breast cancer chemoprophylaxis for high risk women, "D" recommendations include screening for bladder, testicular, pancreatic, and ovarian cancer, and "I" recommendations include screening for lung, prostate, skin, and oral cancer.