![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Screening for hemochromatosis: recommendation statement.

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Preventive Services Task Force. Screening for hemochromatosis:
recommendation statement. Ann Intern Med 2006 Aug 1;145(3):204-8. \[12
references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Hereditary hemochromatosis

#### GUIDELINE CATEGORY

Prevention\
Screening

#### CLINICAL SPECIALTY

Family Practice\
Internal Medicine\
Medical Genetics\
Nursing\
Pediatrics\
Preventive Medicine

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Health Care Providers\
Nurses\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To summarize the U.S. Preventive Services Task Force recommendations on
screening for hemochromatosis, and the supporting focused evidence
review

#### TARGET POPULATION

Asymptomatic general population

#### INTERVENTIONS AND PRACTICES CONSIDERED

Genetic screening for hereditary hemochromatosis, specifically C282Y
homozygosity

#### MAJOR OUTCOMES CONSIDERED

-   **Key Question 1**: What is the risk of developing clinical
    hemochromatosis among those with a homozygous C282Y genotype?

-   **Key Question 2**: Does earlier therapeutic phlebotomy of
    individuals with primary iron overload due to hereditary
    hemochromatosis reduce morbidity and mortality, compared with
    treatment after diagnosis in routine clinical care?

-   **Key Question 3**: Are there groups at increased risk for
    developing hereditary hemochromatosis that can be readily identified
    prior to genetic testing?

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Hand-searches of Published Literature (Primary Sources)\
Hand-searches of Published Literature (Secondary Sources)\
Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

**Note from the National Guideline Clearinghouse (NGC)**: A focused
systematic review of the literature was prepared by the Oregon
Evidence-based Practice Center (EPC) and Oregon Health & Science
University for the Agency for Healthcare Research and Quality (AHRQ) for
use by the U.S. Preventive Services Task Force (USPSTF) (see the
\"Availability of Companion Documents\" field).

**Data Sources**

EPC staff developed literature search strategies and terms for each key
question and conducted four separate literature searches (for Key
Questions 1, 2, 3, and background) in Medline, CINAHL, and the Cochrane
Library databases from 1966 through February 2005. Literature searches
were supplemented with source material from experts in the field and by
examining the bibliographies of included studies. A single investigator
reviewed abstracts, and a second reviewer abstracted all excluded
abstracts. Interreviewer discrepancies were resolved by consensus.

**Study Selection**

Using inclusion criteria developed for each key question, EPC staff
reviewed 1,886 abstracts for inclusion in all key questions. Literature
searches were focused for each key question, but were reviewed with all
key questions in mind.  Two investigators quality rated all included
articles for quality, as well as those excluded for quality-related
reasons, using the USPSTF criteria.

#### NUMBER OF SOURCE DOCUMENTS

Using inclusion criteria developed for each key question, the Oregon
Evidence-based Practice Center (EPC) staff reviewed 1,886 abstracts for
inclusion in all key questions. Literature searches were focused for
each key question, but were reviewed with all key questions in mind.
They reviewed 134 full-text articles for Key Question 1, 69 articles for
Key Question 2, and 55 articles for Key Question 3.

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Weighting According to a Rating Scheme (Scheme Given)

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

The U.S. Preventive Services Task Force grades the **quality of the
overall evidence** for a service on a 3-point scale (good, fair, poor):

**Good**

Evidence includes consistent results from well-designed, well-conducted
studies in representative populations that directly assess effects on
health outcomes.

**Fair**

Evidence is sufficient to determine effects on health outcomes, but the
strength of the evidence is limited by the number, quality, or
consistency of the individual studies, generalizability to routine
practice, or indirect nature of the evidence on health outcomes.

**Poor**

Evidence is insufficient to assess the effects on health outcomes
because of limited number or power of studies, important flaws in their
design or conduct, gaps in the chain of evidence, or lack of information
on important health outcomes.

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review with Evidence Tables

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

**Note from the National Guideline Clearinghouse (NGC)**: A focused
systematic review of the literature was prepared by the Oregon
Evidence-based Practice Center (EPC) and Oregon Health & Science
University for the Agency for Healthcare Research and Quality (AHRQ) for
use by the U.S. Preventive Services Task Force (USPSTF) (see the
\"Companion Documents\" field).

