EXECUTIVE SUMMARY

Since 2009, guidelines from the American College of Obstetricians and Gynecologists have recommended not performing Pap tests in women younger than age 21 years, and not performing routine pelvic exams in those without symptoms.

While pelvic examinations and cervical cancer screenings are no longer recommended for most young women under age 21 years during routine health visits, results from a new national study indicate that millions of women are undergoing these tests unnecessarily.

The analysis indicated that of the approximately 2.6 million young women who received a pelvic exam during the previous year, 54.4% were potentially unnecessary, affecting an estimated 1.4 million young women.


While pelvic examinations and cervical cancer screenings are no longer recommended for most women younger than age 21 years during routine health visits, results from a new national study indicate that millions of women are unnecessarily undergoing these tests.1

Since 2009, guidelines by the American College of Obstetricians and Gynecologists (ACOG) have recommended not performing Pap tests in women under age 21, and not performing routine pelvic exams in those without symptoms, says senior author George Sawaya, MD, professor of obstetrics, gynecology, and reproductive sciences at University Of California, San Francisco (UCSF) and director of the UCSF Center for Healthcare Value. The research team wanted to study how practice patterns have changed since these guidelines have been in place, Sawaya states.

Investigators used a cross-sectional analysis of data from September 2011 through September 2017 from the National Survey of Family Growth, focusing on a population-based sample of 3,410 young women ages 15 to 20 years. Survey weights were used to estimate prevalence and the number of people represented in the U.S. population.

Pelvic exams were classified by researchers into two types: medically indicated or potentially unnecessary. If performed during pregnancy or in association with use of an intrauterine device, or in the context of treatment for a sexually transmitted infection (STI), examinations were considered medically indicated.

Check Current Recommendations

Analysis results indicated that of the approximately 2.6 million young women who received a pelvic exam during the previous year, 54.4% were potentially unnecessary, affecting an estimated 1.4 million young women.1 One-fifth of females younger than the recommended age underwent a Pap test within the past year. Because almost three-quarters of Pap tests were performed as “part of a routine exam,” they were potentially unnecessary, researchers said.

Researchers reported that young women who had been screened for an STI were 3.8 times more likely to receive a Pap test, and 60% more likely to receive a pelvic examination, compared with those who had not been screened.1

In 2018, the U.S. Preventive Services Task Force issued final recommendations for cervical cancer screening, including:

• Women ages 21 to 29 years should be tested every three years with cervical cytology;

• Women ages 30 to 65 years should undergo a Pap test every three years, a high-risk human papillomavirus test alone, or both tests, every five years;

• No screening in women younger than age 21, in women older than age 65 who have received prior screening and are not at high risk for the disease, and in women who have undergone a hysterectomy with removal of the cervix and do not have a history of precancerous lesions or cervical cancer.2

The American College of Physicians and the American Academy of Family Physicians do not recommend performing screening pelvic examinations in asymptomatic women.3,4 While ACOG recommends annual pelvic exams for women age 21 years and older, it also states that the decision should be case by case.5 Adolescent health experts discourage providers from requiring screening in asymptomatic adolescents, as this requirement creates unnecessary barriers.6,7

The study suggests that healthcare providers and patients should communicate clearly and often about the best time for these tests, lead author Jin Qin, ScD, an epidemiologist with the Division of Cancer Prevention and Control at the CDC, said in a statement.8 

REFERENCES

  1. Qin J, Saraiya M, Martinez G, Sawaya GF. Prevalence of potentially unnecessary bimanual pelvic examinations and Papanicolaou tests among adolescent girls and young women aged 15-20 years in the United States. JAMA Intern Med 2020; doi: 10.1001/jamainternmed.2019.5727. [Epub ahead of print].
  2. U.S. Preventive Services Task Force, Curry SJ, Krist AH, et al. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement. JAMA 2018;320:674-686.
  3. Qaseem A, Humphrey LL, Harris R, et al; Clinical Guidelines Committee of the American College of Physicians. Screening pelvic examination in adult women: A clinical practice guideline from the American College of Physicians. Ann Intern Med 2014;161:67-72.
  4. American Academy of Family Physicians. Clinical practice guideline: Screening pelvic examination in adult women. Available at: https://bit.ly/30JwB29.
  5. The utility of and indications for routine pelvic examination. ACOG Committee Opinion No. 754. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;132:e174-180.
  6. Tepper NK, Curtis KM, Steenland MW, Marchbanks PA. Physical examination prior to initiating hormonal contraception: A systematic review. Contraception 2013;87:650-654.
  7. Henderson JT, Sawaya GF, Blum M, et al. Pelvic examinations and access to oral hormonal contraception. Obstet Gynecol 2010;116:1257-1264.
  8. University Of California, San Francisco Helen Diller Family Comprehensive Cancer Center. Young women still may be getting unnecessary pelvic exams. Jan. 6, 2020. Available at: https://bit.ly/36NuAEm.