Do you need a Pap smear after having a hysterectomy. When can you stop getting regular Pap tests. What factors determine if ongoing cervical cancer screening is recommended.

Understanding Hysterectomy Types and Their Impact on Pap Smear Needs

A hysterectomy is a surgical procedure to remove a woman’s uterus. There are two main types of hysterectomies that impact whether ongoing Pap smears are needed:

• Partial hysterectomy: The uterus is removed but the cervix remains
• Total hysterectomy: Both the uterus and cervix are removed

The type of hysterectomy performed is a key factor in determining if a woman still needs regular Pap smears for cervical cancer screening. Let’s explore when Pap tests are still recommended and when they may no longer be necessary.

When Pap Smears Are Still Recommended After Hysterectomy

There are several situations where women should continue getting regular Pap smears even after undergoing a hysterectomy:

Partial Hysterectomy

If you had a partial hysterectomy where your cervix was left in place, you should continue getting routine Pap tests. The cervix remains a potential site for cancer development, so ongoing screening is important.

Hysterectomy Due to Cancer

Women who had a hysterectomy due to cervical cancer or precancerous conditions should continue with regular Pap smears. This allows for monitoring and early detection of any recurrence.

DES Exposure

If your mother took the drug diethylstilbestrol (DES) while pregnant with you, regular Pap tests are still recommended. DES exposure increases cervical cancer risk, even after hysterectomy.

When Pap Smears May No Longer Be Necessary

In certain cases, women can discontinue routine Pap smears after a hysterectomy:

Total Hysterectomy for Non-Cancerous Reasons

If you had a total hysterectomy (removal of uterus and cervix) for benign conditions like fibroids, you can likely stop having Pap tests. With no cervix present, the risk of cervical cancer is eliminated.

Age Considerations

Doctors generally agree that women over 65 can stop routine Pap screening if they have a history of normal results and are not at high risk for cervical cancer. This applies whether you’ve had a hysterectomy or not.

The Importance of Discussing Pap Smear Needs with Your Doctor

Every woman’s situation is unique, so it’s crucial to have an open discussion with your healthcare provider about your ongoing Pap smear needs. Your doctor can consider factors like:

• Your age
• Type of hysterectomy performed
• Reason for hysterectomy
• Personal and family medical history
• Other risk factors for cervical cancer

Based on these factors, your doctor can provide personalized recommendations on whether to continue or discontinue Pap smears.

The Overuse of Pap Smears After Hysterectomy

Research suggests that many women continue to receive unnecessary Pap smears after hysterectomy. A CDC study found that 74% of women who had undergone hysterectomy reported having a Pap smear within the last three years. This rate was similar to women who had not had hysterectomies (77%).

However, experts estimate that only 4-15% of post-hysterectomy women actually need ongoing Pap tests. This indicates a significant overuse of the screening procedure in this population.

Reasons for Overscreening

Several factors may contribute to the overuse of Pap smears after hysterectomy:

• Lack of awareness about current guidelines
• Habit or routine of annual screenings
• Patient anxiety about missing potential cancer
• Uncertainty about the type of hysterectomy performed

Improved education for both patients and healthcare providers could help reduce unnecessary screenings.

The Role of Pelvic Exams After Hysterectomy

While Pap smears may no longer be necessary for many women after hysterectomy, regular pelvic exams may still be recommended. Pelvic exams can help detect other gynecological issues, such as:

• Ovarian cancer
• Vaginal cancer
• Vulvar cancer
• Pelvic organ prolapse
• Urinary incontinence

The frequency of pelvic exams should be discussed with your healthcare provider based on your individual risk factors and health needs.

Alternative Screening Methods for Gynecological Health

For women who no longer need Pap smears after hysterectomy, other screening methods may be recommended to monitor overall gynecological health:

HPV Testing

Human papillomavirus (HPV) testing may be appropriate for some women, as HPV is a major risk factor for cervical cancer. This test can be done without a Pap smear.

Pelvic Ultrasound

For women who have retained their ovaries after hysterectomy, periodic pelvic ultrasounds may be recommended to screen for ovarian abnormalities.

Symptom Awareness

Women should be educated about symptoms that could indicate gynecological issues, such as unusual bleeding, pelvic pain, or changes in urinary or bowel habits. Prompt reporting of these symptoms to a healthcare provider is important.

The Importance of Staying Informed About Changing Guidelines

Medical guidelines for cancer screening, including Pap smears, are periodically updated based on new research and evidence. It’s important for both patients and healthcare providers to stay informed about these changes.

Organizations that provide guidelines for cervical cancer screening include:

• The American Cancer Society
• The U.S. Preventive Services Task Force
• The American College of Obstetricians and Gynecologists

These organizations may have slightly different recommendations, but they generally agree on the main points regarding Pap smears after hysterectomy.

The Role of Shared Decision-Making

Given the complexity of individual health situations and evolving guidelines, shared decision-making between patients and healthcare providers is crucial. This involves:

1. Discussing the potential benefits and risks of ongoing screening
2. Considering the patient’s personal values and preferences
3. Making an informed decision together about the most appropriate screening approach

This collaborative approach ensures that women receive personalized care that aligns with their individual needs and current medical evidence.

Addressing Common Concerns About Stopping Pap Smears

Many women may feel anxious about discontinuing Pap smears after years of regular screening. Common concerns include:

Fear of Missing Cancer

It’s important to understand that after a total hysterectomy for non-cancerous reasons, the risk of cervical cancer is extremely low. Other gynecological cancers can be detected through different means, such as pelvic exams or attention to symptoms.

Habit and Routine

For some women, annual Pap smears have become a routine part of their healthcare. Adjusting to new recommendations may take time and trust in your healthcare provider.

Uncertainty About Hysterectomy Type

If you’re unsure about the type of hysterectomy you had, your doctor can perform a pelvic exam to check if the cervix is present. Medical records can also be reviewed to clarify the details of your surgery.

