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Task force: Evidence insufficient to determine benefits, harms of routine screening pelvic exams
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No direct evidence supports the overall benefits or harms of one-time or periodic screening pelvic examinations for potential gynecologic conditions in asymptomatic women who are not pregnant, according to a draft recommendation statement from the U.S. Preventive Services Task Force.
The task force also found limited evidence for the diagnostic accuracy and harms of routine screening pelvic exams to guide practice in asymptomatic primary care populations.
“Research is needed to illuminate how recent changes in cervical cancer screening periodicity may influence women’s access to other evidence-based preventive services in the primary care setting and to create best practices for achieving high rates of uptake for these recommended services,” Janelle M. Guirguis-Blake, MD, of MultiCare Tacoma Family Medicine and colleagues wrote.
Last year, the American College of Physicians released clinical guidelines for screening average-risk adults without symptoms for several common cancers. Those guidelines recommended against biannual pelvic exams to screen for cervical cancer.
The U.S. Preventive Services Task Force conducted its own systematic review designed to:
- Find direct evidence that pelvic examinations effectively reduced all-cause mortality, reduced cancer- and disease-specific morbidity and mortality, and improved quality of life;
- Determine the test performance characteristics of the pelvic examination in screening for gynecologic cancers and other gynecologic conditions; and
- Evaluate adverse effects of screening using the pelvic examination.
The researchers identified and reviewed relevant studies from MEDLINE, PubMed and the Cochrane Central Register of Controlled Trials against a set of a priori inclusion and quality criteria.
No studies evaluated the effectiveness of pelvic examinations for reducing all-cause mortality, reducing cancer- and disease-specific morbidity and mortality, or improving quality of life.
Eight diagnostic accuracy studies — four for ovarian cancer, two for bacterial vaginosis, one for trichomoniasis and one for genital herpes — examined test characteristics for pelvic examination screening.
These studies also provided information about the potential harms — such as false-positive or false-negative results — of screening pelvic exams.
In the four ovarian cancer screening studies, which included more than 26,000 patients, more than 96% of positive test results were false positives.
“Although lack of evidence is not conclusive evidence of no benefit, the existing evidence highlights the limited sensitivity of screening pelvic examination in detecting ovarian cancer and select infections,” Guirguis-Blake and colleagues wrote.
One large randomized controlled trial documented diagnostic workup, surgeries and complications that occurred within 1 year of abnormal ovarian palpation. Rates of surgery ranged from 5% to 36%; the largest study reported an 11% surgery rate and 1% complication rate.
“Each diagnostic accuracy study for bacterial vaginosis, trichomoniasis and genital herpes was performed in a high-prevalence population with high proportions of symptomatic patients and reported accuracy characteristics for individual physical examination findings, thereby limiting any conclusions that could be made regarding the screening accuracy or adverse effects of the pelvic examination in asymptomatic primary care populations,” Guirguis-Blake and colleagues wrote.
The draft recommendations are available online and for public comment here. – by Kristie L. Kahl
Disclosure: The researchers report no relevant financial disclosures.
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U.S. Preventive Services Task Force. Screening for gynecologic conditions with pelvic examination: A systematic review for the U.S. Preventive Services Task Force. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review148/gynecological-conditions-screening-with-the-pelvic-examination. Accessed on June 28, 2016.
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