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Choosing Wisely: Five Tips for a Meaningful Conversation Between Patients and Providers

RecommendationsCancer CareCervical CancerEndometrial CancerRecommendationsVulvar Cancer
Dec 5, 2023

The Society of Gynecologic Oncology (SGO) created a “Cost of Care” workgroup in response to the ABIM Foundation’s Choosing Wisely® campaign. Workgroup members are comprised of the Society’s clinical practice committee that is made up of gynecologic oncologists, medical oncologists, nurse practitioners, pharmacists and other allied health providers. A literature review was conducted to identify areas of overutilization or unproven clinical benefit and areas of underutilization in the presence of evidence-based guidelines. The workgroup then evaluated these data and presented a list of five topics to the membership of the clinical practice committee and then to the SGO Board of Directors for approval. The five selected interventions were agreed upon as the most important components for women with gynecologic malignancies and their providers to consider.

View the five tips in a PDF.


1. Don’t screen low risk women with CA-125 or ultrasound for ovarian cancer.

Screening CA-125 and ultrasound in low risk, asymptomatic women have not led to a diagnosis of ovarian cancer in earlier stages of disease or reduced ovarian cancer mortality. False positive results of either test can lead to unnecessary procedures, which have risks of morbidity.

2. Don’t perform Pap tests for surveillance of women with a history of endometrial cancer.

Pap test of the vaginal cuff (top of vagina) in women treated for endometrial cancer does not improve detection of recurrent cancer. False positive Pap tests in this group can lead to anxiety and unnecessary procedures such as colposcopy and biopsy.

3. Don’t perform colposcopy in patients treated for cervical cancer with radiation unless high-grade changes are present

Colposcopy for low-grade abnormalities (e.g. positive high-risk HPV test or Pap showing low-grade squamous intraepithelial lesion) in patients treated with radiation for cervical cancer does not detect recurrence unless there is a visible lesion and is not cost effective.

4. Imaging for cancer surveillance in women with gynecologic cancer, specifically ovarian, endometrial, cervical, vulvar and vaginal cancer should be driven by symptoms/signs.

Avoid routine imaging for patients with a history of ovarian, endometrial, cervical, vulvar and vaginal cancer. Imaging in the absence of symptoms, abnormal physical exam findings and/or rising tumor markers for gynecologic cancers has shown low yield in detecting recurrence or impacting overall survival.

5. Don’t delay the provision of palliative care for women with advanced or relapsed gynecologic cancer, including referral for specialty level palliative medicine.

There is an evidence-based consensus among physicians who care for cancer patients that palliative care improves symptom burden and quality of life. Palliative care empowers patients and physicians to work together to set appropriate goals for care and outcomes. Palliative care can and should be delivered in parallel with cancer directed therapies in  appropriate patients.