At that time, it was not unusual for me to screen for cervical cancer in a sexually active teenager, and to advise most women to return for a Pap smear and clinical breast exam every year. I remember our clinic's medical director admonishing the residents not to skip routine breast and pelvic exams in women without symptoms.
However, I am concerned that this positive movement - de-intensifying or eliminating components of the well-woman exam that don't benefit women - appears to have stalled:
Recent federal regulations and recommendations now threaten to replace discontinued components of the well-woman exam with other well-intentioned services that unfortunately have little basis in evidence.
I discussed three examples in my commentary:
Screening for anxiety in all adolescent and adult women, "which has a similar dearth of supporting evidence on benefits and harms."
Each of these recommendations is intended to address a known problem: mammograms are less likely to identify breast tumors in women with higher breast density; urinary incontinence is common, frequently bothersome, and underreported; and anxiety reduces quality of life in many women (and men, for that matter). But a high prevalence of unidentified disease and the availability of effective treatments aren't enough to warrant screening on their own. Women deserve better than preventive care based on good intentions, which in the past led to mistakes such as prescribing menopausal hormone therapy for millions of women who either did not benefit or experienced harm. Instead, they deserve evidence-based, data-driven care.