Nearly 10 million U.S. women who have had hysterectomies are needlessly getting routine Pap tests, researchers say.
Pap tests, or Pap smears, are used to detect cancer of the cervix, at the base of the uterus. But in most hysterectomies, the cervix is removed along with the uterus.
In 1996, the U.S. Preventive Services Task Force said routine Pap tests are unnecessary for women who have had both their cervix and uterus removed for reasons other than cervical cancer. That recommendation was recently echoed by the American Cancer Society and the American College of Obstetricians and Gynecologists.
But Veterans Affairs researchers found that nearly 46 percent of such women were still getting Pap tests in 2002.
“I actually was quite surprised because, in this case, women are being screened for cancer in an organ they don’t have,” said Dr. Brenda Sirovich of the VA Medical Center in White River Junction, Vt., and Dartmouth College.
Her study appears in Wednesday’s Journal of the American Medical Association.
Uncomfortable exam
Hysterectomies are often done in cases of cervical cancer. But they also are performed for other reasons, including noncancerous growths and other uterine disorders.
Doctors advise women with intact wombs to have Pap tests yearly, or sometimes every two or three years if they have had three normal tests in a row.
Pap tests involve scraping cells from the cervix and examining them for abnormalities under a microscope. In women without a cervix, vaginal cells are evaluated, but vaginal cancer is extremely rare and Pap tests were not designed to detect it, Sirovich said.
While the tests are relatively inexpensive, these women are undergoing uncomfortable exams, doctors are being distracted from more important matters, and lab specialists are spending needless time analyzing specimens, Sirovich said.
The researchers analyzed nationally representative data on 187,670 women who had undergone hysterectomies.
Excluding women whose cervixes were not removed and those who had hysterectomies because of cancer, the researchers concluded that almost 10 million women were being screened unnecessarily.
The researchers said that women and their doctors may not realize that screening is unwarranted for most women who have had hysterectomies.
Doctors also “may be reluctant to risk a patient’s trust by stopping such a well-established test,” Sirovich said.
Dr. Kenneth Nolan, chairman of obstetrics and gynecology at Tufts University medical school, said the results are not surprising.
“Patients and physicians get used to doing a Pap smear every year,” he said. “It has been the practice for so many years, it takes awhile for people to change their habits.”