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ImportanceCeliac disease is caused by an immune response in persons who are genetically susceptible to dietary gluten, a protein complex found in wheat, rye, and barley. Ingestion of gluten by persons with celiac disease causes immune-mediated inflammatory damage to the small intestine.ObjectiveTo issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for celiac disease.Evidence reviewThe USPSTF reviewed the evidence on the accuracy of screening in asymptomatic adults, adolescents, and children; the potential benefits and harms of screening vs not screening and targeted vs universal screening; and the benefits and harms of treatment of screen-detected celiac disease. The USPSTF also reviewed contextual information on the prevalence of celiac disease among patients without obvious symptoms and the natural history of subclinical celiac disease.FindingsThe USPSTF found inadequate evidence on the accuracy of screening for celiac disease, the potential benefits and harms of screening vs not screening or targeted vs universal screening, and the potential benefits and harms of treatment of screen-detected celiac disease.Conclusions and recommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic persons. (I statement).

ImportanceCeliac disease is caused by an immune response in persons who are genetically susceptible to dietary gluten, a protein complex found in wheat, rye, and barley. Ingestion of gluten by persons with celiac disease causes immune-mediated inflammatory damage to the small intestine.ObjectiveTo issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for celiac disease.Evidence reviewThe USPSTF reviewed the evidence on the accuracy of screening in asymptomatic adults, adolescents, and children; the potential benefits and harms of screening vs not screening and targeted vs universal screening; and the benefits and harms of treatment of screen-detected celiac disease. The USPSTF also reviewed contextual information on the prevalence of celiac disease among patients without obvious symptoms and the natural history of subclinical celiac disease.FindingsThe USPSTF found inadequate evidence on the accuracy of screening for celiac disease, the potential benefits and harms of screening vs not screening or targeted vs universal screening, and the potential benefits and harms of treatment of screen-detected celiac disease.Conclusions and recommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for celiac disease in asymptomatic persons. (I statement).

ImportanceBased on data from the 1990s, estimated prevalence of obstructive sleep apnea (OSA) in the United States is 10% for mild OSA and 3.8% to 6.5% for moderate to severe OSA; current prevalence may be higher, given the increasing prevalence of obesity. Severe OSA is associated with increased all-cause mortality, cardiovascular disease and cerebrovascular events, diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes.ObjectiveTo issue a new US Preventive Services Task Force (USPSTF) recommendation on screening for OSA in asymptomatic adults.Evidence reviewThe USPSTF reviewed the evidence on the accuracy, benefits, and potential harms of screening for OSA in asymptomatic adults seen in primary care, including those with unrecognized symptoms. The USPSTF also evaluated the evidence on the benefits and harms of treatment of OSA on intermediate and final health outcomes.FindingsThe USPSTF found insufficient evidence on screening for or treatment of OSA in asymptomatic adults or adults with unrecognized symptoms. Therefore, the USPSTF was unable to determine the magnitude of the benefits or harms of screening for OSA or whether there is a net benefit or harm to screening.Conclusions and recommendationThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for OSA in asymptomatic adults. (I statement).

ImportanceTuberculosis remains an important preventable disease in the United States. An effective strategy for reducing the transmission, morbidity, and mortality of active disease is the identification and treatment of latent tuberculosis infection (LTBI) to prevent progression to active disease.ObjectiveTo issue a current US Preventive Services Task Force (USPSTF) recommendation on screening for LTBI.Evidence reviewThe USPSTF reviewed the evidence on screening for LTBI in asymptomatic adults seen in primary care, including evidence dating from the inception of searched databases.FindingsThe USPSTF found adequate evidence that accurate screening tests for LTBI are available, treatment of LTBI provides a moderate health benefit in preventing progression to active disease, and the harms of screening and treatment are small. The USPSTF has moderate certainty that screening for LTBI in persons at increased risk for infection provides a moderate net benefit.Conclusions and recommendationThe USPSTF recommends screening for LTBI in populations at increased risk. (B recommendation).

ImportanceTuberculosis remains an important preventable disease in the United States. An effective strategy for reducing the transmission, morbidity, and mortality of active disease is the identification and treatment of latent tuberculosis infection (LTBI) to prevent progression to active disease.ObjectiveTo issue a current US Preventive Services Task Force (USPSTF) recommendation on screening for LTBI.Evidence reviewThe USPSTF reviewed the evidence on screening for LTBI in asymptomatic adults seen in primary care, including evidence dating from the inception of searched databases.FindingsThe USPSTF found adequate evidence that accurate screening tests for LTBI are available, treatment of LTBI provides a moderate health benefit in preventing progression to active disease, and the harms of screening and treatment are small. The USPSTF has moderate certainty that screening for LTBI in persons at increased risk for infection provides a moderate net benefit.Conclusions and recommendationThe USPSTF recommends screening for LTBI in populations at increased risk. (B recommendation).

The article discusses overtreatment which is a treatment done when there is lack of or no reliable evidence of a clinically meaningful net benefit. Topics discussed include the causes of overtreatment, the dangers of overtreatment following overscreening and overdiagnosis, overtreatment of hypertension and indication creep occurring when physicians apply recommendations appropriate for high-risk patients to all of their patients.

The authors discuss the harms of overdiagnosis. Topics covered include the inconvenience, worry, expense, and adverse effects of treatment, caused by overdiagnosis, especially with regard to breast and prostate cancers, how improved technologies that allow the identification of smaller abnormalities increase the likelihood of overdiagnosis, and a recommendation to develop molecular diagnostic tests and biomarkers to help distinguish overdiagnosed disease from those needing treatment.