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

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Screening for oral cancer: recommendation statement.

#### BIBLIOGRAPHIC SOURCE(S)

U.S. Preventive Services Task Force (USPSTF). Screening for oral cancer:
recommendation statement. Rockville (MD): Agency for Healthcare Research
and Quality (AHRQ); 2004 Feb. 4 p. \[3 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This release updates a previously published guideline: U.S. Preventive
Services Task Force. Guide to clinical preventive services. 2nd ed.
Baltimore (MD): Williams & Wilkins; 1996. Chapter 16, Screening for oral
cancer. p. 175-80.

### 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)

Oral cancer

#### GUIDELINE CATEGORY

Prevention\
Screening

#### CLINICAL SPECIALTY

Family Practice\
Internal Medicine\
Oncology\
Otolaryngology\
Preventive Medicine

#### INTENDED USERS

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

#### GUIDELINE OBJECTIVE(S)

-   To summarize the current U.S. Preventive Services Task Force
    (USPSTF) recommendations for the screening for oral cancer and the
    supporting scientific evidence

-   To update the 1996 recommendations contained in the *Guide to
    Clinical Preventive Services*, Second Edition

#### TARGET POPULATION

Adults seen in primary care settings

#### INTERVENTIONS AND PRACTICES CONSIDERED

Screening for oral cancer with direct inspection and palpation of the
oral cavity

#### MAJOR OUTCOMES CONSIDERED

**Key Question 1**: Does screening for oral cancer lead to decreased
morbidity and mortality from oral cancer?

**Key Question 2**: Is there new evidence of harms associated with
screening for oral cancer?

**Key Question 3**: Are there effective treatments for mitigating the
morbidity/mortality of oral cancer if lesions are identified earlier
rather than later?

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

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

The search strategy for this brief update included a MEDLINE® review for
English-language articles published between 1994 and 2001 on new direct
evidence on the benefits and harms of screening and treatment for oral
cancer. MEDLINE® was searched for articles focusing on meta-analysis,
systematic reviews, randomized controlled trials (RCTs), and controlled
trials reporting demonstrable health outcomes (morbidity and mortality)
in humans. The Cochrane Library and National Guideline Clearinghouse™
were also searched for pertinent articles or recommendations.

The MEDLINE® search strategy combined the exploded Medical Subject
Heading® (MeSH®) of Oral Neoplasm with Lip Neoplasm, Tongue Neoplasm,
and Pharynx Neoplasm and crossed the result with Mass Screening,
yielding 88 articles. These articles were further limited to RCTs by the
exploded headings \"randomized controlled trial/single-blind
method/double blind method/random allocation.\" This approach identified
one article. Limiting the search to reviews yielded 13 articles. A
second search was conducted crossing the exploded Medical Subject
Headings® (MeSH®) of Mouth Neoplasms or Oral Cancer with Therapeutics or
Treatment, yielding 1,725 articles. Limiting the search to RCTs reduced
the number of articles to 42. While none of these 42 addressed the key
questions specifically, several were concerned with treatments for
cancer precursors.

#### NUMBER OF SOURCE DOCUMENTS

**Key Question 1** = 1 study\
**Key Question 2** = 0 studies\
**Key Question 3** = 0 studies

#### 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 (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.

#### METHODS USED TO ANALYZE THE EVIDENCE

Systematic Review

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

Not stated

#### 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 a 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 \[the service\] 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 (USPSTF) makes its final determinations about recommendations on a
given preventive service, the Evidence-based Practice Center (EPC) and
the Agency for Healthcare Research and Quality (AHRQ) 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 oral cancer were considered from the following groups: the
American Cancer Society, the Canadian Task Force on Preventive Health
Care, and the American College of Obstetricians and Gynecologists.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

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.

The U.S. Preventive Services Task Force (USPSTF) concludes that the
evidence is insufficient to recommend for or against routinely screening
adults for oral cancer. **I Recommendation.**

*The USPSTF found no new good-quality evidence that screening for oral
cancer leads to improved health outcomes for either high-risk adults
(i.e., those over the age of 50 who use tobacco) or for average-risk
adults in the general population. It is unlikely that controlled trials
of screening for oral cancer will ever be conducted in the general
population because of the very low incidence of oral cancer in the
United States. There is also no new evidence for the harms of screening.
As a result, the USPSTF could not determine the balance between benefits
and harms of screening for oral cancer.*

**Clinical Considerations**

-   Direct inspection and palpation of the oral cavity is the most
    commonly recommended method of screening for oral cancer, although
    there are little data on the sensitivity and specificity of this
    method. Screening techniques other than inspection and palpation are
    being evaluated but are still experimental.

-   Tobacco use in all forms is the biggest risk factor for oral cancer.
    Alcohol abuse combined with tobacco use increases risk.

-   Clinicians should be alert to the possibility of oral cancer when
    treating patients who use tobacco or alcohol.

