Average-risk, asymptomatic women do not benefit from pelvic exams as part of routine care and face potential harms from false-positive results, according to a new clinical guideline.
When screening for cervical cancer, clinicians should limit the physical examination to visual inspection of the cervix and use of cervical swabs for cancer or human papillomavirus, said a panel of clinical specialists convened by the American College of Physicians (ACP).
A review of more than 60 years’ worth of medical literature did not produce compelling evidence that the benefits of routine pelvic exams outweigh the potential harms, the panel concluded in a statement published online in Annals of Internal Medicine. Instead, the authors of the guideline found that screening pelvic exams have a low diagnostic accuracy for both cancer and infections.
“Our guidelines really have to do with women who do not have symptoms, who do not have a discharge or bleeding or pain,” guideline panelist Russell Harris, MD, of the University of North Carolina in Chapel Hill, told MedPage Today. “Those women clearly need a pelvic examination, and that’s fine.”
“Our guidelines talk about screening of asymptomatic women who are not pregnant. Those women simply don’t need the exam. It’s not something that is useful for them.”
There was a great deal of news coverage of the Annals publication. But the commentary by one “journalist” caught my attention.
ABC News needs to think about what they’ve done by putting an Ob-Gyn front and center as the “reporter” on this study, and without an independent perspective as part of the story.
It is perhaps unavoidable that there would be controversy and debate over such recommendations, but does that mean your network’s only voice in the debate is one that is firmly entrenched on one side of the debate?
Would the network allow a drug rep to double as a journalist and then give opinions about the benefits of certain drugs that he/she promotes?
Would the network allow a politician to double as a journalist and then give opinions about legislation that he/she introduced?
There is an inherent conflict of interest here, and it comes out in some of what Dr. Ashton said on the air:
So internists are chopped liver? They’re not capable of evaluating evidence?
On ABC World News Tonight, the anchorman asked her, “What are you telling your patients tonight?” Did they ask the political reporter, “Which candidate are you supporting?” What makes her opinion – and what she tells her patients – more important than what any other source would say on this topic? ABC: This is a problem.
On Twitter, Dr. Ashton seemed to scoff at the description of tests causing anxiety as a potential harm. She wrote:
“I agree with the ‘first do no harm’ premise of medicine. I have a problem with the paternalistic view that tests cause “anxiety” in women….”
Paternalistic? It could be argued that it’s paternalistic to scoff at anxiety as a harm.
The Annals paper authors cited data from their research:
“…limited evidence suggests that screening pelvic examinations may be associated with pain, discomfort, fear, anxiety, or embarrassment in about one third of women and can lead to unnecessary, invasive, and potentially harmful diagnostic procedures.”
Those numbers would suggest it’s an issue. I’ve talked with women who’ve had a false positive and who describe the anxiety they experienced as a very real harm.
ABC’s website picked up an AP story that included an independent perspective that Ashton’s reporting did not:
Dr. Ranit Mishori, a family physician and associate professor at Georgetown University School of Medicine, said the new guideline “gets rid of an unnecessary practice” that takes up valuable time that could be put to better use.
“Many women will be happy to hear that, and I think also, frankly, many physicians will be happy to hear it. Many of us have stopped doing them for a long time,” said Mishori, who wasn’t involved with the recommendations. …
…editorial coauthors Drs. George Sawaya and Vanessa Jacoby of the University of California, San Francisco, said that whether the new guideline changes doctors’ practice or not, it could lead to better evaluation of what “has become more of a ritual than an evidence-based practice.”
“Clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow,” they wrote.
I’ve written many times about concerns about MD-journalists. But the inherent conflicts came out quite clearly in this latest example. And it’s another example of the screening test bias that exists in much of health care journalism.
Addendum: When a mammography debate was stirring 3 years ago, Dr. Ashton publicly displayed her advocacy for the Komen Foundation on the air. She was with CBS at the time. The networks who hire physicians to act as journalists should consider providing at least a crash course in journalism ethics.
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