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Many Women Getting Unneeded Pap Tests

Most who have had a hysterectomy don't need the exams

TUESDAY, June 22, 2004 (HealthDayNews) -- Many American women who have had a hysterectomy are getting unneeded Pap tests.

That's the finding of new research that shows, despite guidelines that recommend against the routine test for women after hysterectomies, a greater percentage of them are having the test now than before the guidelines were introduced eight years ago.

Pap smear screenings help detect cancer of the cervix, the lower part of the uterus, above the vagina. But, "these days, 95 percent of hysterectomies remove the entire uterus, including the cervix," said lead study author Dr. Brenda E. Sirovich, a research associate at the VA Outcomes Group in White River Junction, Vt.

"Most women who have had a hysterectomy don't need a Pap smear," Sirovich said, adding that unneeded Pap tests waste time for both patients and doctors and may distract them from discussing more pressing health concerns.

The study appears in the June 23-30 issue of the Journal of the American Medical Association.

And it follows a report earlier this week, in the journal Cancer, that found only one in 20 women 40 and older consistently follows the recommendation for annual mammograms.

The two findings suggest that many U.S. women are not following recommended guidelines for preventive health care.

Sirovich's aim was to determine if the Pap test recommendation, issued in 1996 by the U.S Preventive Services Task Force, was being followed. She found it was not.

In 1992, 68.5 percent of women who had had a hysterectomy reported having had a Pap test in the previous three years. In 2002, six years after the recommendations were issued, 69.1 percent said they had had a Pap, Sirovich found.

For her research, Sirovich analyzed data from an annual telephone survey of U.S. adults conducted by the U.S. Centers for Disease Control and Prevention. She evaluated information from more than 187,000 women who reported having a hysterectomy and who answered questions about the timing of their last Pap smear.

Sirovich isn't sure why the screening recommendation for women who have no cervix isn't being followed.

"Some women may not know they don't have a cervix after hysterectomy," she said. "Or they may be so accustomed to the reassurance [of a Pap test] they don't want to give it up."

Or, she added, some physicians may not be aware of the guidelines. Also, health-care "report cards," in which doctors are graded on their recommendation for routine screening tests, may be to blame, she said. The grading of doctors might not allow for exceptions -- such as not recommending Pap tests for women without a cervix. So the physician issues a blanket recommendation for all women to undergo the test, Sirovich said.

"I went into this thinking that Pap smears among women with hysterectomies would have fallen," she said. "Six years later, there is no change at all."

The U.S. Preventive Services Task Force's recommendation that a Pap test was unnecessary for women who have had a hysterectomy does not apply to those women who have had a hysterectomy that spared their cervix. Or those who underwent the surgery due to cervical cancer or pre-cancer.

Both of these groups of women still need Pap tests, Sirovich said.

Dr. William Parker, a clinical professor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles, said he would add one more group of women who need to pay close attention to Pap tests.

"Patients who have had HPV (human papillomavirus, a risk for cervical cancer) should continue to be screened," he said.

"The other issue," Parker added, "is to differentiate Pap smears from seeing the gynecologist."

Women who have had hysterectomies still need to see their gynecologist regularly for other screenings, such as pelvic exams and breast exams, he said.

Pap smears are advised for women beginning at age 18, the American Cancer Society says, and then annually or as recommended by a woman's doctor if she has a series of normal exams. About 10,500 cases of cervical cancer are expected to be diagnosed in 2004, with about 3,900 deaths.

More information

For more information on Pap smears, visit the American Society for Clinical Pathology.

SOURCES: Brenda Sirovich, M.D., research associate at VA Outcomes Group, White River Junction, Vt.; William Parker, M.D., clinical proessor of obstetrics and gynecology at the David Geffen School of Medicine, University of California, Los Angeles, and staff physician and former chairman of obstetrics and gynecology, Santa Monica-UCLA Medical Center, Santa Monica, Calif.; June 23-30, 2004, Journal of the American Medical Association
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