July 2, 2014 | by Nicole White
New pelvic exam recommendations or not, women shouldn't give up those routine gynecological appointments. The revised guidelines from the American College of Physicians exempt most women from pelvic examinations, but a cancer specialist at City of Hope says women should still plan on regular visits with their gynecologist for cancer screening.
The guidelines were published July 1 in the Annals of Internal Medicine, and call for routine pelvic exams to be skipped for women who are asymptomatic, of average risk for problems and not pregnant. No one is disputing the need, however, for regular Pap tests and cervical exams.
The study on which the recommendations are based found that routine pelvic exams were not beneficial to asymptomatic, average risk women who are not pregnant, as the exams rarely detect important disease and don't reduce mortality, said Linda Humphrey, M.D., co-author of the guideline, in a news release.
The key to communicating this new guideline is making sure women understand that they should still receive Pap smear screening to detect cervical cancer. The incidence and death rates for cervical cancer have plummeted in the last 60 years, and continued to drop in the last decade, largely due to good screening, said Robert Morgan, M.D., co-director of the Gynecological Oncology/Peritoneal Malignancy Program at City of Hope.
“In general, I understand the reasoning behind the guideline,” he said. “I, however, look at the issue of health examinations through the eyes of an oncologist. I am concerned that if we take routine testing out of the usual practices of women, that other very important practices – particularly Pap smear screening for cervical cancer – will tend to be neglected.”
Morgan told the Los Angeles Times he fears this will result in an increase in cervical cancer rates.
According to the American College of Physicians, the recommended examination should be limited to visual inspection of the cervix and cervical swabs for cancer, as well as for human papillomavirus in some women. The new guidelines do away with the bimanual examination, in which physicians use their hands to determine the shape and size of the uterus and ovaries. The study finds these examinations are more likely to find benign conditions that lead to unnecessary treatments than harmful ones. In addition to not being a reliable means of finding cancer, the exams may cause women anxiety, embarrassment and discomfort.
The pelvic exam is appropriate for women who have symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction.
Morgan acknowledged the multiple caveats in the guidelines, clarifying that patients who are due for cancer screening should still see their doctors. National Cancer Institute guidelines recommend that women should have a Pap test every three years beginning at age 21. Women ages 30 to 65 should have HPV and Pap co-testing every five years or a Pap test alone every three years. Women with certain risk factors may need to have more frequent screening or to continue screening beyond age 65.
This new screening guideline is the latest in a string of recommendations to limit one-size-fits-all screening, in favor of screening based on individual risk or eliminating certain screenings altogether – such as the pelvic examination.
“The further and further we get toward cost savings, the less we’re recommending any type of routine screening examinations,” Morgan said. “The question becomes: Where do you draw the line?”
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting us online or by calling 800-826-HOPE (4673). Our staff will explain what previous medical records we'll need for your first appointment and help you determine, before you come in, whether or not your insurance will pay for the appointment.