ries must adhere to standards in processing specimens and interpreting results, and rigorous follow-up must be carried out for patients with positive screening test results. Adherence to quality standards maximizes the benefits of prevention services.

The aging of the nation’s population will sharply increase the demand for certain cancer prevention services such as screening. There may be an inadequate supply of personnel to meet these demands. There are uncertainties, for example, about the supply of gastroenterologists to perform colonoscopy for colorectal cancer screening programs and the adequacy of the numbers of mammography personnel (Institute of Medicine, 2001c). If such shortages are anticipated, policies to address them will need to be identified.

  • The Health Resources and Services Administration should assess the adequacy of the future supply of providers of cancer prevention and early detection services.

    Models of successful delivery of services are as essential as an adequate supply of trained providers. There is convincing evidence that nonphysician providers are just as effective as physician providers in delivering certain smoking cessation and screening services, but research is needed on how to integrate provision of prevention services by such providers into routine primary care.

  • The Agency for Healthcare Research and Quality and other research sponsors should support demonstration programs to evaluate innovative models of prevention service delivery.

Recommendation 9: The U.S. Congress should provide sufficient support to the U.S. Department of Health and Human Services for the U.S. Preventive Services Task Force and the U.S. Task Force on Community Preventive Services to conduct timely assessments of the benefits, harms, and costs associated with screening tests and other preventive interventions. Summaries of recommendations should be made widely available to the public, health care providers, and state and local public health officials and policy makers.

Evidence-based guidelines for clinical and community practice provide maps for action. Rigorous assessments of the effectiveness of clinical prevention services are conducted periodically by the U.S. Preventive Services Task Force,2 and the effectiveness of interventions aimed at communities


The U.S. Preventive Services Task Force (USPSTF) is an independent panel of privatesector experts in primary care and prevention convened by the U.S. Public Health Service’s Agency for Healthcare Research and Quality. USPSTF is supported by outside experts, two Evidence-Based Practice Centers (groups that systematically synthesize available literature), and liaisons from the major primary care societies and from U.S. Public Health Service agencies.

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