Hanna E. Bloomfield, MD, MPH; Andrew Olson, MD; Timothy J. Wilt, MD, MPH
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-2881.
Bloomfield HE, Olson A, Wilt TJ. Screening Pelvic Examinations in Asymptomatic, Average-Risk Adult Women. Ann Intern Med. 2014;161:924-925. doi: 10.7326/L14-5034-2
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Published: Ann Intern Med. 2014;161(12):924-925.
First, our literature search included all gynecologic conditions, not just noncervical cancer and pelvic inflammatory disease.
Second, we agree that lack of evidence does not mean lack of value, but it does mean that value has not been empirically shown. Value is defined as the magnitude of benefit relative to the cost. We found no evidence of benefit for pelvic examination (excluding that done for cervical cancer screening) in asymptomatic, average-risk women. Without demonstrable benefit, there cannot be value.
Third, Drs. Jennings and Blake point out that pelvic examination sometimes reveals abnormalities. The issue, however, is not whether it reveals abnormalities but whether finding them in an asymptomatic woman improves her health, well-being, or longevity. We found no evidence that presymptomatic detection of any of the conditions listed by Drs. Jennings and Blake improves patient outcomes.
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