Guidelines for recommended screenings in men's and women's health: Trends and troubles where evidence meets practice

Objective: A significant challenge for health professional educators is helping students/clinicians understand emerging evidence, preventive screening guidelines, and appropriate ways to incorporate clinical judgment when advising patients about health screenings. In this session we will use recent changes in the US Preventive Services Task Force (USPSTF) screening recommendations as a example of such challenges. Methods: A review of USPSTF recommendations was conducted (2002-2011), along with those of leading health advocacy groups. Related recent literature was also reviewed. Results: The USPSTF recently made significant changes in screening recommendations for mammography, female exams, and digital rectal exams. The most contentious was a change from the 2002 guideline of mammograms every 1-2 years after a baseline at age 40, to a recent recommendation of mammography ever 2 years after age 50. They also recommended against the regular use of existing prostate cancer screening tools. These recommendations are incongruous with those of health advocacy and physicians groups. The Affordable Health Care Act, in fact, will utilize the old, rather than newer, controversial recommendations for health screenings. Conclusion: Educators in health professional fields have the responsibility to teach from the evidence-base. However, the recent USPSTF recommendations have created challenges for health educators and clinicians. These recommendations are extremely conservative compared with those of leading health advocacy groups. The scientific rationale for these recommendations was based on cost/benefit ratios and health risk. Such variances in guidelines create the need for educators and clinicians to balance such evidence with clinical judgment on patient risk.