Open communication with your healthcare provider can help address these concerns and ensure you’re comfortable with your personalized screening plan.

In conclusion, while Pap smears play a crucial role in cervical cancer screening, they may not be necessary for all women who have undergone a hysterectomy. Understanding your specific situation, staying informed about current guidelines, and maintaining open communication with your healthcare provider are key to ensuring appropriate and effective gynecological care post-hysterectomy. Remember, your health needs are unique, and your screening plan should be tailored to your individual circumstances.

Pap smear: Still needed after hysterectomy?

Are Pap tests still needed after removal of the uterus (hysterectomy)?

Answer From Tatnai Burnett, M.D.

It depends.

Pap test, also called a Pap smear, is a routine screening test for early diagnosis of cervical cancer.

If you had a partial hysterectomy — when the uterus is removed but the lower end of the uterus (cervix) remains — your doctor will likely recommend continued Pap tests.

Similarly, if you had a partial hysterectomy or a total hysterectomy — when both the uterus and cervix are removed — for a cancerous or precancerous condition, regular Pap tests may still be recommended as an early detection tool to monitor for a new cancer or precancerous change. In addition, if your mother took the drug diethylstilbestrol (DES) while she was pregnant with you, regular Pap tests are recommended, since DES exposure increases the risk of developing cervical cancer.

You can stop having Pap tests, however, if you had a total hysterectomy for a noncancerous condition.

Your age matters, too.

Doctors generally agree that women can stop routine Pap test screening after age 65 — whether you’ve had a hysterectomy or not — if you have a history of regular screenings with normal results and if you’re not at high risk of cervical cancer.

If you’re unsure whether you still need Pap tests, discuss with your doctor what’s best for you.

With

Tatnai Burnett, M.D.

• Pap smear: Do I need one if I’m a virgin?

Oct. 22, 2020

Show references

1. Feldman S, et al. Screening for cervical cancer. https://www.uptodate.com/contents/search. Accessed Sept. 17, 2018.
2. Smith RA, et al. Cancer screening in the United States, 2018: A review of the current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians. 2018;68:297.
3. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins — Gynecology. ACOG Practice Bulletin No. 168. Cervical Cancer Screening and Prevention. Obstetrics & Gynecology. 2016;128:e111.
4. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;320:674.
5. AskMayoExpert. Cervical cancer screening (adult). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2018.

See more Expert Answers

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Most Women Don’t Need Pap Smears After Hysterectomy

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.

Cervical Cancer Screening Among Women Without a Cervix | Cancer Screening, Prevention, Control | JAMA

Context 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.

Objective To determine whether Pap smear screening among women who have undergone
hysterectomy has decreased following the recommendation.

Design 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
other sources.

Study Participants 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.

Results 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.

Conclusions 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.

Papanicolaou (Pap) smear screening for cervical cancer, introduced in
the 1940s, has become a widely accepted cancer screening test. High rates
of screening are the rule in all industrialized nations, and the number of
cases and deaths from cervical cancer has decreased substantially since the
introduction of screening. In the United States, all women have historically
been considered eligible for Pap smear screening. This includes the millions
of women who have undergone complete hysterectomy—women who are not
at risk of cervical cancer.

Women without a cervix who undergo Pap smear testing receive vaginal
smears, screening for cancer of the vagina, a rare gynecologic malignancy
that accounts for 0.3% of cancers in women—a cancer less common than
cancer of the tongue or the small intestine.¹ Previous
Pap smear screening guidelines, including consensus guidelines issued in 1988,^2-4 largely failed to distinguish
between women who had undergone hysterectomy and those with an intact cervix.
In 1996, however, based on accumulated evidence from observational studies,^5,6 the US Preventive Services Task Force
recommended that routine Pap smear screening is unnecessary for women who
have undergone a complete hysterectomy for benign disease.⁷

Although screening among women who had undergone hysterectomy was reported
during the early 1990s,⁸ there have been no
reports for the years following this recommendation. We sought to determine
whether screening has declined following the task force recommendation and
to estimate how many women are currently being screened unnecessarily.

We used data from the Behavioral Risk Factor Surveillance System (BRFSS),
an annual, cross-sectional, population-based, random-digit-dialed telephone
survey conducted by the Centers for Disease Control and Prevention. The BRFSS
collects data on health care use, risk behaviors, and demographics from a
representative sample of civilian, noninstitutionalized adults (18 years or
older) in the United States.⁹ Our analysis
included each year of the survey from 1992 to 2002, except 2001, when no questions
related to Pap smear screening were asked. Median annual response rate, based
on persons estimated to be eligible to participate, ranged from 49% (2000)
to 71% (1993).^10-14

Each state’s yearly BRFSS data file is weighted to the respondent’s
probability of selection and the age-specific, sex-specific, and race-specific
population from the most current census data (or intercensal estimates) for
each state. These weights adjust for differences in probability of selection
and nonresponse and may also partially correct for any bias caused by lack
of telephone coverage.⁹ Because the poststratification
weights reflect the size of the underlying stratum-specific population, we
were able to combine data (using Stata statistical software, version 7.0,
Stata Corp, College Station, Tex) from each state into summary measures that
represent the combined population of the country.

Study Population: Women With Hysterectomy

During the 10 years analyzed, 188 390 women reported having undergone
hysterectomy. Of these, we excluded 720 who did not respond to the question,
“Have you ever had a Pap smear?” (item nonresponse rate, 0.4%), leaving 187 670
women in our study population. Those women who reported having had a Pap smear
were asked about the timing of the most recent test. For each year, we report
the proportion of women with a history of hysterectomy who had received a
current Pap smear. Current is defined by the standard of most US professional
organizations: a Pap smear performed within the past 3 years.^15,16 For
women who reported having had a Pap smear but did not respond to the question
about the timing of the most recent test, we assumed that they did not have
a current Pap smear (item nonresponse rate, 2%-3%).

