In the Journals

Most Pap tests, pelvic exams potentially unnecessary in young women

Photo of Jin Qin
Jin Qin

Millions of women aged 15 to 20 years old in the United States may have received unnecessary Pap tests or bimanual pelvic exams in recent years, according to a study published in JAMA Internal Medicine.

“Unnecessary Pap tests and pelvic exams can lead to false alarms, unnecessary treatment, and needless cost,” Jin Qin, ScD, an epidemiologist in the epidemiology and applied research branch of the division of cancer prevention and control at the the CDC, told Healio Primary Care.

Many young women also associate BPE with fear, embarrassment, discomfort and pain, which could cause some women to forgo contraception or STI screening, Qin continued.

Researchers explained that women with a history of sexual violence could be more vulnerable to these harms, including adolescents and young women — one study found that one in 16 women had a forced first sexual encounter.

Currently, medical organizations in the United States recommend beginning cervical cancer screening with Pap tests at 21 years, and do not recommend the use of BPE unless a patient’s medical history or symptoms indicate that one is needed. Additionally, current guidelines state that a BPE is not required before prescribing contraception methods — other than an intrauterine device (IUD) — or during STI screening.

Qin J, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2019.5727.

Qin and colleagues conducted a cross-sectional analysis of the National Survey of Family Growth from 2011 to 2017, which surveyed a nationally representative sample of people aged 15 to 44 years on family life, general and reproductive health, contraception, pregnancy and infertility.

Within the study, a BPE was considered potentially unnecessary unless it was medically indicated by pregnancy, IUD use, medical problem or treatment for an STI in the past year.

As cervical cancer screening is not recommended in women aged below 21 years unless they have HIV and are sexually active, researchers evaluated unnecessary Pap tests based on the estimated prevalence of tests given during a routine examination.

A total of 3,410 respondents aged 15 to 20 years were included in the study. Researchers used 6-year sampling weights that represented the female population of the United States in 2014 to develop statistically valid results.

Pap testing in the past year was reported by 19.2% (95% CI, 17.2-21.4) of respondents, or an estimated 2.2 million women. Of those, 71.9% (95% CI, 66-77.1) were considered unnecessary, representing approximately 1.6 million women.

Past year BPE was reported by 22.9% (95% CI, 20.7-25.3) of respondents, or approximately 2.6 million women nationwide. Of those, 54.4% (95% CI, 48.8-59.9) were determined to be potentially unnecessary, representing 1.4 million women.

Women who had a Pap test (adjusted prevalence ratio [aPR] = 7.12; 95% CI, 5.56-9.12), were tested for STIs (aPR = 1.60; 95% CI, 1.34-1.90) or used of hormonal contraception other than an IUD (aPR = 1.31; 95% CI, 1.11-1.54) were more likely to receive a BPE than those who did not.

Researchers found that 42.4% (95% CI, 38.1-46.9) of participants who used a hormonal contraception other than in IUD underwent a BPE in the past year, suggesting that there may be a delay in implementing guidelines that state a BPE is not needed to prescribe these contraceptives.

We hope this study could help or encourage efforts to raise awareness of professional guidelines, as well as the limitations and possible harms of routine pelvic examinations and Pap tests,” Qin said. “We want to ensure that these tests and examinations are performed only when medically necessary among young women.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.

Editor's Note: This story was updated to reflect the appropriate population for cervical cancer screening.

Photo of Jin Qin
Jin Qin

Millions of women aged 15 to 20 years old in the United States may have received unnecessary Pap tests or bimanual pelvic exams in recent years, according to a study published in JAMA Internal Medicine.

“Unnecessary Pap tests and pelvic exams can lead to false alarms, unnecessary treatment, and needless cost,” Jin Qin, ScD, an epidemiologist in the epidemiology and applied research branch of the division of cancer prevention and control at the the CDC, told Healio Primary Care.

Many young women also associate BPE with fear, embarrassment, discomfort and pain, which could cause some women to forgo contraception or STI screening, Qin continued.

Researchers explained that women with a history of sexual violence could be more vulnerable to these harms, including adolescents and young women — one study found that one in 16 women had a forced first sexual encounter.

Currently, medical organizations in the United States recommend beginning cervical cancer screening with Pap tests at 21 years, and do not recommend the use of BPE unless a patient’s medical history or symptoms indicate that one is needed. Additionally, current guidelines state that a BPE is not required before prescribing contraception methods — other than an intrauterine device (IUD) — or during STI screening.

Qin J, et al. JAMA Intern Med. 2019;doi:10.1001/jamainternmed.2019.5727.

Qin and colleagues conducted a cross-sectional analysis of the National Survey of Family Growth from 2011 to 2017, which surveyed a nationally representative sample of people aged 15 to 44 years on family life, general and reproductive health, contraception, pregnancy and infertility.

Within the study, a BPE was considered potentially unnecessary unless it was medically indicated by pregnancy, IUD use, medical problem or treatment for an STI in the past year.

As cervical cancer screening is not recommended in women aged below 21 years unless they have HIV and are sexually active, researchers evaluated unnecessary Pap tests based on the estimated prevalence of tests given during a routine examination.

A total of 3,410 respondents aged 15 to 20 years were included in the study. Researchers used 6-year sampling weights that represented the female population of the United States in 2014 to develop statistically valid results.

Pap testing in the past year was reported by 19.2% (95% CI, 17.2-21.4) of respondents, or an estimated 2.2 million women. Of those, 71.9% (95% CI, 66-77.1) were considered unnecessary, representing approximately 1.6 million women.

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Past year BPE was reported by 22.9% (95% CI, 20.7-25.3) of respondents, or approximately 2.6 million women nationwide. Of those, 54.4% (95% CI, 48.8-59.9) were determined to be potentially unnecessary, representing 1.4 million women.

Women who had a Pap test (adjusted prevalence ratio [aPR] = 7.12; 95% CI, 5.56-9.12), were tested for STIs (aPR = 1.60; 95% CI, 1.34-1.90) or used of hormonal contraception other than an IUD (aPR = 1.31; 95% CI, 1.11-1.54) were more likely to receive a BPE than those who did not.

Researchers found that 42.4% (95% CI, 38.1-46.9) of participants who used a hormonal contraception other than in IUD underwent a BPE in the past year, suggesting that there may be a delay in implementing guidelines that state a BPE is not needed to prescribe these contraceptives.

We hope this study could help or encourage efforts to raise awareness of professional guidelines, as well as the limitations and possible harms of routine pelvic examinations and Pap tests,” Qin said. “We want to ensure that these tests and examinations are performed only when medically necessary among young women.” – by Erin Michael

Disclosures: The authors report no relevant financial disclosures.

Editor's Note: This story was updated to reflect the appropriate population for cervical cancer screening.