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    Pap Unneeded for Most After Hysterectomy

    Cost of Routine Screening Can't Be Justified

    Safely Stopping Pap Testing continued...

    In a study published two years ago, Saraiya and CDC colleagues found that three-quarters of the surveyed women who had undergone hysterectomies continued to have Pap smears after their surgery. She tells WebMD the numbers may have dropped after the ACS revised its guidelines, but they are still very high.

    One of the main arguments in favor of routine Pap testing in these women has been that it promotes an annual visit to a health-care provider. Once in the door, the thinking goes, doctors can advise women about other health interventions.

    Ethically Challenged

    But Saraiya and ACS spokesman Carmel J. Cohen, MD, agree that this reasoning borders on being ethically indefensible.

    "The ethics of this are certainly arguable, and it makes no economic sense," says Cohen, professor of gynecology at New York's Mount Sinai School of Medicine.

    "Pap testing is no longer a trifling part of health care. We do 50 million Pap smears a year in this country and 5 million are found to be abnormal. Estimates are that around 5,500 cervical cancers are identified each year through testing, so that is a lot of false positives."

    Saraiya adds that limited public health dollars would definitely be better spent getting women who have not had hysterectomies to be screened.

    "Sixty percent of cervical cancers occur among women who are never screened or are rarely screened," she says. "So that would be the place to put our resources if we want to save women from dying of this cancer."

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