Pap Unnecessary for Many With Hysterectomies

Aug. 14, 2001 -- If you've had a hysterectomy, many experts would argue that you don't need regular Pap smears anymore. Research released this month, however, shows that you're probably getting one anyway.

The Pap smear is a quick way to collect a few cells from a woman's cervix, the opening of her uterus -- cells that are then examined under a microscope to look for signs of cancer. The test is a useful screening tool for several cancers in the vaginal area, particularly cervical cancer.

Women who undergo a hysterectomy, in which their uterus is surgically removed, often have their cervix removed as well. For these women, a Pap smear is less useful. But the test might find other rare, vaginal cancers or cancer of the few cervical cells left over after the surgery.

Research, initially presented in November 1999 at an annual meeting of public health experts, suggests that most women who have undergone a hysterectomy with removal of their cervix have continued to be given Pap smears by their doctors.

Study author Mona Saraiya, MD, MPH, tells WebMD that "because hysterectomy is the second most common surgical procedure among women, the number of women we estimate are receiving Pap test that they don't need ... is almost equivalent to the number of women who did not have a hysterectomy and who are rarely or never" receiving a Pap test, even though they should be." Saraiya is a medical researcher in the division of cancer prevention and control at Atlanta's CDC.

According to Saraiya, the only women who need Pap smears after having a hysterectomy are those who did not have their cervixes removed during the procedure or those who have a history of cancer or abnormal cells on their cervix that might develop into cancer. For these women, there may be enough cervical cells left in their bodies even after a hysterectomy to merit regular Pap tests.

Saraiya and colleagues examined two large, national medical surveys conducted in the U.S. to determine how many women had undergone a Pap smear after having a hysterectomy. Based on these surveys, about 80% of women had recently undergone a Pap smear regardless of whether they had had a hysterectomy. In contrast, hospital discharge records indicated that only about 7-15% of the women who had undergone a hysterectomy actually needed to keep having Pap smears. The study results are in the August Obstetrics and Gynecology.

These findings are a concern to Saraiya because it means healthcare dollars are being spent for unnecessary tests instead of for more useful purposes, such as giving Pap smears to women who are at higher risk for cervical cancer but somehow have fallen through the cracks of the screening system.

Also, Pap smears occasionally bear positive results when there is no cancer present. For women who don't have a cervix, a falsely positive Pap smear would lead to more unnecessary testing, not to mention needless worry.

Expert Kenneth Johnson, DO, disagrees, however. "I continue to recommend a woman's annual Pap smear for life for several reasons. Number one, many women depend on their gynecologist these days to be their primary care provider." Johnson uses yearly visits with his patients to counsel them about lifestyle habits, breast cancer, and other health concerns. Johnson is an assistant professor of obstetrics and gynecology at NOVA Southeastern University College of Osteopathic Medicine in Fort Lauderdale, Fla.

"Although vaginal cancer is rare, it is not so rare that it couldn't be picked up with an annual Pap smear in a hysterectomized patient," says Johnson. "Low risk does not mean no risk."