Which grade indicates harms outweigh benefits and the service should not be offered?

• A. A
• B. B
• C. C
• D. D

Answer: (D)

The important idea here is how USPSTF grades reflect the balance of benefits and harms. The designation that means a service should not be offered is the not-recommended grade. It indicates there is moderate to high certainty that harms exceed benefits, so the overall balance disfavors the service and the net benefit is negative.

By contrast, grades that support offering a service reflect a substantial or moderate net benefit, so the recommendation is to provide it. A grade signals a small net benefit where the decision to offer depends on individual patient values and context. An insufficient-evidence grade means there isn’t enough information to judge the balance, so no clear recommendation is made.