Society of Gynecologic Oncology

Five Things Physicians and Patients Should Question

Released October 31, 2013; Revised July 27, 2021; Revised July 20, 2022

  1. 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. 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. 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. 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. 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.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

The Society of Gynecologic Oncology (SGO) is a 501(c) 6 national medical specialty organization of physicians and allied health care professionals who are trained in the comprehensive management of women with malignancies of the reproductive tract. The Society’s membership, totaling more than 1,600, is primarily comprised of gynecologic oncologists, as well as other related medical specialists including medical oncologists, radiation oncologists, nurses, social workers and pathologists. SGO members provide multidisciplinary cancer treatment including chemotherapy, radiation therapy, surgery and supportive care.

For more information, please visit

The Foundation for Gynecologic Oncology is a 501(c) 3 organization that ensures that SGO meets the needs and provides the resources for members and the women’s cancer care community.

For more information, please visit

How This List Was Created

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.

SGO’s disclosure and conflict of interest policy can be found at


  1. Barton MB, Lin K. Screening for ovarian cancer: Evidence update for the U.S. Preventive Services Task Force reaffirmation recommendation statement [Internet]. Rockville (MD); 2012 Apr. Agency for Healthcare Research and Quality; AHRQ Publication No. 12-05165–EF3. Available from:

    Buys SS, Partridge E, Black A, Johnson CC, Lamerato L, Isaacs C, Reding DJ, Greenlee RT, Yokochi LA, Kessel B, Crawford ED, Church TR, Andriole GL, Weissfeld JL, Fouad MN, Chia D, O’Brien B, Ragard LR, Clapp JD, Rathmell JM, Riley TL, Hartge P, Pinsky PF, Zhu CS, Izmirlian G, Kramer BS, Miller AB, Xu JL, Prorok PC, Gohagan JK, Berg CD; PLCO Project Team. Effect of screening on ovarian cancer mortality: the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011 Jun 8;305(22):2295–303.

    American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. The role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Committee Opinion No. 477. Obstet Gynecol. 2011 Mar;117(3):742–6.

  2. Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, Goff BA. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol. 2011;204:466–78.

    Salani R, Nagel CI, Drennen E, Bristow RE. Recurrence patterns and surveillance for patients with early stage endometrial cancer. Gynecol Oncol. 2011;123:205–7.

    Bristow RE, Purinton SC, Santillan A, Diaz-Montes TP, Gardner GJ, Giuntoli RL, 2nd. Cost-effectiveness of routine vaginal cytology for endometrial cancer surveillance. Gynecol Oncol. 2006; 103:709–13.

  3. Rimel BJ, Ferda A, Erwin J, Dewdney SB, Seamon L, Gao F, DeSimone C, Cotney KK, Huh W, Massad LS. Cervicovaginal cytology in the detection of recurrence after cervical cancer treatment. Obstet Gynecol. 2011;118:548–53.

    Tergas A HL, Guntupalli SR, Huh WK, Massad LS, Fader AN, Rimel BJ. A cost analysis of colposcopy following abnormal cytology in posttreatment surveillance for cervical cancer. Gynecol Oncol. 2013.

  4. Sartori E, Pasinetti B, Carrara L, Gambino A, Odicino F, Pecorelli S. Pattern of failure and value of follow up procedures in endometrial and cervical cancer patients. Gynecol Oncol. 2007;107:S241–7.

    Berchuck A, Anspach C, Evans AC, Soper JT, Rodriguez GC, Dodge R, Robboy S, Clarke-Pearson DL. Postsurgical surveillance of patients with FIGO stage I/II endometrial adenocarcinoma.Gynecol Oncol. 1995;59:20–4.

    Bhosale P, Peungjesada S, Wei W, Levenback CF, Schmeler K, Rohren E, Macapinlac HA, Iyer RB. Clinical utility of positron emission tomography/computed tomography in the evaluation of suspected recurrent ovarian cancer in the setting of normal CA125 levels. Int J Gynecol Cancer. 2010;20:936–44.

    Havrilesky LJ, Wong TZ, Alvarez Secord A, Berchuck A, Clarke-Pearson DL, Jones E. The role of PET scanning in the detection of recurrent cervical cancer. Gynecol Oncol. 2003;90:186–90.

    Rimel BJ, Ferda A, Erwin J, Dewdney SB, Seamon L, Gao F, DeSimone C, Cotney KK, Huh W, Massad LS. Cervicovaginal cytology in the detection of recurrence after cervical cancer treatment. Obstet Gynecol. 2011;118:548–53.

  5. Smith TJ, Temin S, Alesi ER, Abernethy AP, Balboni TA, Basch EM, Ferrell BR, Loscalzo M, Meier DE, Paice JA, Peppercorn JM, Somerfield M, Stovall E, Von Roenn JH. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012 Mar 10;30 (8):880–7.

    Rezk Y, Timmins PF, Smith HS. Review article: palliative care in gynecologic oncology. Am J Hosp Palliat Care. 2011 Aug;28(5):356–74.

    Lewin SN, Buttin BM, Powell MA, Gibb RK, Rader JS, Mutch DG, Herzog TJ. Resource utilization for ovarian cancer patients at the end of life: how much is too much? Gynecol Oncol. 2005 Nov;99(2):261–6.

    Delgado-Guay MO, Parson HA, Li Z, Palmer LJ, Bruera E. Symptom distress, intervention and outcomes of intensive care unit cancer patients referred to a palliative care consult team. Cancer. 2009;115:37–445.

    Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–42.

    Elsayem A, Swint K, Fisch MJ, Palmer JL, Reddy S, Walker P, Zhukovsky D, Knight P, Bruera E. Palliative care inpatient services in a comprehensive cancer center: clinical and financial outcomes. J Clin Oncol. 2004 May 14;22(10):2008–14.

    Fauci J, Schneider K, Walters C, Boone J, Whitworth J, Killian E, Straughn JM Jr. The utilization of palliative care in gynecologic oncology patients near the end of life. Gynecol Oncol. 2012;127:175–9.

    Albanese TH, Radwany SM, Mason H, Gayomali C, Dieter K. Assessing the financial impact of an inpatient acute palliative care unit in a tertiary care teaching hospital. J Palliat Med. 2013;16:289–94.

    Quill TE, Anernethy AP. Generalist plus specialist palliative care-creating a more sustainable model. N Engl J Med. 2013;368:1173–75.