By Sandra G. Boodman
It’s the latest battle over screening: Should healthy women skip annual pelvic exams?
A controversial recommendation last year by the American College of Physicians, which represents the nation’s internists, strongly urged that doctors stop routinely performing the invasive exam on women without symptoms and who are not pregnant.
Citing 60 years of research, the ACP found no evidence that the screening, performed about 63 million times annually at a cost of approximately $2.6 billion, detects cancer or other serious conditions.
The exam, researchers reported, did cause harm: One-third of women reported discomfort, pain, embarrassment or anxiety — leading some to avoid care altogether.
For roughly 1 percent of women, a suspicious finding triggered a cascade of anxiety-provoking interventions — including tests and surgery, which carry a risk of complications for conditions that nearly always turned out to be benign.
The controversy underscores the difficulty of changing long-established clinical practice and raises questions about the role of payment in shaping physician behavior.
The American College of Obstetricians and Gynecologists (ACOG) fired back
. Despite what the group acknowledged was a lack of evidence that “supports or refutes” the exam, ACOG strongly endorsed it, citing the “clinical experiences of gynecologists.”
Patients expect it, the group said, and the screening builds trust, reassures women and encourages them to discuss sensitive matters such as sexual dysfunction. A decision about whether to undergo the exam should be made by doctors and patients, ACOG concluded.
These dueling recommendations leave women in the unenviable position of sorting out what to do. Continue reading