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PAP TEST UNNECESSARY AFTER HYSTERECTOMY FOR BENIGN DISEASE.

Vaginal cancer is the least common of pelvic cancers, accounting for only 1 to 4 percent of primary malignant gynecologic tumors. This large, retrospective study examined the usefulness of Papanicolaou tests in women who underwent hysterectomies previously for benign reasons.

Over the three-year study period, 6265 women with hysterectomies had 10,595 vaginal smears at a New Orleans hospital; 91 percent were estimated to be from women who had the surgery for benign reasons. Of those 9610 vaginal smears, 104 (1.1 percent) had abnormal findings, including atypical squamous cells of undetermined significance, low-grade or high-grade squamous intraepithelial lesions, and squamous-cell cancer. Only 5 women had colposcopically verified biopsies showing vaginal intraepithelial neoplasia type I or II, and none had biopsy-proven vaginal cancers.

Comment: As stated in an accompanying editorial, this study adds powerful evidence that Pap testing is not essential for women who have undergone a hysterectomy for benign disease. Testing these women for the rarest pelvic cancer leads to anxiety, discomfort, and increased costs with very little benefit.

— DM Harper

Published in Journal Watch General Medicine December 6, 1996

Citation(s):

Pearce KF et al. Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996 Nov 21 335 1559-1562.

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Noller KL. Screening for vaginal cancer. N Engl J Med 1996 Nov 21 335 1599-1600.

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