Most US women who have undergone hysterectomy are not at risk of cervical
cancer—they underwent the procedure for benign disease and they no longer
have a cervix. In 1996, the US Preventive Services Task Force recommended
that routine Papanicolaou (Pap) smear screening is unnecessary for these women.
To determine whether Pap smear screening among women who have undergone
hysterectomy has decreased following the recommendation.
We used data from the Behavioral Risk Factor Surveillance System (1992-2002),
an annual, population-based telephone survey of US adults conducted by the
Centers for Disease Control and Prevention. Data about timing, type, and indication
for hysterectomies were obtained from the Nationwide Inpatient Sample and
In each year of the survey, a representative sample of US women 18 years
and older who had undergone hysterectomy (combined n = 188 390) was studied.
Main Outcome Measure
The main outcome was the proportion of women with a history of hysterectomy
who reported a current Pap smear (within 3 years). Overall proportions are
age adjusted to the 2002 US female population.
Twenty-two million US women 18 years and older have undergone hysterectomy,
representing 21% of the population. The proportion of these women who reported
a current Pap smear did not change during the 10-year study period. In 1992
(before the US Preventive Services Task Force recommendations), 68.5% 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% had had a Pap smear
during the same period (P value for the comparison
= .22). After accounting for Pap smears that may have preceded a recent hysterectomy
and hysterectomies that spared the cervix or were performed for cervical neoplasia,
we estimate that almost 10 million women, or half of all women who have undergone
hysterectomy, are being screened unnecessarily.
Many US women are undergoing Pap smear screening even though they are
not at risk of cervical cancer. The US Preventive Services Task Force recommendations
either have not been heard or have been ignored.