ACOG Issues Guidelines on Annual Well-Woman Visits, Testing Pregnant Women for Lead

July 24, 2012 — Although yearly Pap tests are no longer recommended, women should continue to receive annual wellness exams, according to new guidelines released Monday by the American College of Obstetricians and Gynecologists, USA Today reports.

The new guidelines stress the importance of annual "well-woman" visits and continue to recommend annual pelvic exams for women over age 21. However, because "no evidence supports or refutes" the value of internal pelvic exams for detecting signs of cancer or other problems in women without symptoms, the final decision should remain with women and their doctors, the group advised (Painter, USA Today, 7/23).

The new guidelines come shortly after the U.S. Preventive Services Task Force recommended Pap tests for women ages 21 through 65 every three years to screen for cervical cancer. USPSTF also said that a Pap test combined with an HPV test every five years is a safe option for women ages 30 through 65 (Women's Health Policy Report, 3/15).

According to ACOG, a Pap test is just one part of a comprehensive preventive visit. Wellness exams also can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams, and build relationships between physicians and patients, the group says.

Some experts question the cost-effectiveness of annual preventive visits, according to Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. He cited a 2007 study that found 17% of U.S. women -- about 19 million -- had yearly preventive visits with a gynecologist at an average cost of $136. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," he said, adding, "The question is whether we could spend those $8 billion more wisely" (USA Today, 7/23).

ACOG Recommends Against Routine Lead Testing for Pregnant Women

Also on Monday, ACOG issued guidelines advising against routine lead testing for pregnant women, though the group says physicians should ask women a series of questions to determine exposure risk, Reuters reports.

The guidelines list lead exposure risk factors, including remodeling a home with lead paint or using contaminated cosmetics or alternative drugs. If a woman is considered at high risk, the physician should perform a lead screening test and consider treatment options if blood lead levels are elevated (Joelving, Reuters, 7/23).