The American College of Physicians issues a new guideline
Healthy women don’t need regular pelvic exams, says the American College of Physicians, in a new set of guidelines released Monday.
The professional group made its recommendations after examining scientific research published from 1946 to 2014 that studied the effectiveness of the pelvic exam, which has long been part of women’s annual checkups.
“We found that the exam is not particularly good at detecting important disease, such as early ovarian cancer, and it can fool a physician into thinking she has detected an abnormality that, once you notice, will require further investigation,” said Molly Cooke, a member of the committee that drew up the guidelines and the organization’s immediate past president. The guidelines were published in the Annals of Internal Medicine. The physicians group represents internists, who specialize in diagnosing and treating adult diseases.
The American College of Obstetricians and Gynecologists, which represents doctors in those specialties, said in a statement that women should consult with their health-care providers about whether to have a pelvic exam. Although the procedure is “not evidence-based,” the organization said, it continues to endorse the exams because they can bring to light issues such as sexual dysfunction and incontinence.
The American College of Physicians data suggest pelvic exams don’t reduce mortality and can lead to false alarms in 1.5% to 3% of cases, Dr. Cooke said. The exams also can cause anxiety and discomfort for many women, especially those with a history of sexual trauma.
Dr. Cooke stressed that the guidelines apply only to routine pelvic exams and that women with abnormal symptoms should still get checked. In addition, women should continue to get a regular Pap smear, a screening test for cervical cancer, which wasn’t addressed in the new guidelines.
Some gynecologists say they will continue to advise patients to include a pelvic exam as part of their annual checkup. In part, this is because the scientific research didn’t evaluate the usefulness of pelvic exams in detecting noncancerous masses. Although pelvic exams can be uncomfortable, they are important because many women with abnormalities don’t realize that they have symptoms, says David Fishman, a professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai Hospital in New York. For example, 80% of women who develop ovarian cancer don’t have any risk factors, he noted.
“It doesn’t make sense to wait until a patient is symptomatic to go get the exam because by that point, those symptoms are often consistent with advanced-stage disease,” Dr. Fishman said. “This recommendation, in my mind, would unfortunately compromise women’s health care by suggesting that a thorough gynecologic exam is not required.”
“The exam may not be 100% sensitive, and it may not be able to pick up cancer of the ovary, but it gives us a baseline idea of health and is one piece of what we can easily offer women that can help with education and counseling,” said Taraneh Shirazian, an assistant professor of obstetrics, gynecology and reproductive science at Mount Sinai.
Write to Angela Chen at angela.chen@dowjones.com
American Health Imaging (Cumming, GA.) 