Temporal Trends, 1992-2002. We analyzed responses
based on age and report the proportion screened using 3 age categories: 18
to 44 years, 45 to 64 years, and 65 years and older. To produce an overall
proportion, we used the direct method to age adjust (using 9 age categories)
to the 2002 US population of women with hysterectomies, using BRFSS 2002 estimates.
We compared the proportion of women with a history of hysterectomy who reported
a current Pap smear in 1992 and in 2002 (and in 1996 compared with 2002) using
the 2-sample test of proportions. All reported P values
are based on 2-sided tests; P<.05 is considered
statistically significant.

Estimating the Volume of Unnecessary Screening, 2002. To estimate the number of women being screened unnecessarily, we used
BRFSS to determine the total number of women in 2002 who both had a history
of hysterectomy and had been screened in the previous 3 years. From this total,
we subtracted the estimated number in whom screening for cervical cancer may
be warranted—women whose most recent Pap smear could conceivably have
preceded their hysterectomy, those who still had a cervix, and those whose
hysterectomy was performed for cervical neoplasia. We made 2 simplifying assumptions
in this calculation: (1) that the 3 groups were mutually exclusive and (2)
that all the women in these groups had had a Pap smear in the past 3 years.
Both assumptions tend to overestimate the number in whom current Pap smear
may have been warranted and, conversely, underestimate the number being screened
unnecessarily.

Because BRFSS does not collect information about the timing, type, or
indication for a woman’s hysterectomy, we used the Nationwide Inpatient Sample
(NIS),¹⁷ a database containing all hospital
discharge abstracts from a representative sample of nonfederal acute care
hospitals in the United States, to estimate the number of women in each of
the 3 groups. To determine the number of women whose current Pap smear could
have preceded their hysterectomy (in other words, any woman whose hysterectomy
occurred in the past 3 years), we summed the number of US women in each of
the 3 previously specified age groups who underwent hysterectomy during the
3 years before the survey (1999-2001), using data from the NIS.¹⁸ The
resulting figure (1.8 million women) was corroborated by estimates derived
from the National Hospital Discharge Survey¹⁹ and
the 2000 National Health Interview Survey.²⁰ To
determine the number of women who still have a cervix after hysterectomy,
we used data on subtotal hysterectomy incidence (from the NIS, 1997-2001¹⁸) and prevalence²¹ to
derive an upper bound estimate of the proportion of women with hysterectomy
who still have a cervix (5% or, in 2002, 1.1 million women). Finally, to determine
the number of women in whom hysterectomy was performed for cervical neoplasia,
we used previously published estimates from the National Hospital Discharge
Survey (1988-1997)⁸ and data from the NIS (2000)²² to establish an upper bound estimate of the proportion
of women whose hysterectomies were performed for this indication (10% or,
in 2002, 2.2 million women).

Finally, we calculated age-specific estimates of the prevalence of unnecessary
screening, stratifying women into 1 of the 3 previously specified age groups:
18 to 44 years, 45 to 64 years, and 65 years and older.

Overall, 21% of US women have undergone hysterectomy (as of 2002), a
proportion that remained relatively constant during the 10-year study period
(range, 21%-23%). In 1992, the age-adjusted proportion of women with a history
of hysterectomy who reported having a Pap smear within the preceding 3 years
was 68.5% (Figure 1). In 1996, the
year of the US Preventive Services Task Force guidelines, 69.4% had been screened
within the same period, and in 2002, the most recent year for which data are
available, 69.1% reported a current Pap smear. There was no significant difference
between 1992 and 2002 (P = .22) or between 1996 and
2002 (P = .47) in the proportion of women with a
history of hysterectomy who reported having a current Pap smear. Figure 1 also shows that in each of the 3
age groups specified (18-44 years, 45-64 years, and ≥65 years), Pap smear
screening rates remained stable throughout the period from 1992 to 2002.

In 2002, an estimated 22 million US women 18 years and older reported
ever having undergone hysterectomy, of whom 69.1%, or approximately 15 million,
had a current Pap smear. Approximately 1.8 million of these women had undergone
hysterectomy in the previous 3 years (1999-2001), and thus their Pap smear
may have preceded the surgery. Of the remaining 13.2 million, screening may
have been indicated for up to 1.1 million who still had a cervix and as many
as 2.2 million whose hysterectomy was performed for cervical neoplasia. Thus,
we estimate that approximately 10 million American women, or 45.6% of those
who had undergone hysterectomy, were unnecessarily undergoing Pap smear screening
in 2002. Table 1 shows that the
prevalence of unnecessary screening among women who had undergone hysterectomy
was 19.3% for women aged 18 to 44 years, 54.9% for those aged 45 to 64 years,
and 40% for women 65 years and older.

We found that more than two thirds of US women who have undergone hysterectomy
report having had a Pap smear within the past 3 years. Despite a 1996 recommendation
from the US Preventive Services Task Force that routine Pap smear screening
is unnecessary for women who have undergone hysterectomy for benign disease,
we found that the proportion screened did not decrease at all in the subsequent
6-year period. Lastly, we estimate that even accounting for the small fraction
of women in whom a Pap smear may be warranted despite hysterectomy, approximately
10 million women who do not have a cervix are being screened unnecessarily
for cervical cancer.

Our study has several limitations. First, the BRFSS survey was conducted
by telephone, and conclusions apply only to the approximately 95% of the US
population residing in households with a telephone. Second, because women
tend to overreport Pap smear screening,^23-25 self-reported
data overestimate the proportion actually being screened. However, even if
as many as half of the women who reported a current Pap smear had not had
one, millions of women are still being screened unnecessarily. Furthermore,
this limitation does not apply to our temporal analysis, because we have no
reason to believe that the accuracy of Pap smear self-reports has changed
over time. Our estimate of the amount of unnecessary screening is, in fact,
close to that of a medical records study²¹ in
which 58% of women who had previously undergone total hysterectomy for benign
disease were found to have been subsequently screened.

