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  • Adults.


AAFP 2004, USPSTF 2004

  • Insufficient evidence for or against the use of interventions to prevent low-back pain in adults in primary care settings.


  • AAFP. Clinical Recommendations: Low Back Pain. 2004.

  • USPSTF. Low Back Pain. 2004.


  1. Topic is now inactive at USPSTF.

  2. Insufficient evidence to support back strengthening exercises, mechanical supports, or increased physical activity to prevent low-back pain.

  3. Meta-analyses in Lancet 2018;391:2368-2383, Am J Epidemiol. 2018;187(5):1093-1101, and JAMA Intern Med. 2016;176(2):199-208:

    1. Conclude that exercise alone or exercise in combination with education are effective for preventing low-back pain.

    2. Evidence that education alone, back belts, and shoe insoles are not effective.

    3. Exercises that were studied and shown to be effective are a combination of strengthening with either stretching or aerobic exercise, 2–3 times/wk.



  • Adult women.


NCCN 2019

  • If a woman is at high risk secondary to a strong family history or very early onset of breast or ovarian cancer, offer genetic counseling.

  • Healthy lifestyle:

    • Breast cancer risks associated with combined estrogen/progesterone therapy ≥3–5 y duration of use.

    • Limit alcohol consumption.

    • Exercise: at least 150 min/wk of moderate intensity, or at least 75 min/wk of vigorous aerobic physical activity.

    • Weight control.

    • Breast-feeding.

  • Risk-reducing agents:

    • Discussion of relative and absolute risk reducing with tamoxifen, raloxifene, or aromatase inhibitors.

    • Contraindications to tamoxifen or raloxifene: history of deep vein thrombosis, pulmonary embolus, thrombotic stroke, transient ischemic attack, or known inherited clotting trait.

    • Contraindications to tamoxifen, raloxifene, and aromatase inhibitors: current pregnancy or pregnancy potential without effective nonhormonal method of contraception. Common and serious adverse effects of tamoxifen, raloxifene, or aromatase inhibitors with emphasis on age-dependent risks.

  • Risk-reducing surgery:

    • Risk-reducing mastectomy should generally be considered only in women with a genetic mutation conferring a high risk for breast cancer, compelling family history, or possibly with prior thoracic RT at <30 y of age. While this approach has been previously considered for LCIS, the currently preferred approach is risk-reducing therapy. The value of risk-reducing mastectomy in women with deleterious mutations in other genes associated with a 2-fold or greater risk for breast cancer (based on large epidemiologic studies) in the absence of a compelling family history of breast cancer is unknown.

Minimize Known Risk Factor Exposure

  • Hormone Replacement Therapy

    • Approximately 26% increased incidence of invasive breast cancer with combination hormone replacement therapy (HRT) (estrogen and progesterone-Prempro).

    • Estrogen alone with mixed evidence—unlikely to increase risk of breast cancer significantly (decreases risk in African-Americans).

  • Ionizing Radiation to Chest and Mediastinum

    • Increased risk begins approximately 10 y after exposure. ...

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