Q&A

Many unnecessary Pap smears are performed after hysterectomy

Author and Disclosure Information

  • CLINICAL QUESTION: How often are women undergoing Pap smear screening even though they are not at risk of cervical cancer?
  • STUDY DESIGN: Cross-sectional
  • SETTING: Population-based
  • SYNOPSIS: Since 1996, the United States Preventive Services Task Force has suggested that routine Pap tests are unnecessary for women who have undergone hysterectomy with removal of the cervix for benign disease, placing them no longer at risk of cervical cancer. Many clinicians still perform Pap tests on these women, purportedly to screen for vaginal cancer. Since the risk of vaginal cancer is so low, however, women currently screened for cervical cancer with an intact cervix are not routinely screened for vaginal cancer.


 

BOTTOM LINE

Many American women who have had a hysterectomy with removal of the cervix for benign disease continue to undergo routine Papanicolaou (Pap) testing despite a lack of supporting evidence and a clear recommendation from the United States Preventive Services Task Force against it.

Conversely, the vast majority of American women who die from cervical cancer were either underscreened or never screened for cervical disease, most likely as a result of real or perceived cost barriers. The money saved by not inappropriately performing Pap tests on low-risk women would pay for the cost of screening the 17 million women in the United States who are currently underscreened for cervical cancer (J Womens Health Gender Based Med 2002; 11:103–109). (Level of evidence [LOE]=2b)

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