USPSTF seeks comment on pelvic exam recommendations
The public has until July 25 to comment on a new systematic review of evidence on risks and benefits of period screening pelvic examination prepared by the Agency for Healthcare Research and Quality (AHRQ). The analysis—which shows no direct evidence on overall benefits and harms of the examination for periodic screening—is intended to form the basis for a new recommendation statement by the US Preventive Services Task Force (USPSTF).
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?
For the analysis, two investigators independently reviewed abstracts and full-text articles on screening pelvic examination published from 1946 to January 13, 2016. Reference lists from relevant systematic reviews, suggestions from experts, and information on ongoing trials from ClinicalTrials.gov also were used to supplement the literature search.
The investigators found no studies applicable to question #1. Eight studies of diagnostic accuracy for 4 conditions—ovarian cancer, bacterial vaginosis (BV), trichomoniasis, and genital herpes--were identified in regard to question #2. More than 26,000 patients were screened in the 4 studies of pelvic exams for diagnosis of ovarian cancer and more than 96% of the results were false positives. It was not possible to draw conclusions about the accuracy of pelvic exam for BV, trichomoniasis, or genital herpes because the studies reviewed included a high proportion of patients with symptoms, and accuracy characteristics were reported for findings from individual exams. On the question of adverse effects related to pelvic examination, the investigators cited surgery rates resulting from an abnormal pelvic exam that ranged from 5% to 36% within 1 year, and an 11% rate in the largest relevant study.
Individuals who would like to comment on the systematic review before the USPSTF issues its final Evidence Review should visit http://www.uspreventiveservicestaskforce.org/Comment/Collect/Index/draft-evidence-review148/gynecological-conditions-screening-with-the-pelvic-examination