-   Patients should be encouraged to not use tobacco and to limit
    alcohol use in order to decrease their risk for oral cancer as well
    as heart disease, stroke, lung cancer, and cirrhosis.

**[Definitions]{.underline}**:

**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 \[the service\] 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 provided

### 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

The USPSTF found no new good-quality evidence that screening for oral
cancer leads to improved health outcomes for either high-risk adults
(i.e., those over the age of 50 who use tobacco) or for average-risk
adults in the general population. It is unlikely that controlled trials
of screening for oral cancer will ever be conducted in the general
population because of the very low incidence of oral cancer in the
United States. There is also no new evidence for the harms of screening.
As a result, the USPSTF could not determine the balance between benefits
and harms of screening for oral cancer.

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The U.S. Preventive Services Task Force recommendations are independent
of the U.S. government. They should not be construed as an official
position of 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 first and second 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 will make 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\
Pocket Guide/Reference Cards

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 (USPSTF). Screening for oral cancer:
recommendation statement. Rockville (MD): Agency for Healthcare Research
and Quality (AHRQ); 2004 Feb. 4 p. \[3 references\]

#### ADAPTATION

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

#### DATE RELEASED

1996 (revised 2004 Feb 24)

#### 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

*Task Force Members\**: Alfred O. Berg, MD, MPH, Chair, USPSTF
(Professor and Chair, Department of Family Medicine, University of
Washington, Seattle, WA); Janet D. Allan, PhD, RN, CS, Vice-chair,
USPSTF (Dean, School of Nursing, University of Maryland Baltimore,
Baltimore, MD); Ned Calonge, MD, MPH (Acting Chief Medical Officer,
Colorado Department of Public Health and Environment, Denver, CO); Paul
Frame, MD (Tri-County Family Medicine, Cohocton, NY, and Clinical
Professor of Family Medicine, University of Rochester, Rochester, NY);
Joxel Garcia, MD, MBA (Deputy Director, Pan American Health
Organization, Washington, DC); Russell Harris, MD, MPH (Associate
Professor of Medicine, Sheps Center for Health Services Research,
University of North Carolina School of Medicine, Chapel Hill, NC); Mark
S. Johnson, MD, MPH (Professor of Family Medicine, University of
Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark,
NJ); Jonathan D. Klein, MD, MPH (Associate Professor, Department of
Pediatrics, University of Rochester School of Medicine, Rochester, NY);
Carol Loveland-Cherry, PhD, RN (Executive Associate Dean, School of
Nursing, University of Michigan, Ann Arbor, MI); Virginia A. Moyer, MD,
MPH (Professor, Department of Pediatrics, University of Texas at
Houston, Houston, TX); C. Tracy Orleans, PhD (Senior Scientist, The
Robert Wood Johnson Foundation, Princeton, NJ); Albert L. Siu, MD, MSPH
(Professor of Medicine, Chief of Division of General Internal Medicine,
Mount Sinai School of Medicine, New York, NY); Steven M. Teutsch, MD,
MPH (Senior Director, Outcomes Research and Management, Merck & Company,
Inc., West Point, PA); Carolyn Westhoff, MD, MSc (Professor of
Obstetrics and Gynecology and Professor of Public Health, Columbia
University, New York, NY); and Steven H. Woolf, MD, MPH (Professor,
Department of Family Practice and Department of Preventive and Community
Medicine and Director of Research Department of Family Practice,
Virginia Commonwealth University, Fairfax, VA)

*\*Member of USPSTF 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 (USPSTF) has an explicit policy
concerning conflict of interest. All members and Evidence-based Practice
Center (EPC) staff disclose at each meeting if they have an important
financial conflict for each topic being discussed. Task Force members
and EPC staff 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.

This release updates a previously published guideline: U.S. Preventive
Services Task Force. Guide to clinical preventive services. 2nd ed.
Baltimore (MD): Williams & Wilkins; 1996. Chapter 16, Screening for oral
cancer. p. 175-80.

#### GUIDELINE AVAILABILITY

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

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:

-   Screening for oral cancer: a brief evidence update for the U.S.
    Preventive Services Task Force. Rockville (MD): Agency for
    Healthcare Research and Quality (AHRQ), 2004 Feb. 4 p.

Electronic copies: Available from the [U.S. Preventive Services Task
Force (USPSTF) Web
site](http://www.ahrq.gov/clinic/3rduspstf/oralcan/oralcanup.htm).

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 are 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). See the related QualityTool
> summary on the [Health Care Innovations Exchange Web
> site](http://innovations.ahrq.gov/content.aspx?id=699)
>
> 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).

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 summary was completed by ECRI on June 30, 1998. The information was
verified by the guideline developer on December 1, 1998. This summary
was updated by ECRI on April 8, 2004. The updated information was
verified by the guideline developer on April 22, 2004.

#### 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