How does USPSTF address screening harms like false positives?

• A. By randomly selecting tests without considering harms.
• B. By ensuring 100% specificity in all tests.
• C. By weighing harms in the net-benefit analysis and choosing intervals/tests with acceptable specificity.
• D. By only evaluating harms after patients report adverse effects.

Answer: (C)

Screening recommendations are built on balancing benefits with harms. The USPSTF uses a net-benefit framework that explicitly incorporates potential harms from screening—such as false positives, overdiagnosis, anxiety, and unnecessary follow-up procedures—into the overall assessment. By estimating how often a test yields true positives versus false positives and weighing that against the expected benefit of earlier detection, they decide whether a screening approach provides a net benefit to the population. In practice, this means selecting intervals and tests that achieve acceptable specificity, reducing unnecessary harms while preserving benefits. The other ideas don’t fit this approach: randomly choosing tests ignores harms, aiming for 100% specificity is not feasible in real-world screening, and evaluating harms only after adverse events misses proactive harm assessment that informs recommendations.