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'No Recommendation' is NOT a recommendation
Submit responseUnited States Preventive and Services task Force (USPSTF) has done an excellent job over the years at educating medical professionals and the public regarding screening for and prevention of diseases. In the current issue of Annals Of Internal Medicine, the task force is refining evidence- based recommendation development.
I have some comments and suggestions for the Task Force to consider. Lately I have seen under ‘summary of recommendation’, common statement such as ‘ The U.S. Preventive Services Task Force (USPSTF) concludes that the evidence is insufficient to recommend for or against routine screening for….’. The list of some of the diseases for which such recommendations (for adults) are made is as follows.
Table: Diseases for which there are no recommendations for or against screening.
Lung cancer
oral cancer
prostate cancer
skin cancer
vitamins to prevent cancer and cardiovascular disease
screening for abdominal aortic aneurysm in men 65-75 years of age who never smoked
hepatitis C in high risk persons
family and intimate partner violence
dementia
suicide risk
promote a healthy diet
behavioral counseling to promote physical activity
thyroid disease
type 2 diabetes and gestational diabetes
low back pain
bacterial vaginosis in pregnant women
glaucoma
I Believe, if such a statement needs to be made it should be under ‘summary of evidence’ and not under ‘summary of recommendation’. If there is no recommendation to be made for or against then, the Task Force may want to refrain from making any recommendation. Making such recommendations is ambiguous and conflicting. For example, a smoker who was not screened and develops lung cancer may wonder why he/she was not screened for it as there is no recommendation against screening.
Conflict of Interest:
None declared