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January 25, 2021

Addressing Systemic Racism Through Clinical Preventive Service Recommendations From the US Preventive Services Task Force

Author Affiliations
  • 1Mayo Clinic, Rochester, Minnesota
  • 2Northwestern University, Chicago, Illinois
  • 3Virginia Commonwealth University, Richmond
JAMA. 2021;325(7):627-628. doi:10.1001/jama.2020.26188

Wellness and disease prevention are the foundations of health. The US Preventive Services Task Force (USPSTF) is congressionally mandated to make evidence-based recommendations about clinical preventive services, which, if delivered equitably to the intended population, can prevent many premature deaths. All USPSTF recommendations are based on a rigorous and objective methodology that has been continually refined since 1982. This methodology was cited by the Institute of Medicine as a gold standard for making guidelines.1 In addition, the Patient Protection and Affordable Care Act mandated coverage by private insurers without cost sharing for USPSTF grade A and B recommended clinical preventive services, reflecting the importance of these recommendations.

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    2 Comments for this article
    Applaud This Statement
    David Power, MBBS, MPH | University of Minnesota Medical School
    In keeping with the evidence-based origins of the USPSTF, I applaud this statement. For many US primary care physicians, the USPSTF continues to be the least partisan and most evidence-based organization upon which we can rely to guide tricky preventive care decision-making with our patients.

    I particularly recall, a number of years ago, when the USPSTF issued a "D" (do not screen) statement concerning DRE and PSA screening for prostate cancer (which has since softened). As many of us in academic primary care medicine know, the evidence supporting the use of the currently available options
    (DRE and PSA) to screen for prostate cancer is very weak. However, Cancer Treatment Centers of America quickly came out with a catchy TV advertisement centered in an NFL locker room with what appeared to be many athletic African-American football players present and which included recognized, prominent coaching figures urging viewers to, quickly, "get screened for prostate cancer". Ultimately, this may have resulted in MORE African-American men having a prostatectomy for a cancer that was never going to kill or harm them.

    It is very confusing to the public and to our patients when there is disagreement in the health care messaging that they are receiving. We all recognize that US health care is a profit-making business. With a Number Needed to Harm of just 3 for prostatectomy to cause urinary incontinence or erectile dysfunction in one man, we owe it to the American public to convey an honest, evidence-based and consistent message from US health providers - and, right now, the USPSTF does that better than other agencies.
    Timely, Pertinent, and Wide-Ranging
    Vivek Nagaraja, MD | University of Michigan
    I commend JAMA for bringing forth an important topic. I equally commend USPSTF for carefully thinking through this topic of inequity pertaining to recommendations of health and disease. The steps outlined in this article point towards a shift in the fundamental thinking and is an opportunity to intentionally change the basic approach of constructing recommendations in an equitable way.