AAFP RELEASES THIRD LIST OF TESTS, PROCEDURES PATIENTS, PHYSICIANS SHOULD QUESTION

Don’t Routinely Screen for Prostate Cancer Using a PSA Test or Digital Rectal Exam

There is convincing evidence that PSA-based screening leads to substantial over diagnosis of prostate tumors. Many tumors will not harm patients, while the risks of treatment are significant. Physicians should not offer or order PSA screening unless they are prepared to engage in shared decision making that enables an informed choice by patients.

Don’t Require a Pelvic Exam or Other Physical Exam to Prescribe Oral Contraceptive Medications

Hormonal contraceptives are safe, effective, and well tolerated for most women. Data do not support the necessity of performing a pelvic or breast examination to prescribe oral contraceptive medications. Hormonal contraception can be safely provided on the basis of medical history and blood pressure measurement.

Don’t Prescribe Antibiotics for Otitis Media in Children Aged 2 to 12 Years With Non-Severe Symptoms Where the Observation Option is Reasonable

The “observation option” refers to deferring antibacterial treatment of selected children for 48 to 72 hours and limiting management to symptomatic relief. The decision to observe or treat is based on the child’s age, diagnostic certainty, and illness severity. To observe a child without initial antibacterial therapy it is important that the parent or caregiver has a ready means of communicating with the clinician. There also must be a system in place that permits reevaluation of the child.

Don’t Perform Voiding Cystourethrogram Routinely in 1st Febrile Urinary Tract Infection (UTI) in Children Aged 2 to 24 Months

The risks associated with radiation (plus the discomfort and expense of the procedure) outweigh the risk of delaying the detection of the few children with correctable genitourinary abnormalities until their second UTI.

Don’t Screen Adolescents for Scoliosis

There is no good evidence that screening asymptomatic adolescents detects idiopathic scoliosis at an earlier stage than detection without screening. The potential harms of screening and treating adolescents include unnecessary follow-up visits and evaluations due to false positive test results and psychological adverse effects.

“These recommendations demonstrate the ability of our Academy and others to look at evidence that may go against some of the established perceptions out there,” Blackwelder said. “And while they are obviously not absolutes, owing to the fact that we treat individual patients, they are good evidence-based guidelines.”

“For PSA screening in men without symptoms, the data is extremely clear that the test provides very little benefit for patients, along with a significant risk of harm from the diagnostic procedures and the treatments that are performed,” he said. “Similarly, in terms of oral contraceptives to women, the data is very clear that unwanted pregnancy carries a much higher risk than the use of these various medications, as well as the fact that pelvic exams and other evaluations are really not necessary before prescribing.”

To date, more than 50 medical specialty organizations have joined the effort, identifying a list of more than 160 tests and procedures physicians and their patients should question. Other lists will be released throughout 2013 and 2014.