Current evidence is insufficient to support screening pelvic exams for the early detection of certain gynecologic conditions in asymptomatic, nonpregnant women, according to a draft recommendation statement issued by the U.S. Preventive Services Task Force.
The draft recommendations and draft evidence review are available online for public comment at www.uspreventiveservicestaskforce.org through July 25, 2016.
The USPSTF defined the lack of evidence to assess the balance of benefits vs. harms of screening pelvic exams as an “I” recommendation, meaning that the balance of benefits and harms cannot be determined. The draft recommendations note that many malignant conditions including gynecologic cancers; infectious diseases such as genital herpes: and benign conditions including polyps, cysts, and fibroids, may be found during a screening pelvic exam. However, potential harms include false-positive and false-negative results, and the potential for invasive treatment and unnecessary diagnostic work-ups.
Dr. Thomas Gellhaus
This is the first statement by the USPSTF specifically addressing pelvic exams to screen for gynecologic conditions in asymptomatic, nonpregnant women. The statement does not change any existing recommendations, such as those for screening tests for early detection of cervical cancer, chlamydia, and gonorrhea.
Pelvic exams are currently covered as part of the well-woman visit under the Affordable Care Act. “Since the coding structure doesn’t parse out individual elements of the visit, this should not result in any coverage changes,” according to the American College of Obstetricians and Gynecologists communications office.
“ACOG is reviewing the USPSTF’s draft recommendation statement and the evidence upon which it is based to assess whether there is a need to update its guidance on the routine pelvic examination,” Dr. Thomas Gellhaus, president of ACOG, said in a statement. “ACOG recommends annual pelvic examinations for patients 21 years of age or older. However, the College recognizes that this recommendation is based on expert opinion, and limitations of the internal pelvic examination for screening should be recognized.”
“The annual well-woman visit is an opportunity for the patient and her ob.gyn. to discuss whether a pelvic examination is appropriate for her. ACOG promotes shared communication and decision making between the patient and the physician regarding pelvic examinations,” said Dr. Gellhaus of the University of Iowa Hospitals and Clinics in Iowa City.
According to the USPSTF draft statement, no studies “were identified that evaluated the benefit of screening with pelvic examination on all-cause mortality, disease-specific morbidity or mortality, or quality of life.” In addition, the USPSTF “found inadequate evidence on the harms of screening for a range of gynecologic conditions with pelvic examination” and “no studies quantified the amount of anxiety associated with screening pelvic examination.”
The draft recommendations are based on a review of the evidence on the benefits, potential harms, and accuracy of screening pelvic examinations for asymptomatic, nonpregnant women aged 18 years and older. The USPSTF concluded that research is lacking in several key areas including the accuracy and efficacy of screening pelvic exams to detect conditions other than trichomoniasis, genital herpes, bacterial vaginosis, and ovarian cancer; and the potential harms (including psychological) of screening pelvic examinations for asymptomatic women.