**Data Extraction and Quality Assessment**

To overcome the inconsistent uses of terminology in the literature, EPC
staff adopted a set of terms for use in extracting data from studies
into tables in a consistent format. They also established a priori
screening and diagnostic criteria for elevated iron measures and iron
overload due to hereditary hemochromatosis to guide the review and to
establish comparability between studies. Data were abstracted into
evidence tables by a single reviewer and checked by a second reviewer.

EPC staff critically appraised studies according to USPSTF methods using
quality criteria specific to their design. To augment criteria provided
for nonrandomized studies of treatment effectiveness, they added
criteria from the Cochrane Non-Randomized Studies Methods Group. Any
case series or nonrandomized comparative treatment study that used a
nonsystematic method of case accrual was eliminated. EPC staff
critically evaluated reported results, including the comparability of
constructed comparison groups, concerning whether confounding factors
(age, sex, alcohol intake, population prevalence of C282Y homozygosity,
and comorbid liver disease) and secular trends in disease diagnosis and
medical care were adequately considered. Studies with possible serious
biases were eliminated.

**Data Synthesis**

Studies were extremely heterogeneous and could not be easily synthesized
quantitatively. To evaluate whether the review identified adequate data
to create one or more outcomes tables for illustrating the expected
yield from screening, EPC staff used an approach adapted from a previous
report. They considered whether there were adequate data for genetic
screening of two different screening populations (general population and
family-based). Insufficient data were available to create a reliable
outcomes table for either screening approach since very few studies
reported results for all required measures (genotype, iron measures,
iron overload, and disease) among screening study participants,
resulting in extremely small numbers for within-study morbidity
estimates. Therefore, they summarized screening data in tables.

Data was selected from studies that met minimum a priori criteria for
three variables: 1) screening positive for elevated iron parameters; 2)
documented iron overload; and 3) morbidity due to clinical
hemochromatosis.  For iron overload and morbidity, EPC staff calculated
two proportions (selected and all). Among patients selected for further
evaluation, they reported the proportion of positives among those who
were actually tested for iron overload or morbidity (maximum penetrance)
and, for all, the proportion who screened positive among all those
evaluated at the first screening step (minimum penetrance). They then
evaluated whether results were similar enough to combine across studies
and, when they were, they quantitatively combined study results for each
variable to generate a single point estimate for that variable. A range
of results for any variable for which individual study results were too
different to be meaningfully combined were reported. EPC staff did not
include individual study results with 10 or fewer subjects in the
denominator to define a range, but they did include these results if
they could be combined with other results in a single parameter
estimate. Study results were reported as raw numbers for denominators of
10 or fewer.

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Balance Sheets\
Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

When the overall quality of the evidence is judged to be good or fair,
the U.S. Preventive Services Task Force (USPSTF) proceeds to consider
the magnitude of net benefit to be expected from implementation of the
preventive service. Determining net benefit requires assessing both the
magnitude of benefits and the magnitude of harms and weighing the two.

The USPSTF classifies benefits, harms, and net benefits on a 4-point
scale: \"substantial,\" \"moderate,\" \"small,\" and \"zero/negative.\"

\"Outcomes tables\" (similar to \"balance sheets\") are the USPSTF\'s
standard resource for estimating the magnitude of benefit. These tables,
prepared by the topic teams for use at USPSTF meetings, compare the
condition specific outcomes expected for a hypothetical primary care
population with and without use of the preventive service. These
comparisons may be extended to consider only people of specified age or
risk groups or other aspects of implementation. Thus, outcomes tables
allow the USPSTF to examine directly how the preventive service affects
benefits for various groups.

When evidence on harms is available, the topic teams assess its quality
in a manner like that for benefits and include adverse events in the
outcomes tables. When few harms data are available, the USPSTF does not
assume that harms are small or nonexistent. It recognizes a
responsibility to consider which harms are likely and judge their
potential frequency and the severity that might ensue from implementing
the service. It uses whatever evidence exists to construct a general
confidence interval on the 4-point scale (e.g., substantial, moderate,
small, and zero/negative).

Value judgments are involved in using the information in an outcomes
table to rate either benefits or harms on the USPSTF\'s 4-point scale.
Value judgments are also needed to weigh benefits against harms to
arrive at a rating of net benefit.

