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As screening recommendations change, should we re-name the annual exam?

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77449 full

Recently, we told you about the American College of Physicians' new recommendation against pelvic exams for healthy women who are not pregnant and show no symptoms of disease. The advice follows other recommendations in recent years that altered the traditional well-woman exam landscape.

Other exams

In 2009, the U.S. Preventive Services Task Force recommended that women should start regular breast cancer screening at 50, instead of the traditional 40. It also said women should undergo the screening every two years, instead of every year. The CDC says women ages 40 to 49 should talk to their doctors about when to start getting mammograms.

In 2012, the task force recommended that women between 21 and 65 should undergo cervical cancer screening, or a Pap smear, every three years. It recommended that women between 30 and 65 who don't want to have the screening that often could receive a Pap smear and HPV test every five years. Other groups – including the American College of Obstetricians and Gynecologists and the American Cancer Society – also recommend against annual screening.

Annual 'visits’

If women don’t need pelvic exams, Pap smears and mammograms yearly, then do we still need the so-called annual exam?

"The message we don't want to send is that if you don't need a pelvic exam, you don't need to come in,” said Dr. Jennifer Israel, an assistant professor of obstetrics and gynecology at USC’s Keck School of Medicine.

She added: "We just want to make it very clear that if we're going to perform a pelvic exam, we should look for something very specific, and it should be done with the least harm or embarrassment to the patient."

Overall, Israel said, the annual exam is not a relic of the past; it's just a misnomer at this point. "If we were to change the annual 'exam' to annual 'visit,' there may be less confusion," she said.

It's "absolutely reasonable" to allow healthy women under 30 to visit the gynecologist every two to three years for breast exams and pelvic exams, said Israel.

However, she emphasized that annual visits are more than just a pelvic exam and Pap smear. For example, it's recommended that sexually active women get screened for sexually transmitted infections once a year, said Israel. At these visits, women can also be measured for height, weight and blood pressure, which can reveal hypertension, diabetes and heart disease, she added.

These visits are also opportunities for women to maintain a good patient-physician relationship, said Israel.

Have the new recommendations changed your opinion of the annual exam? Tell us about it in the comments section below, or e-mail us, Impatient@scpr.org.

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