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Lack of evidence, agreed; next steps unsure.

THE USPSTF TASK FORCE finding of insufficient evidence to support or refute screening pelvic exams conflicts with the views of other organizations, George F Sawaya, MD, wrote in an editorial (JAMA. 2017 Mar 7. doi: 10.1001/jamainternmed.2017.0271).

The American College of Physicians currently recommends against routine screening in asymptomatic, nonpregnant women, while the American College of Obstetricians and Gynecologists recommends in favor of an annual pelvic exam "based on expert opinion" despite the lack of evidence, he said.

"The USPSTF believes that in the setting of an T statement, clinicians should be forthright with patients about the uncertainty concerning the balance of benefits and harms," Dr. Sawaya wrote.

"But perhaps the conversation should focus on the uncertainty among the three professional groups," he added. "Women should know the facts: that all three groups agree there is no scientific evidence that these examinations are beneficial; that there is evidence of harms including 'false alarms,' further testing, and even unnecessary surgery; and that one group strongly recommends against screening examinations, believing them to be more harmful than beneficial," he said.

The USPSTF recommendation is not a surprise, Colleen McNicholas, DO, MSCI, and Jeffrey F Peipert, MD, PhD, noted in a second editorial (JAMA. 2017;317[9]:910-1). "Despite lack of rigorous research, many would argue that the periodic examination provides opportunity for counseling and trust building between the patient and physician and thus should be universally implemented," they wrote. However, many women express fear and anxiety before the exam and discomfort, pain, or embarrassment during the exam. "To ignore this aspect when comparing individual parts of the examination seems insensitive and inappropriate," they added.

"Women, as patients, should be involved in the decision regarding whether to perform a pelvic examination, and clinicians should not require that the patient undergo this procedure to obtain screening, counseling, and age-appropriate health services," they concluded.

Dr. Sawaya is affiliated with the University of California, San Francisco. He reported having no financial conflicts. Dr. Peipert is affiliated with Indiana University School of Medicine, Indianapolis, and disclosed receiving grants from Teva Pharmaceuticals, Bayer Healthcare Pharmaceuticals, and Merck, as well as serving on the advisory boards of Perrigo and Teva. Dr. McNicholas is affiliated with Washington University, St. Louis, and reported having no financial conflicts.

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Title Annotation:VIEW ON THE NEWS
Publication:OB GYN News
Date:Apr 1, 2017
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