Tag: clinical recommendations

Categories : Cancer Lab Tests and ImagingTags :

US Task Force to Recommend Earlier Start to Breast Cancer Screening

On By ModernMedia
Photo by National Cancer Institute on Unsplash

In a move bringing it closer in line with other organisations’ breast cancer screening guidelines, The United States Preventative Task Force (USPSTF) has released a draft statement recommending mammography every other year (biennially) from ages 40 to 74.

These recommendations are not applicable to women with a genetic marker or syndrome linked to increased breast cancer risk, a history of high-dose chest radiotherapy at a young age, or previous breast cancer or a high-risk breast lesion on previous biopsies.

According to the USPSTF, “new and more inclusive science about breast cancer in people younger than 50 has enabled us to expand our prior recommendation and encourage all women to get screened in their 40s. We have long known that screening for breast cancer saves lives, and the science now supports all women getting screened, every other year, starting at age 40.”

South African cancer screening guidelines typically closely follow American ones, according to an article by Lipschitz in the South African Journal of Radiology. Many countries had not recommended screening at the ages of 40–50 due to fears of overdiagnosis.

The UPSTF made particular attention the fact that black women are 40% more likely to die of breast cancer than white women, and have a high rate of aggressive cancers at young ages.

The recommendations are not without criticism. Biennial screenings are not seen as worth it by Desountis et al., as it leaving two years between tests leaves too much time for a tumour to grow.

Debra Monticciolo, MD, of Massachusetts General Hospital in Boston, and a member of the Society of Breast Imaging’s board of directors, told MedPage Today that she was “disappointed” with the decision to recommend biennial scans.

“Even if you look at their own data,” Monticciolo said, “annual screening results in more deaths averted, no matter what type of screening program you put in those models.”

The UPSTF has posted the new recommendations on its website for comment.

Regarding the ongoing debated about continued screening in women ages 75 and older, and supplemental screening for those with dense breasts, the UPSTF found there was not enough evidence for a recommendation.

Categories : Hospitals Lab Tests and ImagingTags :

Patients ‘Don’t Need to be Checked for Everything’, Recommendation Says

On By ModernMedia
Blood samples
Photo by National Cancer Institute on Unsplash

Commonly ordered tests can provide early warning of underlying disease, but could also create unnecessary risks of false positive results, provoking anxiety in the patient, wasted time and money and risks of invasive testing.

Therefore, to combat commonly ordered – but not always necessary – procedures and tests, the Society of General Internal Medicine (SGIM) on Tuesday released its revised list of recommendations on five primary care procedures and tests that patients and physicians should question.

Northwestern University’s Dr Jeffrey A. Linder and David Liss, who have previously published research on the benefits of primary care checkups, helped revise the list.

For instance, the age-old idea of getting an annual physical exam with “routine blood tests” from a primary care doctor is a misconception because a person’s age and other risk factors should influence how frequently they should see their doctor, Linder said.

“We often have patients come in asking us to ‘check me for everything,’ but this is a potentially anxiety-provoking, dangerous thing for patients because the more testing we do, the more stuff we find, and the more we need to follow up,” said Linder, chief of the division of general internal medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “In someone who is asymptomatic, an ‘abnormality’ is much more likely to be a false positive or of no clinical significance than for us to catch early disease.

“False positives can expose patients to all of the anxiety, costs, hassle and time commitment, and danger from sometimes invasive testing, with a very low likelihood that it is going to improve their health.”

This isn’t to say nobody should get a checkup every year. For instance, patients who have overdue preventive services, rarely see their primary care physician, have low self-rated health and/or are aged 65 or older should get an annual checkup, the scientists said.

The newly revised list is part of SGIM’s Choosing Wisely campaign, which is an initiative of the American Board of Internal Medicine Foundation. SGIM members originally selected the topics in 2013 and later updated the list in 2017.

The list generated controversy when it was first developed in 2013, recalls Linder.

“The list was widely misinterpreted as ‘specialty society says you don’t need to see your doctor,’ but that was not what it said,” Linder said.

