Pelvic examinations and cervical cancer screenings are no longer recommended for most females under age 21 during routine health visits, but a new study has found that millions of young women are undergoing the tests, which can lead to false-positive testing, overtreatment, anxiety, and needless cost. These findings were published by Qin et al in JAMA Internal Medicine.

Researchers at the University of California, San Francisco (UCSF) and the Centers for Disease Control and Prevention estimated that 1.4 million pelvic examinations and 1.6 million Papanicolaou (Pap) tests performed on females 15 to 20 years old in the United States in a single year may have been medically unnecessary. The estimated cost of these exams was approximately $123 million a year.

“Recent media reports have called attention to inappropriate gynecologic examinations in young women,” said senior author George F. Sawaya, MD, Professor of Obstetrics, Gynecology, and Reproductive Sciences at UCSF and Director of the UCSF Center for Healthcare Value. “Parents of adolescents and young women should be aware that cervical cancer screening is not recommended routinely in this age group. Pelvic exams are not necessary prior to getting most contraceptives and are often not needed to screen for sexually transmissible infections.”

Cervical cancer screening is not recommended for individuals under age 21, according to the U.S. Preventive Services Task Force, the American College of Obstetricians and Gynecologists, and the American Cancer Society. Additionally, leading professional organizations recommend against performing pelvic examinations in asymptomatic women who are not pregnant.

Study Design

The new analysis was intended to estimate how often pelvic examinations and Pap tests occurred among young women in the United States, as well as the proportion that were potentially unnecessary. The population-based study used data from 2011 to 2017.

Researchers classified the pelvic examination into two types: medically indicated or potentially unnecessary. Pelvic examinations were considered medically indicated if performed during pregnancy or in association with use of an intrauterine device, or in the context of treatment for a sexually transmitted disease.

Findings

The investigators estimated that of approximately 2.6 million young women who received a pelvic exam during the previous year, more than half (54.4%) were potentially unnecessary, representing an estimated 1.4 million young women.

Additionally, the researchers found that nearly a fifth of females younger than the recommended age had a Pap test within the past year. Because 72% were performed as “part of a routine exam,” they were potentially unnecessary, representing an estimated 1.6 million young women. Almost all of the pelvic examinations were performed at the same time as the Pap test.

Young women who had been screened for a sexually transmitted infection were 3.8 times more likely to receive a Pap test and 60% more likely to receive a pelvic examination compared with those who had not been screened. Similarly, young women who used a hormonal contraception other than an intrauterine device were 75% more likely to receive a Pap test and 31% more likely to receive a pelvic examination compared with those who did not use those contraception methods.

“This study suggests that health-care providers and young women need to communicate clearly and often about the best time for these tests,” said first author Jin Qin, ScD, an epidemiologist with the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention. “We want to ensure that guidelines are followed and lives are saved.”

Disclosure: For full disclosures of the study authors, visit jamanetwork.com.