Lastly, although our information about the timing, type, and indication
for women’s hysterectomies are derived from the best available national data,^8,18-20 some
may be concerned about the technique we used to estimate the number of women
screened unnecessarily. Each of our assumptions, however, tends to overestimate
the number of women in whom screening may be warranted. First, we assumed
that for all women who had both a hysterectomy and a Pap smear in the past
3 years, the Pap smear was warranted because it preceded the hysterectomy.
Second, because the number of subtotal hysterectomies has recently been increasing
in the United States,¹⁸ as elsewhere,²⁶ our use of the most recent estimate (4.9% of all
hysterectomies in 2001 were subtotal) led us to overstate the population prevalence
of women who still have a cervix after hysterectomy. Finally, in our calculations
we assumed that every woman in each of the 3 groups in whom screening may
be warranted had had a Pap smear in the past 3 years and that the 3 groups
were mutually exclusive. All of these assumptions led us to underestimate
the number of women being screened unnecessarily.

There are a number of possible explanations for our findings. It is
possible that women who have had a total hysterectomy are not aware that they
are no longer at risk for cervical cancer. Or they may simply be so enthusiastic
about cancer screening²⁷ that they continue
to have Pap smears regardless of the usefulness of the test. It is also possible
that physicians are largely responsible for continuing cervical cancer screening
after hysterectomy. They may be unaware that screening for vaginal cancer
is unwarranted. They may also be reluctant to suggest stopping screening either
because they are concerned that patients may question their judgment or motivation
or may be wary of the considerable investment of time that might be required
to avoid this possibility. Finally, it is possible that systemic factors,
specifically, Pap smear performance measures, are responsible. Although these
measures may not be intended to apply to women who have undergone hysterectomy,
it can be difficult to identify who these women are using administrative data.
The net effect may be that all women are encouraged to receive Pap smears
in order to meet specified benchmarks for cervical cancer screening. Addressing
the problem of unnecessary screening in women who have undergone hysterectomy
will require identifying which of these factors is primarily responsible and
acting accordingly.

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23.Newell SA, Girgis A, Sanson-Fisher RW, Savolainen NJ, Hons BA. The accuracy of self-reported health behaviors and risk factors relating
to cancer and cardiovascular disease in the general population: a critical
review.  Am J Prev Med.1999;17:211-229.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10987638&dopt=AbstractGoogle Scholar24.Bowman JA, Sanson-Fisher R, Redman S. The accuracy of self-reported Pap smear utilisation.  Soc Sci Med.1997;44:969-976.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9089918&dopt=AbstractGoogle Scholar25.McGovern PG, Lurie N, Margolis KL, Slater JS. Accuracy of self-report of mammography and Pap smear in a low-income
urban population.  Am J Prev Med.1998;14:201-218.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9569221&dopt=AbstractGoogle Scholar26.Gimbel H, Settnes A, Tabor A. Hysterectomy on benign indication in Denmark 1988-1998.  Acta Obstet Gynecol Scand.2001;80:267-272.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11207494&dopt=AbstractGoogle Scholar27.Schwartz LM, Woloshin S, Fowler FJ, Welch HG. Enthusiasm for cancer screening in the United States.  JAMA.2004;291:71-78.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14709578&dopt=AbstractGoogle Scholar

Is Pap Testing Still Needed After Hysterectomy? – Consult QD

By Halle G. Sobel, MD  Elise Everett, MD  and Laura D. Lipold, MD

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services Policy

A 50-year-old woman presents for a new patient visit. She underwent vaginal hysterectomy for menorrhagia 4 years ago, with removal of the uterus and cervix. Tissue studies at that time were negative for dysplasia. Her previous physician performed routine Papanicolaou (Pap) tests, and she asks you to continue this screening. How do you counsel her about Pap testing after hysterectomy for benign disease?

Screening guidelines

Introduced in 1941, the Pap test is an example of a successful screening tool, improving detection of early cervical cancer and reducing rates of morbidity and death due to cervical cancer. Early stages of cervical cancer are the most curable. ¹

Screening in women who have a cervix

In 2012, the US Preventive Services Task Force (USPSTF) updated its 2003 recommendations for cervical cancer screening. ¹ In the same year, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology published a consensus guideline. ² This was followed by publication of a guideline from the American College of Obstetricians and Gynecologists. ³ These guidelines all recommend Pap testing for cervical cancer every 3 years in women ages 21 to 65. In women ages 30 to 65, the screening interval can be lengthened to every 5 years if the patient undergoes cotesting for human papillomavirus (HPV). These recommendations apply only to women with a cervix.

No screening after hysterectomy for benign indications

Women who undergo hysterectomy with complete removal of the cervix for benign indications, ie, for reasons other than malignancy, are no longer at risk of cervical cancer. Pap testing could still detect vaginal cancer, but vaginal cancer is rare and screening for it is not indicated. The USPSTF 2003 and 2012 guidelines recommend not performing Pap testing in women who had had a hysterectomy for benign indications. ¹

Vaginal cancer is rare

Although cervical and vaginal cancers share risk factors, vaginal cancer accounts for only 0.3% of all invasive cancers and 1% to 2% of all gynecologic malignancies in the United States. ⁴

A review of 39 population-based cancer registries from 1998 to 2003 found the incidence rate for in situ vaginal cancer to be 0.18 per 100,000 women, and the incidence rate for invasive vaginal cancer was 0.69 per 100,000. Rates were higher in older women and in certain ethnic and racial groups, including black and Hispanic women. ⁴

