The U.S. Preventive Services Task Force (USPSTF) normally meets in person three times per year: in March, July, and November. This year, they did meet in March, but their meetings have since been suspended as they await the federal government's reopening and Health and Human Services (HHS) Secretary RFK Jr.'s postponed decision on whether to fire them all. Even if they could meet and vote on new or updated recommendations, their support staff at the Agency for Healthcare Research and Quality (AHRQ) has been gutted, and it isn't clear if the Evidence-Based Practice Centers that AHRQ contracts with to produce systematic evidence reviews are still being funded. Is the USPSTF better off remaining intact but non-functional as opposed to the reconstituted Advisory Committee on Immunization Practices, which is technically operating but has been producing nonsense? I don't know. But while the Task Force's activities remain at a standstill, prevention science is moving on.
One of the last topics I worked on as an AHRQ medical officer was screening for oral cancer. The USPSTF's last recommendation statement, concluding that the evidence was insufficient to determine the effectiveness of an oral screening exam in primary care, is nearly 12 years old. At the time, the only direct evidence was a cluster randomized trial performed in an Indian state with an extremely high incidence of oral cancer due in part to widespread betel quid chewing, and the Task Force reasonably concluded that it wasn't possible to extrapolate the mortality benefit seen in that trial to an American primary care population. In 2023, the USPSTF did a quick search for new evidence and determined that there wasn't enough to warrant updating the previous recommendation. The National Cancer Institute's latest summary of the evidence on oral and nasopharyngeal cancer screening, updated in April 2025, reaches a similar conclusion.
Then, the results of a new study were published. It turns out that Taiwan, where betel quid chewing is also common, launched the world's first national oral cancer screening program in 1999. Screening exams were conducted every two years in all male persons aged 30 and older who chew betel quid and/or smoke, as well as in indigenous males starting at age 18. An observational study of the outcomes associated with this screening program found that despite a 2.4 fold increase in early-stage oral cancer diagnoses, there was little change in late-stage incidence and no reduction in oral cancer mortality from 2004 to 2022. The researchers concluded that oral cancer screening is ineffective.
Taiwan isn't the United States, and if members of the USPSTF have reviewed this study, they may have been tempted to conclude that its results aren't any more applicable to our population than the trial from India. My view is different. If oral cancer screening doesn't work in Taiwan, it isn't likely to work anywhere else, especially in a dysfunctional U.S. health system reliant on opportunistic primary care screening in the absence of a robust public health infrastructure. As cigarette smoking and betel nut use have plummeted in the past two decades, this is likely the best evidence that we will ever have on this topic.
This is a small sample of the studies that the USPSTF and its support team should be reviewing but are likely unable due to irresponsible and damaging decisions being made (or intentionally not made) by HHS department leadership. Here's hoping that the Task Force's limbo ends sometime soon and that they emerge with renewed support and funding - but I'm not holding my breath.
