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Pap Smear for a Woman Without a Cervix?

Despite a 1996 USPSTF guideline recommendation, about 70% of women who undergo complete hysterectomies still receive Pap smear screening.

In 1996, the U.S. Preventive Services Task Force concluded that cervical cancer screening with Pap smears is not indicated in women who have undergone complete hysterectomies for benign disease. The effect of this recommendation was assessed with data from a population-based, random-digit-dialing telephone survey. Pap smear screening among 188,390 women (age, 18 or older) who reported having undergone hysterectomies (not necessarily complete) was assessed annually from 1992 through 2002.

At least one Pap smear in the prior 3 years was reported by roughly 69% of surveyed women, with no difference in screening incidence between the 4 years before, or 6 years after, the 1996 recommendation; no changes in incidence were noted among either younger (<45) or older women. After adjusting for Pap smear dates (to account for Pap smears that were completed prior to hysterectomy), possible malignant causes for hysterectomy, and partial hysterectomy in which the cervix was still present, the authors calculated that roughly 10 million women underwent unnecessary Pap smears in 2002.

Comment: Despite the inevitable imprecision of patients' self-reports about whether Pap smears were done during pelvic exams, it appears that unnecessary Pap smears are performed frequently in women who have had complete hysterectomies for benign disease -- probably because of patients' and physicians' habits. However, the small probability of detecting rare vaginal intraepithelial neoplasias is insufficient to justify routine Pap smears among such women.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine July 9, 2004

Citation(s):

Sirovich BE and Welch HG. Cervical cancer screening among women without a cervix. JAMA 2004 Jun 23/30; 291:2990-3.

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