Last week, Choosing Wisely, an initiative of the ABIM Foundation that promotes evidenced-based medicine, released a list of 45 overused tests and treatments as determined by nine major medical societies. No ob/gyn associations were included in the list, but two recommendations are applicable to gynecologists:
From the American Academy of Family Physicians and consistent with ACOG’s guidelines:
Don’t perform Pap smears on women younger than 21 or who have had a hysterectomy for non-cancer disease.
Most observed abnormalities in adolescents regress spontaneously, therefore Pap smears for this age group can lead to unnecessary anxiety, additional testing and cost. Pap smears are not helpful in women after hysterectomy (for non-cancer disease) and there is little evidence for improved outcomes.
From the American College of Radiology:
Don’t recommend follow-up imaging for clinically inconsequential adnexal cysts.
Simple cysts and hemorrhagic cysts in women of reproductive age are almost always physiologic. Small simple cysts in postmenopausal women are common, and clinically inconsequential. Ovarian cancer, while typically cystic, does not arise from these benign-appearing cysts. After a good quality ultrasound in women of reproductive age, don’t recommend follow-up for a classic corpus luteum or simple cyst <5 cm in greatest diameter. Use 1 cm as a threshold for simple cysts in postmenopausal women.
Do you agree, and do you adhere to these recommendations in your practice? Are there other ob/gyn tests that should be on this list?