In making its determinations of net benefit, the USPSTF strives to
consider what it believes are the general values of most people. It does
this with greater confidence for certain outcomes (e.g., death) about
which there is little disagreement about undesirability, but it
recognizes that the degree of risk people are willing to accept to avert
other outcomes (e.g., cataracts) can vary considerably. When the USPSTF
perceives that preferences among individuals vary greatly, and that
these variations are sufficient to make the trade-off of benefits and
harms a \"close-call,\" then it will often assign a C recommendation
(see the \"Recommendation Rating Scheme\" field). This recommendation
indicates the decision is likely to be sensitive to individual patient
preferences.

The USPSTF uses its assessment of the evidence and magnitude of net
benefit to make recommendations. The general principles the USPSTF
follows in making recommendations are outlined in Table 5 of the
companion document cited below. The USPSTF liaisons on the topic team
compose the first drafts of the recommendations and rationale
statements, which the full panel then reviews and edits. Recommendations
are based on formal voting procedures that include explicit rules for
determining the views of the majority.

From: Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow, CD, Teutsch SM,
Atkins D. Current methods of the U.S. Preventive Services Task Force: a
review of the process. Methods Work Group, Third U.S. Preventive
Services Task Force. Am J Prev Med 2001 Apr;20(3S):21-35.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

The U.S. Preventive Services Task Force (USPSTF) grades its
**recommendations** according to one of five classifications (A, B, C,
D, I) reflecting the strength of evidence and magnitude of net benefit
(benefits minus harms):

**A**

The USPSTF strongly recommends that clinicians provide \[the service\]
to eligible patients. The USPSTF found good evidence that \[the
service\] improves important health outcomes and concludes that benefits
substantially outweigh harms.

**B**

The USPSTF recommends that clinicians provide \[this service\] to
eligible patients. The USPSTF found at least fair evidence that \[the
service\] improves important health outcomes and concludes that benefits
outweigh harms.

**C**

The USPSTF makes no recommendation for or against routine provision of
\[the service\]. The USPSTF found at least fair evidence that \[the
service\] can improve health outcomes but concludes that the balance of
benefits and harms is too close to justify a general recommendation.

**D**

The USPSTF recommends against routinely providing \[the service\] to
asymptomatic patients. The USPSTF found at least fair evidence that
\[the service\] is ineffective or that harms outweigh benefits.

**I**

The USPSTF concludes that the evidence is insufficient to recommend for
or against routinely providing \[the service\]. Evidence that the
\[service\] is effective is lacking, of poor quality, or conflicting and
the balance of benefits and harms cannot be determined.

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Comparison with Guidelines from Other Groups\
External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

[Peer Review]{.underline}. Before the U.S. Preventive Services Task
Force makes its final determinations about recommendations on a given
preventive service, the Evidence-based Practice Center and the Agency
for Healthcare Research and Quality send a draft systematic evidence
review to 4 to 6 external experts and to federal agencies and
professional and disease-based health organizations with interests in
the topic. They ask the experts to examine the review critically for
accuracy and completeness and to respond to a series of specific
questions about the document. After assembling these external review
comments and documenting the proposed response to key comments, the
topic team presents this information to the Task Force in memo form. In
this way, the Task Force can consider these external comments and a
final version of the systematic review before it votes on its
recommendations about the service. Draft recommendations are then
circulated for comment from reviewers representing professional
societies, voluntary organizations, and Federal agencies. These comments
are discussed before the whole U.S. Preventive Services Task Force
before final recommendations are confirmed.

[Recommendations of Others]{.underline}. Recommendations regarding
screening for hereditary hemochromatosis from the following groups were
discussed: The Centers for Disease Control and Prevention (CDC); the
American College of Physicians (ACP); the American Association for the
Study of Liver Disease (AASLD); the American College of Gastroenterology
(ACG); and the American Gastroenterological Association Institute
(AGAI).

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

***Note from the U.S. Preventive Services Task Force (USPSTF)***: The
USPSTF is redesigning its recommendation statement in response to
feedback from primary care clinicians. The USPSTF plans to release,
later in 2006, a new, updated recommendation statement that is easier to
read and incorporates advances in USPSTF methodology. The recommendation
statement below is an interim version that combines existing language
and elements with a new format. Although the definitions of grades
remain the same, other elements have been revised.

The U.S. Preventive Services Task Force (USPSTF) grades its
recommendations (A, B, C, D, or I) and the quality of the overall
evidence for a service (good, fair, poor). The definitions of these
grades can be found at the end of the \"Major Recommendations\" field.

**Summary of the Recommendation**

The USPSTF recommends against routine genetic screening for hereditary
hemochromatosis in the asymptomatic general population.

This is a **grade D** recommendation.