When the cervix is removed during hysterectomy for a benign indication, the patient’s risk of vaginal cancer or its precursors is extremely low. Pearce et al ⁵ reviewed Pap tests obtained from the vaginal cuff in 6,265 women who had undergone hysterectomy for benign disease. Their 2-year study reviewed 9,610 vaginal Pap tests, and in only 5 women was vaginal intraepithelial neoplasia type I or II found, and none of the 5 had biopsy-proven vaginal cancer. Only 1.1% of all Pap tests were abnormal. The authors concluded that the positive predictive value for detecting vaginal cancer was 0%. ⁵

A retrospective study by Piscitelli et al ⁶ in 1995 looked back 10 years and found an extremely low incidence of vaginal dysplasia in women who had undergone hysterectomy for a benign indication. Their findings, coupled with the high rate of false-positive tests, do not support cytologic screening of the vagina after hysterectomy for a benign indication. The data also suggested that 633 tests would need to be performed to diagnose 1 case of vaginal dysplasia. ⁶ Other studies have also reported a low yield of vaginal cuff cytologic testing after hysterectomy for benign disease.

Therefore, given the low prevalence of disease and the lack of evidence of benefit of screening after hysterectomy for benign indications, Pap testing of the vaginal cuff is not recommended in these patients. ⁷

Screening for women at high risk after hysterectomy

For women with a history of grade 2 or 3 cervical intraepithelial neoplasia who have undergone hysterectomy, there are only limited data on subsequent disease risk.

Wiener et al ⁸ followed 193 post-hysterectomy patients who had a history of cervical intraepithelial neoplasia with Pap testing annually for more than 10 years for a total of 2,800 years of follow-up. The estimated incidence of abnormal cytology (0.7/1,000) was higher than in the general population. ⁸

Thus, for these women and for others at high risk who have undergone hysterectomy and have a previous diagnosis of cervical cancer, who had been exposed to diethylstilbestrol, or who are immunocompromised, Pap testing to screen for cancer in the vaginal cuff is recommended, as they are at higher risk of dysplasia at the vaginal cuff. ²

Practice trends, areas for improvement

Despite recommendations against screening, many providers continue this non-evidence-based practice. ⁴

The 2000–2013 National Health Interview Survey of women age 20 or older who had undergone hysterectomy asked about their most recent Pap test by self-report. Women were excluded if they had a history of cervical cancer, if they had had a Pap test for another health problem, or if the result of the recent Pap test was not known. In 2000, nearly half (49.1%) of the respondents said they had received a Pap test in the previous year; in 2013, the percentage undergoing testing was down to 32.1%, but testing was unnecessary in 22.1%. Screening was largely due to clinician recommendations, but it was initiated by patients without clinician recommendations in about one-fourth of cases. ⁹Lack of knowledge of the revised 2012 guidelines was cited as the primary reason for unnecessary screening. ¹⁰

A study of provider attitudes toward the cancer screening guidelines cited several reasons for nonadherence: patient concern about the guidelines; quality metrics that are incongruent with the guidelines; provider disagreement with the guidelines; risk of malpractice litigation; and lack of time to discuss the guidelines with patients. ¹¹

As the healthcare landscape changes to team-based care, the clinician and the entire healthcare team should educate patients about the role of vaginal cancer screening after hysterectomy for benign reasons. Given the limited time clinicians have with patients during an office visit, innovative tools and systems outside the office are needed to educate patients about the risks and benefits of screening. ¹¹ And notices in the electronic medical record may help busy clinicians keep up with current guidelines. ¹⁰

The clinical bottom line

Pap testing to screen for vaginal cancer in women who have undergone hysterectomy for a benign indication is an example of more testing, not better care. Evidence is lacking to justify this test in women who are not at high risk of cervical cancer. To reduce the overuse of cytology screening tests, providers need to stay informed about evidence-based best practices and and to pass this information along to patients.

We should focus our resources on HPV vaccination and outreach to increase screening efforts in geographic areas with low rates of Pap testing rather than provide unnecessary Pap testing for women who have undergone hysterectomy for a benign indication.

This article originally appeared in Cleveland Clinic Journal of Medicine, 2018 June;85(6):456-458. Read the full article, Is Pap Testing Still Needed After Hysterectomy?

References

1. Moyer VA; US Preventive Services Task Force. Screening for cervical cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med 2012; 156(11):880–891, W312. doi:10.7326/0003-4819-156-12-201206190-00424
2. Saslow D, Solomon D, Lawson HW, et al; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012; 137(4):516–542. doi:10.1309/AJCPTGD94EVRSJCG
3. Committee on Practice Bulletins—Gynecology. ACOG practice bulletin number 131: screening for cervical cancer. Obstet Gynecol 2012; 120(5):1222–1238. doi:10.1097/AOG.0b013e318277c92a
4. Wu X, Matanoski G, Chen VW, et al. Descriptive epidemiology of vaginal cancer incidence and survival by race, ethnicity, and age in the United States. Cancer 2008; 113(10 suppl):2873–2882. doi:10.1002/cncr.23757
5. Pearce KF, Haefner HK, Sarwar SF, Nolan TE. Cytopathological findings on vaginal Papanicolaou smears after hysterectomy for benign gynecologic disease. N Engl J Med 1996; 335(21):1559–1562. doi:10.1056/NEJM199611213352103
6. Piscitelli JT, Bastian LA, Wilkes A, Simel DL. Cytologic screening after hysterectomy for benign disease. Am J Obstet Gynecol 1995;173(2):424–432. pmid:7645617
7. Stokes-Lampard H, Wilson S, Waddell C, Ryan A, Holder R, Kehoe S. Vaginal vault smears after hysterectomy for reasons other than malignancy: a systematic review of the literature. BJOG 2006; 113(12):1354–1365. doi:10.1111/j.1471-0528.2006.01099.x
8. Wiener JJ, Sweetnam PM, Jones JM. Long term follow up of women after hysterectomy with a history of pre-invasive cancer of the cervix. Br J Obstet Gynaecol 1992; 99(11):907–910. pmid:1450141
9. Guo F, Kuo YF. Roles of health care providers and patients in initiation of unnecessary Papanicolaou testing after total hysterectomy. Am J Public Health 2016; 106(11):2005–2011. doi:10.2105/AJPH.2016.303360
10. Teoh DG, Marriott AE, Isaksson Vogel R, et al. Adherence to the 2012 national cervical cancer screening guidelines: a pilot study. Am J Obstet Gynecol 2015; 212(1):62.e1–e9. doi:10.1016/j.ajog.2014.06.057
11. Haas JS, Sprague BL, Klabunde CN, et al; PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) Consortium. Provider attitudes and screening practices following changes in breast and cervical cancer screening guidelines. J Gen Intern Med 2016; 31(1):52–59.  doi:10.1007/s11606-015-3449-5

