Week Four Discussion replies. 1-2 paragraphs

Respond to at least two of your fellow students discussion posts. These responses must include a journal, news, or website article that critically reflects and pertains to the points of the initial post. You can either agree, disagree, or elaborate using these sources.

Week 4

Kate Empey (student’s name)

The disease screening I chose is breast cancer screening. The new recommendations for breast cancer screening is for every woman over 40 to be screened every other year. The basis of this upgraded recommendation is due to commonality of breast cancer and health disparities. Black women have a 40% higher chance of dying from breast cancer compared to white women. Other racial disparities are prevalent in other minority populations that historically have faced barriers of racism in quality healthcare access. 

The grade of a B means that the task force still recommends breast cancer screening with assurance of moderate benefit. There are a variety of reasons why breast cancer screening did not receive an A. Most of the reasons fall back on not having enough research on the unknowns attributed to breast cancer screening. 50% of women have dense breast tissue and often undergo multiple additional screening measures without assurance of how much assurance they can gain from screenings. Women with dense breast tissue have a higher chance of getting breast cancer, therefore screenings need to improve to ensure higher quality results. 

Breast cancer screening has long been a debated topic. As a female who has a close relative that became a breast cancer survivor before the age of 50, I have sought personal education on breast cancer screening. The use of radiation can increase rates of breast cancer, which is in part why screenings are not done more frequently than every other year. In addition, mammograms are not sensitive enough for women with dense breast tissue, but most insurances make all women receive a mammogram prior to further screening even if the doctors know that they will have to get an MRI anyways. There is a lot of research being conducted currently that hopefully more women will be able to be properly screened with an affordable price. I agree with the USPSTF that better research needs to be done for dense breast tissue and access to for all women, regardless of age, race, and location. 

Reference:

USPSFT. Task Force Issues Draft Recommendation Statement on Screening for Breast Cancer. 
https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/breast-cancer-screening-draft-rec-bulletin.pdf

CVD and Aspirin

Daniel Pryor (student’s name)

The U.S. Preventive Services Taskforce (USPSTF) is a volunteer panel of independent experts who make evidence-based recommendations on U.S. clinical preventive services (United States Preventive Services Taskforce, n.d.-a).

Similar to traditional US academic grades, the USPSTF assigns letter grades to signal the strength of recommended practices. The letter grade “A” indicates a high certainty of substantial benefit, while “B” indicates a high certainty of substantial to moderate benefit. The grade “C” indicates at least moderate certainty of small benefit for case-by-case consideration, while “D” indicates no benefit or even potential harm based on a particular practice. Finally, the grade of “I” concludes insufficient evidence to either support or reject a practice (
United States Preventive Services Taskforce, 2022b).

Providing aspirin to adults aged 40 to 59 with a 10 percent or greater risk of cardiovascular disease (CVD) is graded “C”, with those at lower risk for bleeding the most likely to benefit from low-dose aspirin. For those over 60 years, low-dose aspirin is graded “D” and thus not recommended (United States Preventive Services Taskforce, 2022c).

In meta-analysis of six randomized trials evaluating 9,853 patients, Berger et al. (2018) concluded that prophylactic, low-dose aspirin resulted in a 21 percent reduction in cardiovascular events such as myocardial infarction (MI), stoke, and death. This study also concluded that in the hypothetical treatment of 1,000 patients for 33 months, low-dose aspirin could prevent an estimated 33 cardiovascular events, 12 MIs, 25 strokes and nine deaths, while serving as the cause of nine major bleeding events.

USPSTF’s letter grade of “C” for the use of low-dose aspirin for 40 to 59 year-olds is supported by the meta-analysis of Berger et al. (2018). The letter grade of “D” for the use of low-dose aspirin for those 60 years and older is not supported by Berger et al. (2018), since despite a small percentage of major bleeding events, the mortality from all causes was significantly reduced by low-dose aspirin through the prevention of CVD and cardiovascular events.

To address this issue, USPSTF can and should further investigate the by-age risk of low-dose aspirin resulting in gastrointestinal and intracranial bleeding, and hemorrhagic stroke. As age is one of the most significant risk factors for CVD, a clearer understanding of the true risk of low-dose aspirin through further systematic review may reduce the incidence of cardiovascular events for those over 60 years (Celentano & Szklo, 2018).

References

Berger, J. S., Brown, D., & Becker, R. C. (2018). Low-dose aspirin in patients with stable cardiovascular disease: A meta-analysis. 
The American Journal of Medicine, 
121(1), 43–49. doi: 10.1016/j.amjmed.2007.10.002

Celentano, D. D., & Szklo, M. (2018). 
Gordis Epidemiology. Elsevier Health Sciences, 387-389

United States Preventive Services Taskforce. (n.d.-a). 
About the USPSTF. https://www

.uspreventiveservicestaskforce.org/uspstf/

United States Preventive Services Taskforce. (2022-b). 
Grade definitions. https://www

.uspreventiveservicestaskforce.org/uspstf/about-uspstf/methods-and-processes/grade-definitions

United States Preventive Services Taskforce. (2022-c). 
Aspirin use to prevent cardiovascular disease: Preventive medication. https://www.uspreventiveservicestaskforce

.org/uspstf/recommendation/aspirin-to-prevent-cardiovascular-disease-preventive

-medication