New research by University of Michigan Health System physicians finds that most women who have had a hysterectomy for a non-cancerous disease can forgo annual Pap smear exams. Its authors found that even in the best conditions, women only add three weeks to their lives through regular screenings. The cost of these screenings per year of life saved can run up to $12 million for more aggressive screening plans. But the study's authors stressed that women who have had hysterectomies linked to cervical cancer or who have a history of human papillomavirus (HPV) infection should continue to have regular Pap smears.
This is the first study to look at the value of Pap smear screenings for women who have had a hysterectomy.
"Everyone thinks more prevention is better," said lead author Michael Fetters, M.D., M.P.H., M.A., assistant professor of Family Medicine at the UM Medical School. "What we found is that just because you have a test available doesn't mean you should use it. Some tests are not really going to lead to any benefit."
More than a third of American women will undergo a hysterectomy by age 60, making it the second most common major surgical procedure in the United States, after the cesarean section. A hysterectomy removes a woman's uterus and usually removes the cervix. Pap smears, a standard part of women's annual health check-ups, have proven effective at detecting cervical cancer. Physicians traditionally continue to screen women who have had hysterectomies, believing the Pap test may help detect vaginal cancer or other abnormalities. However, aggressive screening is less effective at detecting vaginal cancer in women with a total hysterectomy because the cancer spreads more easily into adjacent organs when the woman has neither cervix nor uterus.
"Why are doctors doing Pap smears on women who don't have a cervix?" Fetters asked. "It doesn't make sense."
"In a woman who has been married for years and has only one sexual partner, it's appropriate to forgo Pap smears after hysterectomy," said study co-author Richard Lieberman, M.D., clinical assistant professor in Pathology and Obstetrics and Gynecology at UM Medical School. "But if the woman's risk factors for lower genital tract cancer change, all bets are off and she'll need to be screened regularly. The main risk factors associated with the development of precancerous and cancerous changes of the lower genital tract (cervix, vagina, or vulva) include human papillomavirus infection and other sexually transmitted diseases, multiple sexual partners, and alteration of immune status."
The study, "Cost Effectiveness of Pap Smear Screening for Vaginal Cancer After Total Hysterectomy for Benign Disease," appeared in the Journal of Lower Genital Tract Disease (2003; 7(3):194-202).