Conflicting Pelvic Screening Recommendations

Expert recommendations on routine pelvic screening in asymptomatic women vary significantly.

For years, women have undergone routine pelvic screening examinations. However, new recommendations from experts and professional societies may be changing the landscape.

The US Preventive Services Task Force (USPSTF) recently finalized a recommendation statement regarding periodic pelvic screening examinations. The USPSTF statement says there is no good evidence either for or against routine pelvic screening.

The new statement, however, has muddied the waters.

George F. Sawaya, MD, of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco, calls the new statement “remarkable” and “unusual.”

Writing in a JAMA Internal Medicine editorial, Dr. Sawaya notes that it is unusual for the USPSTF to make recommendations about a specific test unless that test is related to a specific health condition. The “remarkable” part of the statement, he says, is that the task force says there simply isn’t enough evidence to show that the benefits of screening outweigh the potential harms.

In addition to the USPSTF, two professionals societies have also developed pelvic screening recommendations. The problem is that the American College of Physicians (ACP) and the American Congress of Obstetricians and Gynecologists (ACOG) have made diametrically opposite recommendations.

The ACP recommends against routine screening, while ACOG is for routine screening, based on “expert opinion.” The ACP’s recommendation was based on an extensive review of the literature which found no evidence to support screening but evidence of harm such as psychological distress from false positive findings and from unnecessary surgery.

None of the recommendations apply to health conditions like cervical cancer or sexually transmitted disease. The recommendation is strictly about the hands-on exam in which the physician palpates the lower abdomen to feel for masses or inserts a speculum and looks inside the vagina.

The three groups do agree that there is not enough evidence to show a benefit in the use of the pelvic exam to screen for ovarian cancer.

The take-home message for doctors and patients, according to Dr. Sawaya, is a complete and thorough discussion of the possible risks and benefits in an individual situation. For example, a postmenopausal women doesn’t have the same issues as a woman in the childbearing years.

The editorial was published in the April issue of JAMA Internal Medicine.

JAMA Internal Medicine, “Screening Pelvic Examinations The Emperor’s New Clothes, Now in 3 Sizes?”
http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2605478
Written by: Beth Greenwood, RN | Medically reviewed by: Dr. Robert Carlson, M.D.