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Comment & Response
July 18, 2017

Screening Pelvic Examinations

Author Affiliations
  • 1American College of Physicians, Philadelphia, Pennsylvania
  • 2Oregon Health and Science University, Portland
  • 3Penn Health System, Philadelphia, Pennsylvania
JAMA. 2017;318(3):300. doi:10.1001/jama.2017.7825

To the Editor Every guidelines committee struggles with uncertainty when there is limited evidence. However, we believe that the US Preventive Services Task Force (USPSTF) missed the mark by issuing an “I” statement (insufficient evidence) rather than a “D” recommendation against the screening pelvic examination.1 We believe that existing evidence provides at least moderate certainty that any benefits are uncertain to small and that known harms are at least small to moderate.2 Thus, there is no net benefit, and screening pelvic examinations should be discouraged in healthy asymptomatic women.2 Furthermore, an I statement is not an actionable clinical recommendation for a clinician. After sifting through literature, clinical guidelines panels need to advise for or against an intervention, with appropriate grading to identify certainty.