**Clinical Considerations**

This recommendation applies to asymptomatic persons. This recommendation
does not include individuals with signs or symptoms that would include
hereditary hemochromatosis in the differential diagnosis. Furthermore,
it does not include individuals with a family history of clinically
detected or screening-detected probands for hereditary hemochromatosis.

Clinically important disease due to hereditary hemochromatosis appears
to be rare. Even among individuals with mutations on the hemochromatosis
(*HFE*) gene, it appears that only a small subset will develop symptoms
of hemochromatosis. An even smaller proportion of these individuals will
develop advanced stages of clinical disease.

Clinically recognized hereditary hemochromatosis is primarily associated
with the *HFE* mutation C282Y. Although this is a relatively common
mutation in the U.S. population, great racial and ethnic variations
exist. The frequency of homozygosity is 4.4 per 1000 among white
persons, with much lower frequencies among Hispanic persons (0.27 per
1000), black persons (0.14 per 1000), and Asian-American persons
(\<0.001 per 1000). Screening of family members of probands identifies
the highest prevalence of undetected C282Y homozygotes (23% of all
family members tested), particularly among siblings (33% homozygosity).

The natural history of disease due to hereditary hemochromatosis is not
well understood but appears to vary considerably among individuals.
Clinically recognized hereditary hemochromatosis is about twice as
common in men as in women. Iron accumulation and disease expression are
modified by environmental factors, including blood loss or donation,
alcohol use, diet, and infections such as viral hepatitis. Among C282Y
homozygotes newly identified in the general population by genotypic
screening, 6% of those undergoing further evaluation had cirrhosis
(representing 1.4% of all newly screening-identified C282Y homozygotes).
Cirrhosis is a serious, late-stage disease development, and its
prevention would be a major goal of screening and treatment.

Individuals with a family member, especially a sibling, who is known to
have hereditary hemochromatosis may be more likely to develop symptoms.
These individuals should be counseled regarding genotyping, with further
diagnostic testing as warranted as part of case-finding.

In addition to genotyping, more common laboratory testing can sometimes
identify iron overload. Clinical screening with these laboratory tests,
or phenotypic screening, was not included in the evidence synthesis on
which this recommendation is based. Genotyping primarily focuses on the
identification of the C282Y mutation on *HFE*. While other mutations
exist, C282Y homozygosity is most commonly associated with clinical
manifestations. Identifying an individual with the genotypic
predisposition does not accurately predict the future risk for disease
manifestation.

Therapeutic phlebotomy is the primary treatment for hemochromatosis.
Treated individuals report inconsistent improvement of their signs and
symptoms. It is uncertain whether cirrhosis at diagnosis confers a worse
prognosis based on the potential lack of reversibility of liver damage.
Recent research reports survival rates in treated individuals with or
without cirrhosis that are similar to rates in healthy controls. The
degree to which clinically important manifestations can be averted
remains uncertain, as does the optimal time for early treatment.

**Definitions**:

**Strength of Recommendations**

The USPSTF grades its **recommendations** according to one of five
classifications (A, B, C, D, I) reflecting the strength of evidence and
magnitude of net benefit (benefits minus harms):

**A**

The USPSTF strongly recommends that clinicians provide \[the service\]
to eligible patients. The USPSTF found good evidence that \[the
service\] improves important health outcomes and concludes that benefits
substantially outweigh harms.

**B**

The USPSTF recommends that clinicians provide \[this service\] to
eligible patients. The USPSTF found at least fair evidence that \[the
service\] improves important health outcomes and concludes that benefits
outweigh harms.

**C**

The USPSTF makes no recommendation for or against routine provision of
\[the service\]. The USPSTF found at least fair evidence that \[the
service\] can improve health outcomes but concludes that the balance of
benefits and harms is too close to justify a general recommendation.

**D**

The USPSTF recommends against routinely providing \[the service\] to
asymptomatic patients. The USPSTF found at least fair evidence that
\[the service\] is ineffective or that harms outweigh benefits.

**I**

The USPSTF concludes that the evidence is insufficient to recommend for
or against routinely providing \[the service\]. Evidence that the
\[service\] is effective is lacking, of poor quality, or conflicting and
the balance of benefits and harms cannot be determined.

**Strength of Evidence**

The USPSTF grades the **quality of the overall evidence** for a service
on a 3-point scale (good, fair, poor):

**Good**

Evidence includes consistent results from well-designed, well-conducted
studies in representative populations that directly assess effects on
health outcomes.

