USPSTF issues final recommendation on pelvic exam
Evidence is insufficient to assess balance versus risk of screening pelvic examination for asymptomatic, nonpregnant adult women, according to a Recommendation Statement issued by the US Preventive Services Task Force (USPSTF). Published in JAMA, the findings are based on a review of abstracts and full-text articles on screening pelvic examination published from 1946 to January 13, 2016.
The report also took into consideration comments from the public received after release of a draft version of the statement, which was posted from June 28, 2016 to July 25, 2016.
The literature review was designed to answer 3 questions:
1. What is the direct evidence for the effectiveness of the pelvic examination in reducing all-cause mortality, cancer- and disease-specific morbidity and mortality, and improving quality of life?;
2. What are the test performance characteristics of the pelvic examination in screening for gynecologic cancers and other gynecologic conditions?; and
3. What are the adverse effects of screening using the pelvic examination?
The investigators found inadequate evidence on the accuracy or benefits of pelvic examination for detection of a range of gynecologic conditions. Evidence was similarly inadequate on harms of screening for a variety of gynecologic conditions. No studies were found that looked at pelvic examination’s benefit on all-cause mortality, disease-specific morbidity or quality of life.
The USPSTF acknowledged the difficulty of performing studies on the effectiveness of screening pelvic examination. The panel said that their findings do not apply to screening for cervical cancer, gonorrhea, or chlamydia, although some public comments mentioned that misperception. The authors also clarified, in response to public comments, that costs of preventive service are not considered when determining a recommendation grade.
“In the absence of clear evidence on the balance of benefits and harm of using pelvic examination to screen for asymptomatic gynecologic conditions,” USPSTF said in summary, “clinicians are encouraged to consider the patient’s risk factors for various gynecologic conditions and the patient’s values and preferences, and engage in shared decision making with the patient to determine whether to perform pelvic examination.”
The American College of Obstetricians and Gynecologists recommends performing pelvic examinations annually in all patients age 21 and older.