What does an 'A' or 'B' grade indicate for clinicians?

• A. The service should be avoided.
• B. The service is optional and only for high-risk patients.
• C. The service has no net benefit or harms outweigh benefits.
• D. The service has a reasonable net benefit and should be offered or provided.

Answer: (D)

When USPSTF assigns an A or B, it means there is a net health benefit from the service and it should be offered or provided in routine care. Net benefit means benefits minus harms; the grade reflects certainty about that benefit. An A grade indicates high certainty of a substantial net benefit, while a B grade indicates moderate certainty of a net benefit. Practically, this signals to clinicians that they should discuss the option with patients and provide it when it fits the patient’s values and situation. Other grades describe different situations (for example, no net benefit or harms outweigh benefits, or insufficient evidence), which do not apply here.