Non-risk women still having Pap smears

Many women in the United States who have had a hysterectomy are undergoing Pap smear screening even though they are not at risk of cervical cancer, according to a report in the June 23-30, 2004, issue of The Journal of the American Medical Association (JAMA).

Pap smear screening for cervical cancer was introduced in the 1940s and quickly became a widely accepted cancer screening test, according to background information in the article. In 1996, “based on accumulated evidence from observational studies, the U.S. Preventive Services Task Force recommended that routine Pap smear screening is unnecessary for women who have undergone a complete hysterectomy for benign (non-cancerous) disease.” The authors add that most women who have undergone hysterectomy are not at risk of cervical cancer because they no longer have a cervix.

Yet, according to researchers, medical doctors are still sending three out of four of them for Pap smears. Conducting the research were Brenda E. Sirovich, MD, M.S., and H. Gilbert Welch, MD, M.P.H., from the VA Outcomes Group, White River Junction, VT and Dartmouth Medical School in Hanover, NH.

They analyzed data from the Behavioral Risk Factor Surveillance System (1992-2002), an annual, population-based telephone survey of U.S. adults conducted by the Centers for Disease Control and Prevention. The authors evaluated the information from 187,670 women who reported having a hysterectomy and answered questions about the timing of their last Pap smear.

“Twenty-two million U.S. women 18 years and older have undergone hysterectomies, representing 21 percent of the population,” the researchers revealed. “In 1992 (before the U.S. Preventive Services Task Force recommendations), 68.5 percent of women who had undergone hysterectomy reported having had a Pap smear in the past 3 years; in 2002 (6 years after the recommendation), 69.1 percent had had a Pap smear during the same period."

The researchers estimated that approximately 10 million women, or almost half of all women who have undergone hysterectomy, are being screened unnecessarily and the amount of screening has not declined following the task force recommendation.

The authors noted that, while some patients may merely be “so enthusiastic about cancer screening” that they have the test regardless of its usefulness, they also admit that “ It is also possible that physicians are largely responsible for continuing cervical cancer screening after hysterectomy... The U.S. Preventive Services Task Force recommendations either have not been heard or have been ignored.”

SOURCE: “Cervical Cancer Screening Among Women Without a Cervix,” The Journal of the American Medical Association, June 23/03, 2004; 291:2990-2993.