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FNP III Module 1
Lesson 1: Screening & Counseling
Define the evidence-based rating scale categories used by
USPSTF (A, B, C, D, I)
*Evidence-based preventive services are graded by the U.S.
Preventative Services Task Force (USPSTF) based on the balance of
benefits and harms
Grade A: strongly recommended- there is a high certainty of
substantial net benefit. Providers SHOULD offer or provide this
service.
Grade B: recommended- there is a high certain or moderate benefit or
moderate certainty of moderate-to-substantial benefit. Providers
should offer or provide this service.
Grade C: Selectively recommended- there is at least moderate
certainty of small net benefit. Providers should offer based on
individual circumstances.
Grade D: NOT recommended- there is moderate or high certainty of
no net benefit or that harm outweighs benefits. DISCOURAGE use of
this service.
Grade I: Insufficient evidence- current evidence is lacking or
conflicting, so NO RECOMMENDATION can be made; if it is offered
by providers, patients should understand the uncertainty
Identify the major A and B ratings for prevention screening,
counseling topics, and prevention meds for adults as
recommended by the USPSTF. Especially know the cancer
detection recommendations for breast, cervical, prostate,
colon, and lung
Breast Cancer- screening mammography-Grade B recommendation
biennial mammograms for women aged 40-74. Early detection via
mammography has shown moderate-to-substantial benefit in reducing
mortality.
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Cervical Cancer- pap smear and HPV testing- recommended screening
women ages 21-65; pap test every 3 years in those ages 21-29. For ages
30-65 recommend pap every 3 years, high-risk HPV test every 5 years or
co-testing (pap+HPV) every 5 years. Screening can be stopped after age
65 if there’s a history of adequate normal results.
Colorectal Cancer- colonoscopy, FIT, or other approved tests- Grade A for
screening all adults aged 50-75. Grade B for screening ages 45-49 due
to rising colorectal cancer occurrences in younger adults. Different ways
to do these screenings including colonoscopy every 10 years, annual
fecal occult blood tests. Etc.)
Lung Cancer- Grade B recommendations of low-dose CT scan annually in
high-risk adults age 50-80 who have a 20 or more pack-year smoking
history, currently smoke, or quit smoking within last 15 years. This
detects lung cancer at earlier treatable stages and has a moderate net
benefit in this high-risk group.
Prostate Cancer- NO grade A/B recommendation. Grade C for men
age 55-69 so individualized decision-making so providers should discuss
potential benefits vs. harms and respect patient preferences
HIV- Grade A screening recommendations for all adolescents and adults
age 15-65 at least once and those at high risk
Hep C- Grade B screening recommendations for one-time screening for
adults age 18-79
STI- Grade B screening for chlamydia/gonorrhea in sexually active
women less than and up to 24 years old. Syphilis screening grade A for
high-risk individuals.
Preventative medication & counseling- smoking cessation Grade A
recommendation to ask all adults about tobacco use, advise them to quit,
provide behavioral interventions and FDA approved medications to assist
with tobacco/smoking cessation; alcohol misuse counseling Grade B
recommendation to screen adults for unhealthy alcohol use and provide
brief counseling interventions; fall prevention Grade B recommendation
for community-dwelling older adults at risk for falls…exercise, PT,
vitamin D supplementation
FNP III Module 1
Lesson 1: Screening & Counseling
Define the evidence-based rating scale categories used by
USPSTF (A, B, C, D, I)
*Evidence-based preventive services are graded by the U.S.
Preventative Services Task Force (USPSTF) based on the balance of
benefits and harms
Grade A: strongly recommended- there is a high certainty of
substantial net benefit. Providers SHOULD offer or provide this
service.
Grade B: recommended- there is a high certain or moderate benefit or
moderate certainty of moderate-to-substantial benefit. Providers
should offer or provide this service.
Grade C: Selectively recommended- there is at least moderate
certainty of small net benefit. Providers should offer based on
individual circumstances.
Grade D: NOT recommended- there is moderate or high certainty of
no net benefit or that harm outweighs benefits. DISCOURAGE use of
this service.
Grade I: Insufficient evidence- current evidence is lacking or
conflicting, so NO RECOMMENDATION can be made; if it is offered
by providers, patients should understand the uncertainty
Identify the major A and B ratings for prevention screening,
counseling topics, and prevention meds for adults as
recommended by the USPSTF. Especially know the cancer
detection recommendations for breast, cervical, prostate,
colon, and lung
Breast Cancer- screening mammography-Grade B recommendation
biennial mammograms for women aged 40-74. Early detection via
mammography has shown moderate-to-substantial benefit in reducing
mortality.
, 2
Cervical Cancer- pap smear and HPV testing- recommended screening
women ages 21-65; pap test every 3 years in those ages 21-29. For ages
30-65 recommend pap every 3 years, high-risk HPV test every 5 years or
co-testing (pap+HPV) every 5 years. Screening can be stopped after age
65 if there’s a history of adequate normal results.
Colorectal Cancer- colonoscopy, FIT, or other approved tests- Grade A for
screening all adults aged 50-75. Grade B for screening ages 45-49 due
to rising colorectal cancer occurrences in younger adults. Different ways
to do these screenings including colonoscopy every 10 years, annual
fecal occult blood tests. Etc.)
Lung Cancer- Grade B recommendations of low-dose CT scan annually in
high-risk adults age 50-80 who have a 20 or more pack-year smoking
history, currently smoke, or quit smoking within last 15 years. This
detects lung cancer at earlier treatable stages and has a moderate net
benefit in this high-risk group.
Prostate Cancer- NO grade A/B recommendation. Grade C for men
age 55-69 so individualized decision-making so providers should discuss
potential benefits vs. harms and respect patient preferences
HIV- Grade A screening recommendations for all adolescents and adults
age 15-65 at least once and those at high risk
Hep C- Grade B screening recommendations for one-time screening for
adults age 18-79
STI- Grade B screening for chlamydia/gonorrhea in sexually active
women less than and up to 24 years old. Syphilis screening grade A for
high-risk individuals.
Preventative medication & counseling- smoking cessation Grade A
recommendation to ask all adults about tobacco use, advise them to quit,
provide behavioral interventions and FDA approved medications to assist
with tobacco/smoking cessation; alcohol misuse counseling Grade B
recommendation to screen adults for unhealthy alcohol use and provide
brief counseling interventions; fall prevention Grade B recommendation
for community-dwelling older adults at risk for falls…exercise, PT,
vitamin D supplementation
