Hanna E. Bloomfield, MD, MPH; Andrew Olson, MD; Nancy Greer, PhD; Amy Cantor, MD, MHS; Roderick MacDonald, MS; Indulis Rutks, BS; Timothy J. Wilt, MD, MPH
Acknowledgment: The authors thank the topic nominators and technical expert panel members: Michelle Berlin, MD, MPH; Navjit Goraya, MD; Sally G. Haskell, MD; Linda Humphrey, MD, MPH; Linda S. Kinsinger, MD, MPH; Terri Murphy, RN, MSN; Wanda Nicholson, MD, MPH; and Laurie C. Zephyrin, MD, MPH, MBA.
Financial Support: By the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative (project 09-009), and the American College of Physicians Clinical Guidelines Committee.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2881.
Requests for Single Reprints: Hanna E. Bloomfield, MD, MPH, Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Mail Code 151, Minneapolis, MN 55417; e-mail, Hanna.Bloomfield@va.gov.
Current Author Addresses: Dr. Bloomfield: Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Mail Code 151, Minneapolis, MN 55417.
Dr. Olson: Division of General Internal Medicine, Department of Medicine, University of Minnesota, MMC 741, 420 Delaware Street SE, Minneapolis, MN 55455.
Drs. Greer and Wilt and Mr. MacDonald: Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Mail Code 111-O, Minneapolis, MN 55417.
Dr. Cantor: Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Mail Code BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239.
Mr. Rutks: Minneapolis Veterans Affairs Health Care System, One Veterans Drive, Mail Code 152, Minneapolis, MN 55417.
Author Contributions: Conception and design: H.E. Bloomfield, A. Olson, N. Greer, A. Cantor, T.J. Wilt.
Analysis and interpretation of the data: H.E. Bloomfield, A. Olson, N. Greer, A. Cantor, R. MacDonald, T.J. Wilt.
Drafting of the article: H.E. Bloomfield, A. Olson, A. Cantor.
Critical revision of the article for important intellectual content: A. Olson, N. Greer, A. Cantor, T.J. Wilt.
Final approval of the article: H.E. Bloomfield, A. Olson, N. Greer, A. Cantor, R. MacDonald, I. Rutks, T.J. Wilt.
Provision of study materials or patients: I. Rutks.
Obtaining of funding: T.J. Wilt.
Administrative, technical, or logistic support: N. Greer, I. Rutks, T.J. Wilt.
Collection and assembly of data: H.E. Bloomfield, A. Olson, N. Greer, A. Cantor, R. MacDonald, I. Rutks.
Pelvic examination is often included in well-woman visits even when cervical cancer screening is not required.
To evaluate the diagnostic accuracy, benefits, and harms of pelvic examination in asymptomatic, nonpregnant, average-risk adult women. Cervical cancer screening was not included.
MEDLINE and Cochrane databases through January 2014 and reference lists from identified studies.
52 English-language studies, 32 of which included primary data.
Data were extracted on study and sample characteristics, interventions, and outcomes. Quality of the diagnostic accuracy studies was evaluated using a published instrument, and quality of the survey studies was evaluated with metrics assessing population representativeness, instrument development, and response rates.
The positive predictive value of pelvic examination for detecting ovarian cancer was less than 4% in the 2 studies that reported this metric. No studies that investigated the morbidity or mortality benefits of screening pelvic examination for any condition were identified. The percentage of women reporting pelvic examination–related pain or discomfort ranged from 11% to 60% (median, 35%; 8 studies [n = 4576]). Corresponding figures for fear, embarrassment, or anxiety ranged from 10% to 80% (median, 34%; 7 studies [n = 10 702]).
Only English-language publications were included; the evidence on diagnostic accuracy, morbidity, and mortality was scant; and the studies reporting harms were generally low quality.
No data supporting the use of pelvic examination in asymptomatic, average-risk women were found. Low-quality data suggest that pelvic examinations may cause pain, discomfort, fear, anxiety, or embarrassment in about 30% of women.
Department of Veterans Affairs.
Bloomfield HE, Olson A, Greer N, Cantor A, MacDonald R, Rutks I, et al. Screening Pelvic Examinations in Asymptomatic, Average-Risk Adult Women: An Evidence Report for a Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2014;161:46–53. doi: 10.7326/M13-2881
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Published: Ann Intern Med. 2014;161(1):46-53.
Cancer Screening/Prevention, Hematology/Oncology, High Value Care, Infectious Disease, Prevention/Screening.
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