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Women's Health

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Hysterectomy? Pap Smear May Be Unnecessary

But Don't Cancel Annual Ob-Gyn Appointment -- You Still Need Exam

Pap Smear So Successful, Doctors Resist Giving It Up continued...

During this 10-year period, she found no change in the number of Pap smears performed: Fully 69% of these women had the test. In 1992, before the guidelines for Pap smear screening changed, 69% had the test performed, compared with 69% in 1996, the year the task force made its recommendation. More recently, 69% of women surveyed in 2002 also had Pap smears done.

Sirovich then factored in circumstances warranting a Pap smear, like precancerous cervical cells in the past, DES exposure, or compromised immunity.

Even then, she found that upwards of 10 million American women -- or 46% of those who had hysterectomies -- were getting unnecessary Pap smears, Sirovich writes.

"The guidelines had no effect; the rates of Pap smear did not change," she tells WebMD. "Each year, more than two-thirds of these women reported having a current Pap smear."

A Pap smear can be uncomfortable as well as a waste of time and money, Sirovich says. "There is only so much time in an office visit. Time spent on a Pap smear is not spent on more important issues. Also, millions of unnecessary dollars are spent on unnecessary procedures."

"Any time there is a drastic change in practice guidelines, it takes awhile for doctors to feel comfortable with it," Guido tells WebMD. "[The Pap smear] has been so effective that doctors resist changing it. That's understandable. But physicians need to adapt to changes in medicine."

The U.S. Preventive Services Task Force advisory applies only to women who have a hysterectomy for benign disease, he says. "If women don't know if they had dysplasia [abnormal cells], they should get three annual Pap smears, and if those are negative, they don't need another. Also, if women have had dysplasia in the past, or if they had DES exposure or are immune-compromised, they need a Pap smear."

SOURCE: Sirovich, B. The Journal of the American Medical Association (JAMA), June 23/30, 2004; vol 291: pp 2990-2992. Brenda E. Sirovich, MD, MS, professor of medicine, Dartmouth Medical School; Veterans Administration Outcomes Group, White River Junction, Vt. Richard Guido, MD, professor of obstetrics, gynecology, and reproductive sciences, University of Pittsburgh School of Medicine.

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