Robert A. Smith, PhD Senior Director, Cancer Control Science Cancer Control Sciences Department

1. USPSTF Screening Recommendations:Implications for Adults at Higher RiskNYFAHC Roundtable, June 18, 2013 Robert A. Smith, PhD Senior Director, Cancer Control Science Cancer Control Sciences Department

2. Cancer Screening, the ACA, and the USPSTF • Under the ACA, preventive services that are given an A or B rating by the USPSTF must be provided without any co-pays or deductibles • USPSTF screening recommendations specifically are targeted to average risk adults

3. Cancer Screening, the ACA, and the USPSTF • The need for a different screening regimen for adults at higher risk typically is acknowledged, but recommendations are not issued due to lack of adequate evidence • The USPSTF commonly acknowledges that other organizations have issued different and specific recommendations for adults at higher risk

4. Colorectal Cancer Screening

5. Colorectal Screening in Average Risk Adults: Update 2008

6. CRC Screening in Average Risk Adults: Update 2008

7. USPSTF Clinical Considerations • “These recommendations apply to adults 50 years of age and older, excluding those with specific inherited syndromes (the Lynch syndrome or familial adenomatous polyposis) and those with inflammatory bowel disease. The recommendations do apply to those with first-degree relatives who have had colorectal adenomas or cancer, although for those with first-degree relatives who developed cancer at a younger age or those with multiple affected first-degree relatives, an earlier start to screening may be reasonable.”

8. USPSTF Clinical Considerations • “When the screening test results in the diagnosis of clinically significant colorectal adenomas or cancer, the patient will be followed by a surveillance regimen and recommendations for screening are no longer applicable. The USPSTF did not address evidence for the effectiveness of any particular surveillance regimen after diagnosis and/or removal of adenomatous polyps.”

9. AVERAGE RISK INCREASED RISK HIGHEST RISK

10. Breast Cancer Screening Guidelines

11. Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)

12. Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)

13. Breast Cancer Screening in Average Risk Women: ACS (2003); USPSTF (2009)

14. USPSTF Clinical Considerations • “This recommendation statement applies to women 40 years or older who are not at increased risk for breast cancer by virtue of a known underlying genetic mutation or a history of chest radiation.”

15. ACS Guidelines for Breast MR in High Risk Women

16. Cervical, Prostate, and Lung Screening • ACS and USPSTF cervical cancer screening guidelines are similar • USPSTF recommends against prostate cancer screening. ACS recommendations accommodate men at average and high risk • Lung cancer screening recommendations are expected in 2013

17. Thank you