Yet another pillar of conventional preventive-health wisdom is crumbling. On Tuesday, a federal panel of medical experts announced that it has found an insufficient amount of evidence to support annual pelvic exams for healthy women who aren’t pregnant.
The U.S. Preventive Services Task Force now says that the reasons often offered to justify pelvic exams—that they detect potentially deadly cancers and other abnormalities—are not backed by any attending decreases in mortality or preventive benefits. Research has shown that women with the kinds of health problems pelvic exams can help detect, including ovarian cysts, uterine fibroids, genital herpes, and pelvic inflammatory disease, do not benefit from early detection before symptoms hit.
In other words, treatment would be just as effective if women waited until they experienced a physical indication of a reproductive health problem before getting a pelvic exam, wherein a medical practitioner examines the vulva and vagina using a speculum, feels the patient’s internal organs with her fingers and hands inside the vagina and outside the abdomen, and may insert a finger into the patient’s rectum. The kind of pre-symptom detection our current health paradigm fetishizes is extraordinarily rare in the cases of these health issues, and current available treatments are not the kind that could cure the conditions before symptoms occur.
Annual pelvic exams for screening purposes (as opposed to diagnostic purposes, as in the case of a patient presenting physical symptoms) carry a high risk of false positives, which can lead to expensive and sometimes risky unnecessary biopsies or surgeries. There’s also the less-calculable but very real risk of false negatives, which can cause a woman to brush off symptoms of something like ovarian cancer if and when they do pop up. The new recommendation from USPSTF does not apply to Pap smears for cervical cancer screening in women aged 21 to 65—still the best way to detect the cancer when done every three to five years.
After the USPSTF made its conclusion on Tuesday, the American College of Obstetricians and Gynecologists, which has long recommended annual pelvic exams for all women over 21, allowed that “limitations of the internal pelvic examination for screening should be recognized” for women who don’t exhibit symptoms of any disease or disorder. The American College of Physicians has recommended against annual pelvic exams for asymptomatic women since 2014.
In lieu of any better options for screening or early detection, pelvic exams would seem to many patients to be the best option for keeping healthy and taking regular stock of one’s reproductive wellbeing. It’s disquieting to find that the evidence says that’s just not true. The new USPSTF finding is “the latest reminder that many seemingly sensible procedures have little basis in science and fewer clear benefits than once thought,” Sharon Begley writes at STAT.
Annual physicals, too, have been found to have no effect on mortality rates or treatment outcomes. That’s because accidents, suicides, and diseases like Alzheimer’s that don’t benefit from early intervention account for a large proportion of U.S. deaths, and routine screening of seemingly healthy patients yields very few accurate surprise diagnoses. Of those, most are likely to be diseases that would have never progressed to present any real threat to the patient, or diseases that are too aggressive and fast-spreading to successfully treat.
The same holds true for regular screening mammograms, once the most-hyped element of preventive women’s health care. In recent years, several medical societies have recommended getting fewer mammograms because the evidence doesn’t support their efficacy: One study estimated that 1,000 50-year-old women would have to get yearly mammograms for a decade just to save a single life. Breast self-exams and clinical breast exams have also been discredited as tools in the fight against breast cancer. But when patients have taken some measure of comfort in the idea that they can stave off death with diligent screening, it’s hard to confront the cold evidence that these preventive procedures don’t change health outcomes after all.
Update, July 1, 2016: The headline of this post has been changed to clarify the nature of the USPSTF’s recommendation.