**Fair**

Evidence is sufficient to determine effects on health outcomes, but the
strength of the evidence is limited by the number, quality, or
consistency of the individual studies, generalizability to routine
practice, or indirect nature of the evidence on health outcomes.

**Poor**

Evidence is insufficient to assess the effects on health outcomes
because of limited number or power of studies, important flaws in their
design or conduct, gaps in the chain of evidence, or lack of information
on important health outcomes.

#### CLINICAL ALGORITHM(S)

None available

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is identified in the
\"Major Recommendations\" field.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate screening for hereditary hemochromatosis in primary care
settings

#### POTENTIAL HARMS

**Harms of Detection and Early Treatment**

Screening could lead to identification of a large number of individuals
who possess the high-risk genotype but may never manifest the clinical
disease. This may result in unnecessary surveillance, labeling,
unnecessary invasive work-up, anxiety, and, potentially, unnecessary
treatments.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

Recommendations made by the U.S. Preventive Services Task Force are
independent of the U.S. government. They should not be construed as an
official position of the Agency for Healthcare Research and Quality
(AHRQ) or the U.S. Department of Health and Human Services.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

The experiences of the U.S. Preventive Services Task Force (USPSTF), as
well as that of other evidence-based guideline efforts, have highlighted
the importance of identifying effective ways to implement clinical
recommendations. Practice guidelines are relatively weak tools for
changing clinical practice when used in isolation. To effect change,
guidelines must be coupled with strategies to improve their acceptance
and feasibility. Such strategies include enlisting the support of local
opinion leaders, using reminder systems for clinicians and patients,
adopting standing orders, and audit and feedback of information to
clinicians about their compliance with recommended practice.

In the case of preventive services guidelines, implementation needs to
go beyond traditional dissemination and promotion efforts to recognize
the added patient and clinician barriers that affect preventive care.
These include clinicians\' ambivalence about whether preventive medicine
is part of their job, the psychological and practical challenges that
patients face in changing behaviors, lack of access to health care or of
insurance coverage for preventive services for some patients, competing
pressures within the context of shorter office visits, and the lack of
organized systems in most practices to ensure the delivery of
recommended preventive care.

Dissemination strategies have changed dramatically in this age of
electronic information. While recognizing the continuing value of
journals and other print formats for dissemination, the Agency for
Healthcare Research and Quality makes all U.S. Preventive Services Task
Force (USPSTF) products available through its [Web
site](http://www.preventiveservices.ahrq.gov/). The combination of
electronic access and extensive material in the public domain should
make it easier for a broad audience of users to access U.S. Preventive
Services Task Force materials and adapt them for their local needs.
Online access to U.S. Preventive Services Task Force products also opens
up new possibilities for the appearance of the annual, pocket-size
*Guide to Clinical Preventive Services*.

To be successful, approaches for implementing prevention have to be
tailored to the local level and deal with the specific barriers at a
given site, typically requiring the redesign of systems of care. Such a
systems approach to prevention has had notable success in established
staff-model health maintenance organizations, by addressing organization
of care, emphasizing a philosophy of prevention, and altering the
training and incentives for clinicians. Staff-model plans also benefit
from integrated information systems that can track the use of needed
services and generate automatic reminders aimed at patients and
clinicians, some of the most consistently successful interventions.
Information systems remain a major challenge for individual clinicians\'
offices, however, as well as for looser affiliations of practices in
network-model managed care and independent practice associations, where
data on patient visits, referrals, and test results are not always
centralized.

#### IMPLEMENTATION TOOLS

Foreign Language Translations\
Patient Resources\
Personal Digital Assistant (PDA) Downloads\
Pocket Guide/Reference Cards\
Tool Kits

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Preventive Services Task Force. Screening for hemochromatosis:
recommendation statement. Ann Intern Med 2006 Aug 1;145(3):204-8. \[12
references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2006

#### GUIDELINE DEVELOPER(S)

United States Preventive Services Task Force - Independent Expert Panel

#### GUIDELINE DEVELOPER COMMENT

The U.S. Preventive Services Task Force (USPSTF) is a
federally-appointed panel of independent experts. Conclusions of the
U.S. Preventive Services Task Force do not necessarily reflect policy of
the U.S. Department of Health and Human Services (DHHS) or its agencies.

