RESUMEN
BACKGROUND: Many women see their general practitioner for 'well woman' checks, which often include Pap tests and a pelvic examination. A recent review of the evidence revealed pelvic examination in asymptomatic women is not a valid screening test, particularly with regard to ovarian cancer screening. METHOD: This project explored the attitudes of GPs regarding the performance of pelvic examinations in asymptomatic women. Twenty-seven GPs were interviewed about their current practice and opinions of the value, advantages and disadvantages of pelvic examinations in asymptomatic women. The interview data was analysed qualitatively. DISCUSSION: The majority of the GPs interviewed perform pelvic examinations as part of a well woman check. Despite broad consensus by the GPs that the value of a pelvic examination as a screening test was questionable, they were performed for a range of reasons including patient reassurance, documenting the norm, 'because I was taught to', for legal reasons, and for completeness. The disadvantages of performing pelvic examinations in asymptomatic women noted by the GPs were time constraints, chaperone issues, intimacy concerns, and false reassurance and unnecessary anxiety caused by unexpected findings. However, neither these disadvantages nor the presentation of evidence based guidelines dissuaded the doctors from performing the examinations. This highlights the ongoing discrepancy between the theoretical development of such recommendations and their practical implementation.
Asunto(s)
Actitud del Personal de Salud , Palpación , Pelvis , Médicos de Familia/psicología , Práctica Profesional , Femenino , Humanos , Masculino , Palpación/psicología , Examen Físico , Guías de Práctica Clínica como Asunto , Encuestas y CuestionariosRESUMEN
BACKGROUND: Clinical breast examination (CBE) is often offered as a component of the well woman check or carried out at the request of an asymptomatic woman. In these cases the examination is a screening procedure, as opposed to a diagnostic CBE in a symptomatic woman. OBJECTIVE: This article examines the evidence for screening CBE. DISCUSSION: Screening CBE should involve informed consent. A negative examination does not exclude the presence of breast cancer and women should be aware of this. There have been no randomised controlled trials of CBE alone, only trials comparing CBE with mammography for the detection of breast cancer. While there is a low sensitivity (54%) for CBE, the specificity is high (94%). It is unlikely that these figures are discussed with patients. There are different methods of CBE, and these are described in the literature without a firm evidence base as to effectiveness. However, evidence does suggest that practice on models and retraining help improve clinicians' skills.
Asunto(s)
Neoplasias de la Mama/diagnóstico , Examen Físico , Medicina Familiar y Comunitaria , Femenino , Humanos , Tamizaje Masivo , Examen Físico/métodosRESUMEN
BACKGROUND: A routine pelvic examination is often performed as part of a 'well woman' check, in combination with a Pap test, sexually transmitted infection screening, or before commencing the contraceptive pill or hormone therapy. This check is also done at the woman's request, on the understanding that it may screen for ovarian cancer and other pathology. OBJECTIVE: This article reviews the evidence regarding the use of routine pelvic examination in asymptomatic women as a screening test, and if the examination is performed, what information should be imparted to the patient to obtain informed consent. DISCUSSION: Review of the literature indicates that the use of routine pelvic examination as screening for ovarian malignancy (with or without serum CA-125 and ultrasound) cannot be justified due to the low prevalence of the disease and low sensitivity and specificity of the examination. Pelvic examinations may be performed at the time of routine Pap tests to aid in technical issues with the Pap test itself, but are not recommended for screening purposes. There is no evidence to support pelvic examination of asymptomatic women taking hormone therapy or attending for a sexual health check. The performance of pelvic examination at the woman's request must be preceded by thorough gynaecological, medical and family history and after obtaining informed consent from the patient.