Nov. 9, 1999 (Chicago) -- Rarely is less cancer screening considered good medicine. However, in women who have had prior hysterectomies, less is more, according to Mona Saraiya, MD, MPH, speaking on a panel here at the 127th annual meeting of the American Public Health Association. Although most of these women have had a recent Pap smear, it is usually not necessary, she says.
Some women have had a supracervical hysterectomy, which leaves the cervix intact. In these women a Pap smear is still valid. Also, if the woman had the surgery because she had cervical cancer or premalignant lesions, periodic Pap smears are required.
However, most women are still getting routine Pap smears after hysterectomy, says Saraiya, an epidemiologist in the CDC's division of cancer prevention and control. "The reason we do a Pap is to detect cervical cancer," she tells WebMD. Therefore, the procedure is unnecessary for most of these women, she says.
In a review of data from surveys conducted by the CDC through 1994, Saraiya and colleagues compared women's histories of Pap smears with their hysterectomy status. Among all the respondents, 74% of the women who had had a hysterectomy also reported having a Pap smear within the last three years. This result was comparable to respondents who had not had hysterectomies, of whom 77% had had a Pap smear.
The clinical indications for a Pap smear cannot account for the lack of a discrepancy between these groups, says Saraiya. Less than 1% of the 600,000 hysterectomies performed annually leave the cervix intact, she says. Furthermore, more than 90% of hysterectomies are for conditions unrelated to cancer, such as fibroids, she says.
"Only 4% to 15% of women who have had hysterectomies should be getting Pap smears -- not 74%," she says. "Of the 12.4 million post-hysterectomy women who have had a recent Pap smear, 10.6 million to 11.9 million didn't need it." However, these data are limited because they are based on surveys, she says.
Many women do not know if the cervix was removed at the time of their hysterectomies. In these cases, a woman can ask her physician to find out by giving her a pelvic examination, she tells WebMD.
"By only going to 1994, [the information] may be out of date," James J. Philips, MD, tells WebMD in an interview seeking independent commentary. "For example, no one does supracervical hysterectomies anymore." If so, even fewer post-hysterectomy women would need Pap smears, says Philips, a family physician in private practice in Sturgis, Mich.
"This gap between who should and who does get Pap smears after hysterectomy is just an example of the gaps between evidence and practice [we see in women's health care]," moderator Ellen E. Shaffer, MPH, tells WebMD. "We need a better system for getting research-based evidence to physicians, as well as to patients. We also need the information to be disseminated by an entity that is not a for-profit HMO," so that the information will be seen as objective. Shaffer is the director of policy of the Robert Wood Johnson Patient-Provider Initiative at the University of California at San Francisco.