#### SOURCE(S) OF FUNDING

United States Government

#### GUIDELINE COMMITTEE

U.S. Preventive Services Task Force (USPSTF)

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Corresponding Author*: Ned Calonge, MD, MPH, Chair, U.S. Preventive
Services Task Force, c/o Program Director, USPSTF, Agency for Healthcare
Research and Quality

*Task Force Members\**: Ned Calonge, MD, MPH, Chair, USPSTF (Chief
Medical Officer and State Epidemiologist, Colorado Department of Public
Health and Environment, Denver, CO); Diana B. Petitti, MD, MPH ,
Vice-chair, USPSTF (Senior Scientific Advisor for Health Policy and
Medicine, Regional Administration, Kaiser Permanente Southern
California, Pasadena, CA); Thomas G. DeWitt, MD (Carl Weihl Professor of
Pediatrics and Director of the Division of General and Community
Pediatrics, Department of Pediatrics, Children\'s Hospital Medical
Center, Cincinnati, OH); Leon Gordis, MD, MPH, DrPH (Professor,
Epidemiology Department, Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD); Kimberly D. Gregory, MD, MPH (Director, Women\'s
Health Services Research and Maternal-Fetal Medicine, Department of
Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles,
CA); Russell Harris, MD, MPH (Professor of Medicine, Sheps Center for
Health Services Research, University of North Carolina School of
Medicine, Chapel Hill, NC); Kenneth W. Kizer, MD, MPH (President and
CEO, National Quality Forum, Washington, DC); Michael L. LeFevre, MD,
MSPH (Professor, Department of Family and Community Medicine, University
of Missouri School of Medicine, Columbia, MO); Carol Loveland-Cherry,
PhD, RN (Executive Associate Dean, Office of Academic Affairs,
University of Michigan School of Nursing, Ann Arbor, MI); Lucy N.
Marion, PhD, RN (Dean and Professor, School of Nursing, Medical College
of Georgia, Augusta, GA); Virginia A. Moyer, MD, MPH (Professor,
Department of Pediatrics, University of Texas Health Science Center,
Houston, TX); Judith K. Ockene, PhD (Professor of Medicine and Chief of
Division of Preventive and Behavioral Medicine, University of
Massachusetts Medical School, Worcester, MA); George F. Sawaya, MD
(Associate Professor, Department of Obstetrics, Gynecology, and
Reproductive Sciences and Department of Epidemiology and Biostatistics,
University of California, San Francisco, CA); Albert L. Siu, MD, MSPH
(Professor and Chairman, Brookdale Department of Geriatrics and Adult
Development, Mount Sinai Medical Center, New York, NY); Steven M.
Teutsch, MD, MPH (Executive Director, Outcomes Research and Management,
Merck & Company, Inc., West Point, PA); and Barbara P. Yawn, MD, MSc
(Director of Research, Olmstead Research Center, Rochester, MN)

*\*Members of the Task Force at the time this recommendation was
finalized. For a list of current Task Force members, go to
[www.ahrq.gov/clinic/uspstfab.htm](http://www.ahrq.gov/clinic/uspstfab.htm).*

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The U.S. Preventive Services Task Force has an explicit policy
concerning conflict of interest. All members disclose at each meeting if
they have an important financial conflict for each topic being
discussed. Task Force members with conflicts can participate in
discussions about evidence, but members abstain from voting on
recommendations about the topic in question.

From: Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow, CD, Teutsch SM,
Atkins D. Current methods of the U.S. Preventive Services Task Force: a
review of the process. Methods Work Group, Third U.S. Preventive
Services Task Force. Am J Prev Med 2001 Apr;20(3S):21-35.

#### GUIDELINE STATUS

This is the current release of the guideline.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [U.S. Preventive Services Task
Force (USPSTF) Web
site](http://www.ahrq.gov/clinic/uspstf/uspshemoch.htm). Also available
from the [Annals of Internal Medicine
Online](http://www.annals.org/cgi/content/full/145/3/204?maxtoshow=&HITS=25&hits=25&RESULTFORMAT=1&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT).

Print copies: Available from the Agency for Healthcare Research and
Quality (AHRQ) Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
only).

#### AVAILABILITY OF COMPANION DOCUMENTS

The following are available:

Evidence Reviews:

-   Whitlock EP, Garlitz BA, Harris EL, Bell TL, Smith PR. Screening for
    hereditary hemochromatosis: a systematic evidence review for the
    U.S. Preventive Services Task Force. Ann Intern Med;
    2006;145:209-223.

