The USPSTF has revised their grading system for recommending periodic health examinations. In the past, only the quality of evidence was weighed. Now the magnitude of the benefit is incorporated. Here are the revised definitions for the rating grades:
The codes for the current USPSTF recommendations include A (strongly recommended, good evidence, and substantial benefit), B (recommended, fair evidence, and moderate to substantial benefit), C (no recommendation, fair to good evidence, with closely balanced benefit and harm), D (recommend against, fair evidence of ineffectiveness, harm outweighs benefit), and I (insufficient evidence and/or evidence and balance of benefit and harm are indeterminable).
This has resulted in some changes in cancer screening test recommendations. Notably, the recommendation for breast cancer screening has been dropped from A to B, while screening for colorectal cancer has been upgraded to A. Also, prostate cancer screening is now denoted as I.
Regarding what is not recommended:
Screening that is not recommended (grade D) includes tests for testicular cancer, pancreatic cancer, ovarian cancer, bladder cancer, and in selected patients, cervical cancer. Besides prostate cancer screening, there is insufficient evidence to make a recommendation regarding screening for skin cancer, oral cancer, and lung cancer.
Although screening can and does save lives in certain instances, it is important to note that there is a definite downside to screening tests. That is why considering the evidence is so important.
