The USPSTF and where screening recommendations come from

This page explains who the U.S. Preventive Services Task Force is, what its letter grades mean, and how to use them with your clinician.

You may hear that colon cancer screening should start at a certain age, or that a scan is recommended for heavy smokers. That advice came from somewhere. Often it came from the U.S. Preventive Services Task Force.

The Task Force is a scientifically independent, volunteer panel of national experts in prevention and evidence-based medicine. It was established in 1984. Its job is to make evidence-based recommendations about clinical preventive services in order to improve health.

Its members come from preventive medicine and primary care. That includes internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. They serve as volunteers.

Since 1998, Congress has authorized the Agency for Healthcare Research and Quality to convene the Task Force. The panel remains scientifically independent in its judgments.

The Task Force reviews the evidence on a service and gives it a letter. Each letter carries a suggestion for practice.

Grade A. The Task Force recommends the service. There is high certainty that the net benefit is substantial. Suggestion: offer or provide it.

Grade B. The Task Force recommends the service. There is high certainty that the net benefit is moderate, or moderate certainty that it is moderate to substantial. Suggestion: offer or provide it.

Grade C. The Task Force recommends selectively offering the service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small. Suggestion: offer it for selected patients depending on individual circumstances.

Grade D. The Task Force recommends against the service. There is moderate or high certainty that it has no net benefit, or that the harms outweigh the benefits. Suggestion: discourage its use.

I statement. The current evidence is insufficient to assess the balance of benefits and harms. If the service is offered, patients should understand that uncertainty about benefits and harms.

The first is scope. The recommendations apply only to people who have no signs or symptoms of the specific disease, and they address primary care settings.

That single sentence resolves a lot of confusion. If you have a symptom such as a lump, bleeding or a persistent cough, do not wait for a screening schedule. Call your care team. The Task Force recommendations apply only to people with no signs or symptoms.

The second is cost. The Task Force does not consider costs when determining grades.

Its recommendations are published on its website or in peer-reviewed journals, and it submits annual reports to Congress identifying research gaps.

It can also give you better language for a conversation. Instead of asking whether you "should" get a test, you can ask what grade it carries and whether you fall inside the group the recommendation covers.

It cannot tell you what to do. A grade is a population-level statement about people with no symptoms. You are a person with a history, a family, a risk level and your own preferences.

It does not treat anyone. It does not consider cost when determining grades, so a grade tells you nothing about what a test will cost you. Ask your plan about coverage.

A C grade means selectively offering the service based on professional judgment and patient preferences, so it is a decision to make with your clinician. An I statement means the evidence is insufficient to assess the balance of benefits and harms.

The Task Force makes recommendations for people without symptoms. It is not a substitute for advice from your clinician.

Bring that record to your next primary care visit and ask where you personally fit. That conversation, not the letter grade alone, is what turns a recommendation into a decision.