On June 28th, a panel of physicians and other medical experts reported that there isn’t enough evidence to recommend healthy (those who are not pregnant and who do not have pelvic symptoms, i.e., pain or unusual bleeding) women continue to get annual pelvic exams. While millions of women undergo this routine exam every year, the US Preventive Services Task Force- which advises the federal government on preventive care- concluded that studies have not shown that pelvic exams decrease a woman’s chance of developing illnesses such as ovarian cancer or of dying prematurely.

Also on Tuesday, in a rather surprising turn, the American College of Obstetricians and Gynecologists- who once adamantly supported annual pelvic exams- acknowledged that there is little to no evidence that the exam benefits asymptomatic women. This is the same conclusion the American College of Physicians, which represents internists, reached in 2014. After decades of studies, they found that routine pelvic exams weren’t shown to benefit asymptomatic women because the procedure rarely detects hidden disease and does not reduce mortality.

But this announcement is just the latest in a string of similar findings. It’s becoming apparent that many seemingly sensible procedures have little basis in science and fewer clear benefits than the medical community once thought. For instance, procedures such as screening mammograms and PSA tests for prostate cancer- even annual physicals- have turned out to be of questionable benefit.

So, why has the task force changed their mind? Two reasons: pelvic exams have minimal benefits and they can potentially cause harm.

From the PBS article:

“Pelvic exams can find endometriosis, ovarian cysts, uterine fibroids, warts, herpes, pelvic inflammatory disease, and cervical polyps. But research has not shown that detecting and treating these before they produce symptoms is better than waiting for early symptoms to appear, said Dr. Amir Qaseem, vice president for clinical policy at the American College of Physicians. “You want to find things before they cause symptoms only if you have treatments that will keep full-blown symptoms from appearing,” he said. “We don’t have those for the conditions pelvic exams find.”

The exams also have the potential to cause harm, reports task force member Dr. Maureen Phipps, professor of obstetrics and gynecology at the Warren Alpert Medical School of Brown University and chief of OB-GYN at Women & Infants Hospital of Rhode Island:

“Their rate of “false positives” — finding an apparent problem that isn’t there — ranges up to 46 percent. For instance, when a pelvic exam “detects” ovarian cancer, the chance that the woman actually has that often-fatal disease is 0 percent to 3.6 percent. But a woman given that frightening news, or the less dire news that she has a less serious condition such as ovarian cysts or fibroids, will typically undergo additional, sometimes risky, tests, including biopsies and even surgery for something that might never have affected her.

Pelvic exams can also give false reassurance. When an exam finds no sign of ovarian cancer, for instance, there is a chance the woman actually has it, according to studies reviewed by the task force. Such “false negatives” can cause a woman to ignore early symptoms of a potentially deadly disease, Phipps said.”

But, one thing thet task force didn’t change their minds on was screening for cervical cancer, which they still highly recommend. And that type of screening can be done without a pelvic exam.

The public will be allowed to comment on the draft recommendation, which was accompanied by a 71-page review of the scientific evidence, through July 25. After the task force considers the feedback, they will issue a final recommendation, which the federal government and some private insurers can use to decide what procedures to cover.

Source: PBS