USPSTF: Carotid screening overused

Ultrasonography screening tests yield many false positive results in general adult population.

USPSTF: Carotid screening overused
USPSTF: Carotid screening overused

HealthDay News -- The U.S. Preventive Services Task Force has reaffirmed its recommendation against screening for asymptomatic carotid artery stenosis (CAS) in the general adult population, according to draft guidance.

In it's first update since 2007, USPSTF conducted a systematic review of the current evidence on the benefits and harms of screening for CAS in asymptomatic adults. The task force concluded "with moderate certainty that the harms of screening for asymptomatic carotid artery stenosis outweigh the benefits."

The recommendation against screening is consistent with previous USPSTF guidelines on the topic, as well as those from the American Heart Association, American Stroke Association and the American College of Cardiology.

"CAS is uncommon in the general adult population, so screening everyone would lead to many false positive results, and this can lead to follow-up tests and surgery that carry risk of serious harms, including stroke, heart attack, and death," USPSTF member Jessica Herzstein, MD, MPH, said in a statement. 

CAS affects 1% or fewer of the general population; furthermore, when stenosis is present, few cases actually trigger a stroke and there are no reliable ways to identify problematic cases.

The most feasible screening test for CAS is ultrasonography, which has high-accuracy, but yields false positive results that may lead to unnecessary testing. 

For selected trial participants with CAS, carotid endarterectomy reduces the absolute incidence of all strokes or perioperative death compared with medical management (about 3.5% reduction), but the magnitude of these benefits is likely to be smaller in the general population. There is currently no targeted screening method to identify patients at greatest risk for CAS.

These findings form the basis of a draft recommendation statement against screening for asymptomatic CAS in the general population (Grade D recommendation), which is available for comment from Feb. 18 to March 17, 2014.


References

  1. U.S. Preventive Services Task Force. Screening for Carotid Artery Stenosis: Draft Recommendation Statement. AHRQ Publication No. 13-05178-EF-2. http://www.uspreventiveservicestaskforce.org/draftrec3.htm
Loading links....
You must be a registered member of Clinical Advisor to post a comment.

Sign Up for Free e-newsletters