Summary of Choosing Wisely Women’s Health Care "Don’t's"*
Hormonal Contraceptives |
- Don’t require a pelvic exam or other physical exam before prescribing.
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Irregular or Abnormal Menstrual Bleeding |
- Don’t obtain FSH levels in women in their 40s to identify menopause transition as a cause of irregular or abnormal menstrual bleeding.
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Cervical Cancer Screening and Abnormal Cytology Management.** |
- Don’t screen women younger than 21 years.
- Don’t screen women who have had a hysterectomy for non-cancer disease.
- Don’t screen women younger than 30 years with HPV testing, either alone or in combination with cytology.
- Don’t perform annual screening for average-risk women between the ages 30-65.
- Don’t screen women older than 65 years who have had adequate prior screening and are not at high-risk.
- Don’t perform Pap tests for surveillance of women with a history of endometrial cancer.
- Don’t treat women with mild dysplasia of less than 2 years’ duration.
**These recommendations do not apply to women who have received a diagnosis of a high-grade precancerous cervical lesion or cervical cancer, women with in utero exposure to diethylstilbestrol, or women who are immunocompromised (such as those who are HIV positive).
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Ovarian Cancer Screening |
- Don’t screen for ovarian cancer in asymptomatic women at low/average risk.
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Breast Cancer Screening |
- Don’t routinely use breast MRI for breast cancer screening in average risk women.
- Don’t perform screening mammography in asymptomatic patients with normal exams who have less than 5-year life expectancy.
- Don’t perform surveillance testing (biomarkers) or imaging (PET, CT, and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
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General Cancer Screening |
- Don’t recommend cancer screening in adults with life expectancy of less than 10 years.
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Osteoporosis Screening |
- Don’t use dual-energy x-ray absorptiometry (DEXA) screening for osteoporosis in women younger than 65 with no risk factors.
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Management of Benign Breast Disease |
- Don’t routinely surgically excise biopsy proven fibroadenomas that are smaller than 2 centimeters in size.
- Don’t routinely drain non-painful fluid-filled breast cysts.
- Don’t routinely operate for a breast abscess without an initial attempt to percutaneously aspirate or drain it.
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*Choosing Wisely Clinician Lists www.choosingwisely.org/clinician-lists
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