After Hysterectomy, Do You Need Annual Pap Smears?

Medically reviewed by
Dr. Stephen Jones
McLeod OB/GYN Dillon

The removal of a uterus (a hysterectomy) can help with a number of women’s problems, such as bleeding and endometriosis.

“A common question that arises after hysterectomy is: Do I still need an annual Pap Smear?” says McLeod OB/GYN Dr. Stephen Jones. “Although several years ago new guidelines for a Pap Smear were adopted by the professional organization of OB/GYNs and the American Cancer Society, there are still other considerations to take into account.”

OTHER CONSIDERATIONS
A total hysterectomy involves the removal of the uterus and the cervix (the tissue that connects the uterus to the vagina).  In this case, a woman could consider stopping Pap Tests or HPV tests. Testing for the Human Papilloma Virus has also been approved as another screening tool for cervical cancer.

If the hysterectomy was performed because of abnormal cervical cells or cervical, ovarian or endometrial cancer, the woman should continue with tests according to the guidelines.

If you have an history of pre-cancer cells, you should maintain testing for at least 25 years after that condition was found, even after age 65.

If a woman has the fairly uncommon supra-cervical hysterectomy in which the cervix is not removed, she should consider continuing with Pap Smears under the guidelines.

IT’S A PERSONAL THING
You have to take into account everything about the patient. Professional organizations are also recommending that we space out Pap Smears at 3 or 5 years. Whether or not that is the right thing to do for you – is up to you and your doctor.

As physicians, we take into account what these organizations say and apply them to each patient as a unique individual — rather than consider everyone the same.  So, you and your Gynecologist should talk about whether you should stop having Pap Smears.

Find an OB/GYN near you.

Sources include: McLeod Health, American Cancer Society, Harvard Health, US Department of Health & Human Services, American College of Obstetricians & Gynecologists

Cervical Cancer Screening | ACOG

Anus: The opening of the digestive tract through which bowel movements leave the body.

Cells: The smallest unit of a structure in the body. Cells are the building blocks for all parts of the body.

Cervical Biopsy: A minor surgical procedure to remove a small piece of cervical tissue that is then examined under a microscope in a laboratory.

Cervical Cancer: A type of cancer that is in the cervix, the opening to the uterus at the top of the vagina.

Cervical Cytology: The study of cells taken from the cervix using a microscope. Also called a Pap test.

Cervix: The lower, narrow end of the uterus at the top of the vagina.

Colposcopy: Viewing of the cervix, vulva, or vagina under magnification with an instrument called a colposcope.

Co-Testing: Use of both the Pap test and human papillomavirus (HPV) test to screen for cervical cancer.

Diabetes Mellitus: A condition in which the levels of sugar in the blood are too high.

False-Negative: A test result that says you do not have a condition when you do.

False-Positive: A test result that says you have a condition when you do not.

Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).

Human Papillomavirus (HPV): The name for a group of related viruses, some of which cause genital warts and some of which are linked to cancer of the cervix, vulva, vagina, penis, anus, mouth, and throat.

Hysterectomy: Surgery to remove the uterus.

Immune System: The body’s natural defense system against viruses and bacteria that cause disease.

Loop Electrosurgical Excision Procedure (LEEP): A procedure that removes abnormal tissue from the cervix using a thin wire loop and electric energy.

Menopause: The time when a woman’s menstrual periods stop permanently. Menopause is confirmed after 1 year of no periods.

Menstrual Period: The monthly shedding of blood and tissue from the uterus.

Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.

Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer.

Pelvic Exam: A physical examination of a woman’s pelvic organs.

Pelvic Floor Disorders: Disorders that affect the muscles and tissues that support the pelvic organs.

Penis: The male sex organ.

Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called “having sex” or “making love.”

Speculum: An instrument used to hold open the walls of the vagina.

Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.

Vagina: A tube-like structure surrounded by muscles. The vagina leads from the uterus to the outside of the body.

Virus: An agent that causes certain types of infections.

Vulva: The external female genital area.

Pap tests and HPV screening after hysterectomy

View all recommendations from this society

February 14, 2017; Updated October 3, 2019

Don’t perform vaginal cytology (Pap test) or HPV screening in patients who had hysterectomy (with removal of the cervix) and have no history of high-grade cervical dysplasia (CIN 2/3) or cancer.

