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Press Release Date: April 17, 2001
In its first set of recommendations, the third U.S. Preventive Services Task Force (USPSTF) today recommended that primary care clinicians screen all sexually active women ages 25 and younger, as well as older women at risk for chlamydia, as part of regular health care visits.
"So many of our health problems can be avoided through healthy lifestyles and preventive health care," said HHS Secretary Tommy G. Thompson. "These screening recommendations are an important step in our efforts to improve the quality of health care and quality of life for all Americans."
Chlamydia is the most common bacterial sexually transmitted disease in the United States, with an estimated 3 million new cases each year. Most women have no symptoms when initially infected, but if not treated, can develop pelvic inflammatory disease, infertility and other serious health problems, including increased risk of HIV infection. Although chlamydia is most common in women 25 and younger, older women can also be at risk for chlamydia if they have a new or multiple sexual partners, have had a sexually transmitted disease in the past, or do not use condoms consistently and correctly. In addition, treatment with antibiotics is easy and effective.
The USPSTF recommendation is particularly important because data indicate that many women are not being screened. According to a survey of 546 doctors reported in the March 2001, Journal of Adolescent Health, only 32 percent said they would screen an asymptomatic sexually active teenage girl for chlamydia as part of a routine gynecologic examination. A 1997 study of four major U.S. health plans indicated that only 2 percent to 42 percent of sexually active females aged 15 to 25 years had been screened for chlamydia.
The USPSTF, a panel of independent, private-sector experts in prevention and primary care, made its recommendation after concluding that there is good scientific evidence that routine screening and treatment could reduce serious consequences of chlamydia in women.
"The pioneering work of the Task Force has made evidence-based preventive care the gold standard in medical and nursing practice," said John M. Eisenberg, M.D., director of the Agency for Healthcare Research and Quality (AHRQ), which sponsors the USPSTF. "These new recommendations underscore the importance of prevention in primary care and further the scientific foundation for improved preventive care around the world."
In a broadening of its 1996 recommendations, the USPSTF today also stated that regular screening for high blood cholesterol and other lipid abnormalities that can lead to coronary heart disease should not have an upper age limit, which the panel had previously set at age 65. The USPSTF also issued a new recommendation calling for the screening of younger adults for lipid abnormalities beginning at age 20 if they have risk factors for coronary heart disease such as diabetes, family history of heart disease, tobacco use, or high blood pressure. In addition, the panel revised its 1996 statement to recommend that, for initial screening purposes, clinicians measure high density lipoprotein (HDL) cholesterol along with total cholesterol.
In addition, the USPSTF also released recommendations on skin cancer and bacterial vaginosis:
- There is still insufficient scientific evidence to determine whether regular total body skin examination for skin cancer is effective in reducing illness and death, the same conclusion the Task Force reached in 1996.
- Despite research showing that pregnant women with bacterial vaginosis (a common condition among women of childbearing age resulting in a vaginal discharge caused by an imbalance in vaginal bacteria) have a higher risk of pre-term delivery, evidence does not merit regular screening to reduce the incidence of pre-term delivery. For women at high risk due to a previous pre-term delivery, however, the USPSTF found conflicting results regarding the benefit of screening and treatment, and concluded that these options be left to the discretion of clinicians.
The USPSTF conducts impartial assessments of scientific evidence for a broad range of clinical conditions to produce recommendations for the regular provision of clinical preventive services. It grades the strength of evidence from A (strongly recommends) to D (recommends against) and I (insufficient evidence to recommend for or against). As the panel updates the 70 chapters in its 1996 report, it is issuing individual updates as they are completed. The recommendations on these four topics and summaries of the evidence on which they are based are published in the April 2001, edition of the American Journal of Preventive Medicine. These four recommendations were based on the evidence reviewed for the U.S. Preventive Services Task Force by the Evidence-based Practice Centers at Oregon Health Sciences University and the Research Triangle Institute/University of North Carolina.
"Releasing the recommendations as they are finished rather than all at once will get them into the hands of clinicians more quickly so they can make measurable improvements in the health care of their patients," said USPSTF chairman Alfred O. Berg, M.D., M.P.H., Chair of the Department of Family Medicine, University of Washington, Seattle.
USPSTF recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse at 1-800-358-9295, on the AHRQ Web site at http://www.ahrq.gov/clinic/prevenix.htm and through the National Guideline Clearinghouse™ at http://www.guideline.gov. AHRQ is planning to compile all of the USPSTF chapters and summaries of evidence in a semiannual incremental release notebook that will include an annual cumulative index. For more information on how you can subscribe to this notebook, contact the AHRQ Publications Clearinghouse.
To help clinicians apply Task Force recommendations in practice and to help patients understand which clinical preventive services they should expect clinicians to provide, AHRQ sponsors the Put Prevention Into Practice (PPIP) program. Information about the PPIP program and products is available on the AHRQ Web site at http://www.ahrq.gov/clinic/ppipix.htm.
Editor's Note: Audio news releases (ANRs) on the chlamydia recommendations, with a quote from Dr. Janet Allen, Dean and Professor, School of Nursing, University of Texas Health Science Center at San Antonio (in English), and a quote from Dr. Eduardo Ortiz, M.D., M.P.H., a Senior Service Fellow at AHRQ (in Spanish), will be available for download by 12:00 PM on Monday, April 16, 2001. Select for an English version in MP3 (549 KB) or Real Audio (146 KB) formats, or for a version in Spanish in MP3 (804 KB) and Real Audio (213 KB) formats. Transcripts of the audio news releases in English and Spanish are also available.