Electronic copies: Available from the [U.S. Preventive Services Task
Force (USPSTF) Web
site](http://www.ahrq.gov/clinic/uspstf06/hemochromatosis/hemochrev.pdf).
Also available from the [Annals of Internal Medicine
Online](http://www.annals.org/cgi/content/full/145/3/209?maxtoshow=&HITS=25&hits=25&RESULTFORMAT=1&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT).

Background Articles:

-   Woolf SH, Atkins D. The evolving role of prevention in health care:
    contributions of the U.S. Preventive Services Task Force. Am J Prev
    Med 2001 Apr;20(3S):13-20.

-   Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow, CD, Teutsch SM,
    Atkins D. Current methods of the U.S. Preventive Services Task
    Force: a review of the process. Methods Work Group, Third U.S.
    Preventive Services Task Force. Am J Prev Med 2001 Apr;20(3S):21-35.

-   Saha S, Hoerger TJ, Pignone MP, Teutsch SM, Helfand M, Mandelblatt
    JS. The art and science of incorporating cost effectiveness into
    evidence-based recommendations for clinical preventive services.
    Cost Work Group of the Third U.S. Preventive Services Task Force. Am
    J Prev Med 2001 Apr;20(3S):36-43.

Electronic copies: Available from [U.S. Preventive Services Task Force
(USPSTF) Web site](http://www.ahrq.gov/clinic/uspstmeth.htm).

The following is also available:

-   The guide to clinical preventive services, 2006. Recommendations of
    the U.S. Preventive Services Task Force. Rockville (MD): Agency for
    Healthcare Research and Quality (AHRQ), 2006. 228 p. Electronic
    copies available from the [AHRQ Web
    site](http://www.ahrq.gov/clinic/pocketgd.htm).

-   A step-by-step guide to delivering clinical preventive services: a
    systems approach. Rockville (MD): Agency for Healthcare Research and
    Quality (AHRQ), 2002 May. 189 p. Electronic copies available from
    the [AHRQ Web site](http://www.ahrq.gov/ppip/manual/). See the
    related QualityTool summary on the [Health Care Innovations Exchange
    Web site](http://innovations.ahrq.gov/content.aspx?id=542).

Print copies: Available from the Agency for Healthcare Research and
Quality Publications Clearinghouse. For more information, go to
<http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
only).

The [Electronic Preventive Services Selector
(ePSS)](http://epss.ahrq.gov/PDA/index.jsp), available as a PDA
application and a web-based tool, is a quick hands-on tool designed to
help primary care clinicians identify the screening, counseling, and
preventive medication services that are appropriate for their patients.
It is based on current recommendations of the USPSTF and can be searched
by specific patient characteristics, such as age, sex, and selected
behavioral risk factors.

#### PATIENT RESOURCES

The following is available:

-   The Pocket Guide to Good Health for Adults. Rockville (MD): Agency
    for Healthcare Research and Quality (AHRQ); 2003.

> Electronic copies: Available from the [U.S. Preventive Services Task
> Force (USPSTF) Web site](http://www.ahrq.gov/ppip/adguide/). Copies
> also available in Spanish from the [USPSTF Web
> site](http://www.ahrq.gov/ppip/spadguide/).
>
> Print copies: Available from the Agency for Healthcare Research and
> Quality (AHRQ) Publications Clearinghouse. For more information, go to
> <http://www.ahrq.gov/news/pubsix.htm> or call 1-800-358-9295 (U.S.
> only).

-   Screening for hemochromatosis: recommendations from the U.S.
    Preventive Services Task Force. Ann Intern Med. 2006 Aug
    1;145(3):I-18.

> Electronic copies: Available from the [Annals of Internal Medicine
> Online](http://www.annals.org/cgi/content/full/145/3/I-18).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This NGC summary was completed by ECRI on July 26, 2006. The information
was verified by the guideline developer on July 28, 2006.

#### COPYRIGHT STATEMENT

Requests regarding copyright should be sent to: Gerri M. Dyer,
Electronic Dissemination Advisor, Agency for Healthcare Research and
Quality (formerly the Agency for Health Care Policy and Research),
Center for Health Information Dissemination, Suite 501, Executive Office
Center, 2101 East Jefferson Street, Rockville, MD 20852; Facsimile:
301-594-2286; E-mail: <gdyer@ahrq.gov>.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008