are being assessed by the U.S. Task Force on Community Preventive Services.3 These task forces are overseen by the Agency for Healthcare Research and Quality and CDC, respectively, federal agencies that have been at the forefront in identifying effective prevention intervention strategies. Widely accepted public health goals and objectives have been established through the Healthy People 2010 initiative (US DHHS and Office of Disease Prevention and Health Promotion, 2000), and efforts are under way to chart the nation’s progress toward those goals (see Chapter 9, Box 9.1).

Although there is a general consensus among public health scientists regarding interventions that work, many areas of controversy remain and evidence is inconsistently applied across federal, state, and private programs. There are examples of screening and other prevention interventions that were quickly adopted before adequate research had been completed to fully understand their potential benefits and harms. Screening for prostate cancer by prostate-specific antigen testing, for example, for which there is comparatively little evidence of effectiveness, is more commonly used than colorectal cancer screening, for which there is strong evidence of effectiveness. More recently, low-dose computed tomography scanning has been promoted as a screening test for lung cancer among high-risk individuals, with the scientific community divided on the merits of its effectiveness. The history of the rapid dissemination into practice of X-ray screening for lung cancer in the 1960s and 1970s and its later withdrawal after evidence from clinical trials showed that it did not reduce the rate of mortality from lung cancer provides a cautionary precedent for the use of computed tomography scanning as a routine screening test for lung cancer. It will be years before the results of clinical trials are available to answer questions about the test’s effectiveness. Until definitive evidence is available to resolve the controversies, clear information should be available to the public on the potential benefits, harms, and costs of new technologies so that consumers and health care providers can make informed judgments.

The U.S. Preventive Services Task Force has provided comprehensive assessments of clinical prevention services, but the task force has, until recently, been convened only periodically. In 2001 it published selected updates of recommendations made in 1996 (U.S. Preventive Services Task Force 2001a,b, 2002). Assessments of prevention services are needed on a

   

Currently, the third USPSTF, convened in 1998, is issuing recommendations updated from its 1996 Guide to Clinical Preventive Services (U.S. Preventive Services Task Force, 1996) (www.ahcpr.gov/clinic/uspstfaab.htm).

3  

The 15-member independent, nonfederal U.S. Task Force on Community Preventive Services first met in 1996 and has issued reports on improving vaccination coverage, reducing exposure to environmental tobacco smoke, and increasing physical activity (www.thecommunityguide.org).



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