8.3 Recommendations regarding screening in comparative countries

TABLE 8.3 Recommendations regarding screening in comparative countries

CONDITION MAIN SCREENING TESTS US PREVENTIVE SERVICES TASK FORCE RECOMMENDATION

US PREVENTIVE SERVICES TASK FORCE GRADEa RECOMMENDATIONS IN COMPARATIVE COUNTRIES

Colorectal cancer Colonoscopy, flexible sigmoidoscopy, fecal occult blood tests, fecal immunochemical tests Screening for colorectal cancer using fecal occult blood tests, sigmoidoscopy, or colonoscopy in adults beginning at age 50 and continuing until age 75

Breast cancer Mammography, MRI Biennial screening for breast cancer with mammography in average-risk women ages 50–74

Lung cancer (screening in high-risk smokers and former smokers) Low-dose CT Annual screening for lung cancer with low-dose CT in adults ages 55–80 who have a history of smoking 30 packs per year and who currently smoke or have quit within the past 15 years A Cancer Council Australia (2017) recommends immunochemical fecal occult blood tests every two years, starting at age 50 and continuing to age 74. The Canadian Task Force on Preventive Health Care (2016a) recommends screening adults ages 50–74 with fecal occult blood tests every two years or flexible sigmoidoscopy every 10 years. It recommends not using colonoscopy as a screening test. Japan recommends fecal occult blood tests. It does not recommend colonoscopy for use in population-wide screening but allows colonoscopy to be used on an individualized basis (Hamashima 2018). The Netherlands invites individuals to be screened using a fecal immunochemical home testing kit between the ages of 55 and 75 (Netherlands National Institute for Public Health and the Environment 2020).

B The Canadian Task Force on Preventive Health Care recommends screening every two to three years in average-risk women ages 50–74 conditional on the relative value that a woman places on possible benefits and harms from screening (very lowcertainty evidence) (Klarenbach et al. 2018). The Breast Cancer Screening Program in Ontario, Canada, screens high-risk women ages 30–69 annually with both a mammogram and an MRI (Warner et al. 2018). Japan recommends mammography for women ages 40–74 supplemented by clinical breast exams for women ages 40–64 (Hamashima et al. 2016). The Netherlands invites women to have a mammogram every two years between ages 50 and 75 (Netherlands National Institute for Public Health and the Environment 2020).

B The recommendation of the Canadian Task Force on Preventive Health Care (2016b) is identical to that of the US Preventive Services Task Force.

Cancer Council Australia (n.d.) does not recommend low-dose CT screening in people at high risk of lung cancer, citing the lack of local evidence of cost-effectiveness.

Japan does not recommend low-dose CT in population-wide screening, but allows it on an individualized basis (Hamashima et al., 2016). (Continued)

TABLE 8.3, continued

CONDITION MAIN SCREENING TESTS US PREVENTIVE SERVICES TASK FORCE RECOMMENDATION

US PREVENTIVE SERVICES TASK FORCE GRADEa RECOMMENDATIONS IN COMPARATIVE COUNTRIES

Childhood and adolescent obesity

Gestational diabetes mellitus

High blood glucose Measurement of height and weight and calculation of age- and sexadjusted BMI at each primary care visit

50 grams oral glucose challenge test, oral glucose tolerance test Screening for obesity in children older than age 6 and, if clinically indicated, referral for moderate- to high-intensity comprehensive behavioral interventions

After 24 weeks of gestation

Hemoglobin A1C test, oral glucose tolerance test Screening for abnormal blood glucose as part of cardiovascular risk assessment in adults ages 40–70 who are overweight or obese B The Canadian Task Force on Preventive Health Care (2015) recommends growth monitoring at all appropriate primary care visits. Overweight or obese children should be referred to structured behavioral interventions aimed at healthy weight management. B The Royal Women’s Hospital Clinical Guidelines, widely accepted in Australia, recommend routine screening of all pregnant women (except those with preexisting diabetes) at 26–28 weeks (Royal Women’s Hospital 2020). The College of Obstetricians and Gynaecologists, Singapore (2018) recommends universal screening at 24–28 weeks gestation. B The Canadian Task Force on Preventive Health Care (2012) recommends screening high-risk people with an A1C test every three to five years and screening very high-risk people annually. Screening of low- and moderate-risk people is not recommended.

High blood pressure Blood pressure measurement

Lipid disorders Lipid panel Screening for high blood pressure in adults ages 18 and older

Screening for high blood pressure in adults ages 40 or older and persons at increased risk for high blood pressure annually Screening for high blood pressure in adults ages 18–39 with normal blood pressure (below 130/85 mmHG) who do not have other risk factors every three to five years Screening for lipid disorders in men ages 35 and older

Screening for lipid disorders in women ages 45 and older if they are at increased risk for coronary heart disease; the optimal interval for screening is uncertain A The Canadian Task Force on Preventive Health Care recommends blood pressure measurement at all appropriate primary care visits (strong recommendation; moderate quality of evidence) (Lindsay et al. 2013). The United Kingdom recommends screening all adults for hypertension at least once every five years (UK National Institute for Health Care Excellence 2019b)

A A panel of Canadian experts recommends testing asymptomatic men every five years starting at age 40 and asymptomatic women every five years starting at age 50 (Allan et al. 2015)

Source: Original compilation for this publication. Note: BMI = body mass index. CT = computed tomography. mmHG = millimeters of mercury. MRI = magnetic resonance imaging. a. Indicates strength of evidence, determined by the US Preventive Services Task Force.