Vaginal cancer after hysterectomy is very rare, less likely than breast cancer for men, for which screening is not recommended. Screening these women is more likely to discover benign changes that prompt invasive testing than to prevent cancer. Continued surveillance is recommended for patients who had a hysterectomy and have a history of high-grade cervical dysplasia or cancer in the last 25 years, as their risk of vaginal cancer remains elevated. Vaginal assessment may also be indicated in the presence of HPV-associated vulvar cancer.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

As a national medical specialty society with membership across multiple disciplines and differing healthcare providers, including doctors and advanced practice nurses, the ASCCP (The Society for Lower Genital Tract Disorders) relies on input from its committee structure and governance for document development. For the Choosing Wisely campaign, the list was obtained through expert discussion of members of the Practice Committee. A literature search was conducted related to each item. The list was then ratified by the Society’s Executive Committee and Chief Medical Officer. Due to the complexity of language around cervical cancer screening, several items use more than one term to describe the same concept (i.e., cervical cytology/Pap test, and high-grade cervical dysplasia/CIN 2/3). This was done intentionally to avoid confusion, and the statements include all terms thought to be important by members of the ASCCP. All comments from the Executive committee were incorporated into the final approved list.

American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology.

Am J Clin Pathol. 2012 Apr;137(4):516-42.
CA Cancer J Clin. 2012 May-Jun;62(3):147-72.
J Low Genit Tract Dis. 2012 Jul;16(3):175-204.

ACOG Committee on Practice Bulletins – Gynecology. Cervical Cancer Screening and Prevention. Practice Bulletin #157. Obstet Gynecol 2016;127:e1–20

90,000 Pap test and cervical cancer

Pap tests – what are they?

The vast majority of women (over 90%) over the age of 18 have had a Pap smear at least once. According to a study published in the journal “ Journal of General Internal Medicine ” , in 20% of American women, the Pap smear showed abnormalities that could indicate cervical cancer.

Screening for cervical cancer is an important aspect of healthcare worldwide. The Pap test is recognized for its effectiveness in fighting cancer in many countries, and deaths from this disease have decreased by more than 70% since the 1950s. This is mainly due to the proliferation of screening programs that have become more accessible.

What is a Pap test?

A Pap test, or Pap smear, is a procedure in which cells are taken from the walls of the cervix and examined under a microscope.The test is needed to identify cellular abnormalities that can be a sign of cervical cancer and other conditions such as infection and inflammation. A Pap test can detect precancerous conditions and small tumors that can cause cervical cancer.

The Pap smear is named after the Greek scientist Georgios Nicolaou Papanikolaou, who developed the method. Between 1917 and 1928, Papanicolaou was one of the first to draw attention to the diagnosis of disease using cell samples.Several studies have shown that mortality rates from cervical cancer have dropped significantly since the 1950s, when pap smear screening programs were introduced.

To do a Pap test, a gynecologist examines the cervix and vagina, then he takes samples of cells from the walls of the cervix, which goes to the vagina, and the cervical canal, which goes into the uterus. Then these cells are placed in a solution, transferred to a small glass slide and sent to the laboratory for cytological examination.

Cytological examination evaluates the appearance, structure and function of cells under a microscope. If abnormalities are found in the cells, the smear is sent for further examination to determine the degree of danger of deviations.

Key recommendations

In 2004, a team of scientists collected data on the frequency of screening for cervical cancer in the United States. They found that among women whose Pap test results were within the normal range, 55% had regular swabs, 17% every two years, 16% every three years, and 11% were screened occasionally.Scientists found that even older women reported regular screening (38% of women aged 75 to 84 and 20% of women over 85). About 20% of all respondents reported that they received unsatisfactory test results at least once, while among them 80% regularly took the Pap test. Based on the findings, the researchers suggested that doctors perform Pap tests on women over the age of 21 who are not at risk of developing cervical cancer every 2-3 years.

The American Society of Obstetricians and Gynecologists recommends that women have a Pap test every two years from the age of 21.After age 30, screening can be done every 3 years if the woman is not at risk and has received three satisfactory Pap tests in a row. The American Cancer Society believes that women aged 30-65 should have both a Pap test and an HPV test every 5 years. Women who are at high risk of developing cervical cancer due to a weakened immune system due to infection, organ transplantation, or long-term steroid use should be screened more frequently.

The American Cancer Society also believes that women over 65 who have received regular screening that have not shown any serious precancerous disease in the past 20 years may stop taking the Pap test.

Women who have had a total hysterectomy may also not have a Pap smear if the operation was done as part of cervical precancerous disease.

Use

The main benefit of the Pap test is that it is an effective method for diagnosing cervical cancer and has saved the lives of many women. Cervical cancer occurs when healthy cells in the cervix become abnormal and grow uncontrollably. Cancer cells invade deeper tissues, and as it develops, cancer can spread to other organs.

According to a study published in the journal Obstetrics and Gynecology Clinics of North America in 2009, the incidence and death of cervical cancer has dropped significantly in the United States since the 1950s by more than 70%.This decline is mainly due to the introduction of Pap tests in the 1940s. Cervical cancer was once the leading cause of death among women (it now ranks 12th). Scientists have found that in most developed countries, cervical cancer accounts for only 7% of all malignant neoplasms in women, while in developing countries this figure is 27%. This difference is primarily due to the lack of tests and timely treatment of precancerous conditions.

A 1994 study published in the International Journal of Gynecology and Obstetrics evaluated the effectiveness of a Pap smear screening program in reducing cervical cancer mortality.The analysis showed a 53% reduction in mortality due to screening, which supports the hypothesis that the Pap test plays an important role in a woman’s health.

What if the Pap test shows abnormalities?

If the test shows abnormalities, this does not mean that you have cancer, but it does indicate that abnormal cells are present in the cervix. Since a smear is not a method for diagnosing a disease, it cannot show the presence of cancer for sure.A poor test may be due to inflammation or minor cellular changes (such as dysplasia). Before the appearance of cancer cells in the tissues, healthy ones undergo some changes, this is called dysplasia. With dysplasia, the cells look different, but they may never become cancerous. Other reasons for an unsatisfactory Pap test include the use of a vaginal diaphragm, intercourse, or cellular changes associated with the menstrual cycle.

