By Genevra Pittman
NEW YORK (Reuters Health) - Women should have a well-woman appointment with their doctor every year, typically including pelvic and breast exams as well as any recommended screening, according to a group of U.S. ob-gyns.
The American College of Obstetricians and Gynecologists (ACOG) calls for annual pelvic exams starting at age 21. But it says that because there isn't a lot of hard evidence for examinations in symptom-free women, women can discuss with their doctors whether or not they want one.
The group also recommends annual clinical breast exams in women age 40 and older and exams every one to three years for those in their 20s and 30s, according to a new report, published in the journal Obstetrics & Gynecology.
An annual well-woman visit also provides doctors the opportunity to advise women on maintaining a healthy lifestyle as well as take their vital signs and check their weight.
"The need for an annual exam, I think the most important thing about that is the need for counseling," said Dr. Rebekah Gee, who has studied women's preventive services at the Louisiana State University Health Sciences Center in New Orleans but wasn't involved in the committee opinion.
Discussing obesity, smoking, physical activity and sexual behavior, she said, is "as, if not more, important in my opinion than the Pap (smear)" used to screen for cervical cancer.
ACOG's recommendations aren't all in line with what other doctors or organizations believe the evidence supports.
In a recent study from the Centers for Disease Control and Prevention, researchers pointed out that pelvic exams can come with harms - such as false positives that lead to unnecessary but invasive biopsies and other procedures (see Reuters Health story of December 14, 2011).
That report also found many doctors did pelvic exams when they weren't called for, such as to check for ovarian cancer or before prescribing birth control pills.
A pelvic exam involves the doctor looking at the vagina and cervix and doing a manual exam with one hand inside the vagina and one outside to feel the uterus and ovaries.
"I think one of the big unknowns really in gynecology is the value of the pelvic examination in women who have no symptoms," said Dr. George Sawaya, an ob-gyn and reproductive sciences professor from the University of California, San Francisco.
"I still think it's unclear exactly what we're supposed to be using that examination for."
Sawaya, who had no ties to the ACOG report, said it was difficult to understand its lack of explanation for why pelvic exams should be done in most women and what doctors should plan to get out of them.
"Certainly in women with symptoms, a pelvic examination is indicated," he told Reuters Health. "I have not found any compelling reason to do it in asymptomatic women, but it has been a part of standard practice."
CLINICAL BREAST EXAMS USEFUL?
Screening for cervical cancer should begin at age 21, according to ACOG.
That's in line with guidelines from the U.S. Preventive Services Task Force, which call for Pap smears to start then and be repeated every three years - or every five years together with HPV tests once a woman hits 30.
When it comes to clinical breast exams, the USPSTF, a government-backed panel, says there is "insufficient evidence" to determine whether the checks are helpful over and above the benefits of mammography.
Gee said she has found masses that weren't picked up on mammograms during the exams.
"There is insufficient evidence from the standpoint of systematic reviews, however some of these things make sense in an individual patient" if she has risk factors, Gee told Reuters Health.
As with pelvic exams, Gee said, whether or not breast exams are done should be based on both the patient and the doctor's preferences.
Sawaya pointed to a specific strength of ACOG's report: its recommendation to women, themselves, when it comes to keeping track of their breast health.
"ACOG does make an important point in this document that women should certainly be aware of any changes in their breasts and bring that to the attention of their provider," he said.
SOURCE: http://bit.ly/Oa9IMi Obstetrics & Gynecology, online July 23, 2012.