A study published in the June 23 issue of the Journal of the American Medical Association discusses a surprising discovery about the regular Pap smears that many women undergo in an attempt to maintain continuing good health.The study found that in a number of cases, the tests are unnecessary. This is true not because Pap smears fail to diagnose cervical cancer – in fact, they are a vital tool in finding cancerous cells in time for treatment to be helpful – but because many of the women tested have already had their cervixes removed as part of "total hysterectomy," which is the medical term for surgery to remove the uterus and the cervix (and sometimes the fallopian tubes and ovaries, depending on the reason for the hysterectomy).
Dr. Brenda E. Sirovich of the VA Outcomes Group in Vermont and Dr. H. Gilbert Welch of the VA Outcomes Group and the Center for the Evaluative Clinical Sciences at Dartmouth Medical School penned the study. They used data from the 1992-2002 results of the Behavioral Risk Factor Surveillance System, a population-based telephone survey of US adults conducted annually by the Centers for Disease Control and Prevention, to come up with their findings.
The survey upon which the study was based included a combined number of 188,390 women age 18 or older. In 1992, over 68% of the women who had undergone hysterectomy reported having had a Pap smear in the past three years, and by 2002, over 69% of the women who had undergone hysterectomy reported having the test in the past three years.
In the U.S., an estimated 22 million women over the age of 18 have undergone hysterectomy, representing a surprising 21% of the overall population.
"After accounting for Pap smears that may have preceded a recent hysterectomy and hysterectomies that spared the cervix or were performed for cervical neoplasia," wrote the authors, "we estimate that almost 10 million women, or half of all women who have undergone hysterectomy, are being screened unnecessarily."
Dr. Sirovich and Dr. Welch also mentioned that in 1996, the US Preventive Services Task Force noted that routine Pap smears were unnecessary for women who had undergone hysterectomy and did not have any of a small handful of additional risk factors. But the Task Force’s recommendations, they noted, "either have not been heard or have been ignored."
Any patient who has undergone hysterectomy and whose doctor still recommends Pap smears should not be apprehensive about discussing her concerns. While it may be that the test is necessary because the hysterectomy did not include removal of the cervix or because of another risk factor, it is never wrong for a patient to ask why a test is being performed and make sure doctors and other health care professionals know about past medical conditions, problems, and surgeries that may change her needs – and the frequency of repeated and unnecessary testing.