Time and downstream financial costs also are issues of these commonly ordered but oftentimes unnecessary tests and procedures, Liss said.

“Patients and care teams often spend valuable time on low-value checkups that could have been devoted to high-need patients,” said Liss, research associate professor of general internal medicine at Feinberg. “There also is the overall increase in costs to the health system. And even if annual checkups are covered by most insurance, patients often have copays for services like blood draws and other diagnostic tests.”

The revised list was developed after months of careful consideration and review, using the most current evidence about management and treatment options. Linder and Liss served as ad hoc members of the SGIM’s Choosing Wisely Working Group.

Here are the five recommendations, based on a review of the most recent studies in the field:

  1. Don’t recommend daily home glucose monitoring in patients with Type 2 diabetes mellitus not using insulin.
  2. Don’t perform routine annual checkups unless patients are likely to benefit; the frequency of checkups should be based on individual risk factors and preferences. During checkups, don’t conduct comprehensive physical exams or routine lab testing.
  3. Don’t perform routine pre-operative testing before low-risk surgical procedures.
  4. Don’t recommend cancer screening in adults with life expectancy of less than 10 years.
  5. Don’t place, or leave in place, peripherally inserted central catheters for patient or provider convenience.

Source: Northwestern University

Categories : Cardiovascular DiseaseTags :

New Guidance Pivot on Daily Aspirin Advice

On By ModernMedia
Source: Pixabay CC0

In a distinct on previous advice, new draft recommendations posted by the U.S. Preventive Services Task Force (USPSTF) advise against adults 60 and older to begin taking aspirin to lower their risk of a first heart attack or stroke. 

They further advise that people aged 40 to 59 at higher risk for cardiovascular disease, but without a history of it, should talk to a health care provider before starting an aspirin regimen.

The proposed guidance is based on new evidence that suggests the potential harms of taking aspirin can outweigh the benefits. While daily aspirin use reduces the odds of a first heart attack or stroke, it increases the risks of gastrointestinal and intracerebral bleeding, which progressively increase with age.

“The latest evidence is clear: starting a daily aspirin regimen in people who are 60 or older to prevent a first heart attack or stroke is not recommended,” UPTSTF member Chien-Wen Tseng, MD, a professor at the University of Hawaii John A. Burns School of Medicine, said in a statement. “However, this Task Force recommendation is not for people already taking aspirin for a previous heart attack or stroke; they should continue to do so unless told otherwise by their clinician.”

The new guidance will be finalised after public comments close in November. It pivots from previous recommendations issued in 2016, which suggest that people ages 50 to 59 with a risk of cardiovascular disease ≥ 10% in the next decade and a low risk for bleeding take a daily low-dose aspirin (≤ 100mg/day) to reduce the likelihood of suffering a heart attack or stroke. According to the 2016 recommendations, the decision to start taking aspirin for preventive reasons should be “an individual one” for adults ages 60 to 69 who are at risk for cardiovascular disease

At present, neither the American Heart Association nor the American College of Cardiology recommend aspirin use for the prevention of heart attack and stroke in the general population; this only applies for some people between the ages of 40 and 70 who have never had a heart attack or stroke but have an increased risk for cardiovascular disease and a low risk for bleeding. The groups recommend that adults 70 and up should not take aspirin for first stroke or heart attack prevention.

Still, aspirin use for cardiovascular risk prevention is widespread in the US, “and is often self-initiated rather than recommended by a physician,” the latest USPSTF report states. A 2017 National Health Interview Survey (NHIS) found that 23.4 percent of adults age 40 or older and without cardiovascular disease took aspirin for primary prevention; among adults 60-69 years, 34.7 percent reported aspirin use.
Tomas Ayala, MD, a cardiologist at Mercy Personal Physicians, said that this pivot had been anticipated by doctors.

“It is not that aspirin is less effective at reducing heart attacks or strokes than it once was,” he told Health. “Rather, it is that we have other therapies at our disposal that have reduced the overall population risk of these conditions, so the relative benefit of aspirin is less, and in many cases, is outweighed by the risks.” 

Source: AARP