USPSTF Final Recommendation

Evidence Lacking on Routine Gynecologic Screening Pelvic Exams

March 08, 2017 01:52 pm Chris Crawford

On March 7, the U.S. Preventive Services Task Force (USPSTF) published its final recommendation statement(www.uspreventiveservicestaskforce.org) and evidence report(jamanetwork.com) on screening asymptomatic, nonpregnant adult women for gynecologic conditions using pelvic examination. The task force found that current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic exams in these women -- an "I" statement(www.uspreventiveservicestaskforce.org).

[Gynecological exam table]

This is the first time the USPSTF has reviewed evidence on screening for a wide range of gynecologic conditions using pelvic examination.

This final recommendation applies to asymptomatic women 18 and older who aren't at increased risk for various gynecologic conditions. These conditions include infectious diseases such as bacterial vaginosis, candidiasis, genital warts, genital herpes, trichomoniasis and pelvic inflammatory disease, as well as other benign problems such as cervical polyps, endometriosis, ovarian cysts, dysfunction of the pelvic wall and floor, and uterine fibroids.

The USPSTF previously made separate recommendations on screening for cervical cancer, gonorrhea and chlamydia using tests that are often performed during a pelvic examination (e.g., Pap smear, HPV test and nucleic acid amplification tests).

Story highlights
  • On March 7, the U.S. Preventive Services Task Force published its final recommendation statement on screening asymptomatic, nonpregnant adult women for gynecologic conditions using pelvic examination.
  • The task force found that current evidence is insufficient to assess the balance of benefits and harms of performing screening pelvic exams in these women -- an "I" statement.
  • The Academy's Commission on Health of the Public and Science subcommittee on clinical preventive services still needs to vote before the AAFP offers its own final recommendation.

"The task force is calling for more research to better understand the benefits and harms associated with performing screening pelvic exams to detect gynecologic conditions in women without any gynecologic signs, symptoms or risk factors," said task force member Maureen Phipps, M.D., M.P.H., in a USPSTF news bulletin(www.uspreventiveservicestaskforce.org). "Until more research is available, clinicians should continue to use their clinical judgment, taking each patient's individual values, preferences and circumstances into consideration when deciding with patients whether or not a pelvic exam should be performed."

Response to Public Comment

A draft version of this recommendation statement was posted for public comment on the USPSTF website from June 28 to July 25, 2016.

Some commenters expressed concern that it appeared the task force was recommending against performing screening pelvic examinations and therefore, against screening for cervical cancer. In response, the USPSTF clarified that it is recommending neither for nor against pelvic exam screening for gynecologic conditions other than cervical cancer, gonorrhea or chlamydia.

Other commenters worried the USPSTF had based its recommendation on costs. Regarding this concern, the task force explained in its final recommendation that it doesn't consider the cost of a preventive service when determining a recommendation grade, but rather bases its decision on the quality and strength of the available evidence about the potential benefits and harms of a preventive service.

Finally, a number of commenters expressed concern that the task force didn't sufficiently consider the harms of performing pelvic examinations and, therefore, should have recommended against performing them altogether.

The USPSTF said it reviewed all available relevant studies that reported on harms of screening pelvic examinations and too few studies were available for the group to determine the net benefit or harm of performing them.

AAFP's Final Recommendation

Jennifer Frost, M.D., medical director for the AAFP Health of the Public and Science Division, told AAFP News the Academy's Commission on Health of the Public and Science Subcommittee on Clinical Preventive Services still needs to vote before the AAFP offers its own final recommendation.

"We are reviewing the evidence report from the USPSTF to determine what the AAFP's recommendation statement will be," she said.

When the draft recommendation statement was released in July 2016, Frost told AAFP News there was no evidence of any benefit of screening pelvic exams in asymptomatic women.

To provide further context on the Academy's stance on the issue, she pointed out that in 2014, the AAFP had endorsed the American College of Physicians' guideline recommending against screening asymptomatic, nonpregnant women for pathology using pelvic examination.

"It isn't an effective screening strategy for ovarian or uterine cancer, and a pelvic exam isn't necessary to screen for gonorrhea or chlamydia," she said at the time. "In a woman without symptoms, it's unclear what a pelvic exam might reveal that would reduce her morbidity or mortality."

Related AAFP News Coverage
Chlamydia Screens Dropped After Cervical Cancer Screening Change
Unlink Chlamydia Screening from Pelvic Exams, Cervical Cancer Tests, Study Suggests
(8/10/2015)

Choosing Wisely
AAFP Releases Third List of Tests, Procedures Patients, Physicians Should Question
(9/24/2013)