Most of the noncancerous problems found with a Pap test will resolve on their own.If your doctor notices any minor abnormalities, he or she will most likely recommend repeating the test after a few months. If the abnormalities do not disappear, and the abnormal cells continue to progress, then a more detailed diagnosis may be required.

The human papillomavirus (HPV) test detects the presence of human papillomavirus, which can lead to the development of genital herpes, changes in cervical cells, or the development of cervical cancer. If the Pap test is not satisfactory, your doctor may recommend an HPV test to find out if the virus is causing the cellular changes.Most cases of cervical cancer are caused by an infection with HPV, which is sexually transmitted from person to person. HPV infections usually go away on their own, causing minor cellular changes. But in some women, HPV remains and leads to serious violations of the development of cells of the cervix. The study, published in the journal Clinical Microbiology Reviews , believes that Pap and HPV tests go a long way toward identifying women at risk for cervical cancer.

If your Pap smear and HPV test are not satisfactory, you may be scheduled for colposcopy. During the colposcopy procedure, the doctor examines the cervix with a multi-magnification instrument (colposcope). The doctor uses a weak solution of acetic acid on the cervix to make abnormal areas more visible. If abnormalities have been noticed, a tissue sample (biopsy) is taken from the suspicious area. A biopsy is the only way to know if the changes are cancerous or precancerous.

In the case of precancerous changes, the abnormal tissue is removed and the growth stops. Regular Pap tests are due to the slow progression of cervical cancer. Preventing the development of abnormal cells will help protect against the development of more serious diseases.

Warning

Screening for cervical cancer is not always accurate. Sometimes the result may be unsatisfactory, although all cells are healthy. Or, conversely, screening cannot detect changes, although they are present.A false negative result can be caused by a small number of abnormal cells, an insufficient number of cells taken for analysis, or the presence of inflammatory cells that hide the abnormality. To get the most accurate result, experts recommend that you give up sexual intercourse, douching or vaginal creams 48 hours before the test. Also, do not screen for cervical cancer during menstruation.

Unfortunately, an unsatisfactory Pap test can cause feelings of anxiety and stress.In 2009, a study was carried out in Thailand in which 75 women with a negative result of abnormal cell growth and 76 women with a positive one. The researchers found that women who were found to have negative changes were concerned about issues such as having cancer, pain when visiting a gynecologist, and the possibility of transmission from a partner during intercourse.

If your Pap smear is unsatisfactory, talk with your doctor about other possible diagnostic tests for treatment.

In many women, cells return to normal without the use of drugs, but if this does not happen, keep in mind that cancer takes years and serious cellular changes to develop.

Final conclusions

• Cervical cancer screening is one of the most important aspects of healthcare worldwide. Pap smears have been shown to be effective in reducing cervical cancer mortality.
• A Pap test, or Pap smear, is a procedure for taking samples of cells from the walls of the cervix and examining them under a microscope.The test is used to detect cellular abnormalities, which could be a sign of cancer or other medical conditions, such as infection or inflammation.
• Women should have a Pap test every two years from the age of 21. After 30 years, the smear can be taken less often, every 3 years, if the woman is not at risk. After reaching the age of 65, the Pap test can be stopped if, over the past 20 years, regular screening of the cervix has not shown serious precancerous abnormalities.
• A study suggests that the incidence and death rate of cervical cancer has declined by more than 70% in the United States since the 1950s. This is largely due to the introduction of the Pap test in the 1940s.
• An unsatisfactory Pap smear does not always indicate cancer, it only indicates a cellular abnormality.
• Most of the noncancerous problems identified with the Pap test resolve on their own. If the doctor notices any abnormalities, he or she will probably recommend re-taking the test after a few months.

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Cytological analysis: how the PAP test is performed and why it is needed | Healthy life | Health

This study got its name from the Greek scientist Georgios Papanikolaou, a pioneer in cytology and early diagnosis of cancer. The PAP test helps to identify those cellular changes in the cervical epithelium, which can subsequently lead to cancer, and to initiate treatment in a timely manner.Today this analysis is used all over the world, and it has already saved the lives of hundreds of thousands of women.

How is the PAP test done

The procedure for collecting cellular material is painless. It is performed during the examination in the gynecological chair. First, using a cotton swab, the doctor cleans the surface of the cervix of the uterus from secretions, then using a special brush, the material for research is taken, which is applied to the glass slide. This piece of glass will go to the laboratory, where it will be studied under a microscope.

How often should a cytological smear be taken for analysis

The Association for Cervical Pathology and Colposcopy gives such recommendations in this regard.

All women should begin to undergo a cytological examination 3 years after the onset of sexual activity, but no later than 21 years.

Women from 21 to 49 years old need to undergo a cytological examination every 3 years, and from 50 to 65 years old – every 5 years. However, there is a category of women with weakened immunity (HIV-infected, after organ transplant, after chemotherapy, or constantly using steroids) who must undergo this study annually.Gynecologists also advise women over 30 years of age with normal smear counts to do a human papillomavirus DNA test at every three-year check.

Women aged 65 and older who have not had anything wrong with three cytological examinations in the past 10 years may no longer be screened for cervical cytology. However, this does not apply to those who have previously received treatment for cervical cancer, HIV carriers, or immunocompromised women.They need to keep testing.

A special group is made up of women who have undergone surgery to remove their reproductive organs. After a complete hysterectomy (removal of the uterus together with the cervix), cytological screening is no longer necessary, unless this operation was performed as part of the treatment of cancer or precancer of the cervix. If the amputation affected only the uterus, without removing the cervix (supravaginal amputation), then cytological screening should be continued, adhering to the general principles of cervical cancer prevention.

How to prepare for the study?

First of all, a cytological smear is not taken during menstruation and during inflammatory processes of an infectious nature.

In order not to smear the paintings, it is not recommended to douche, insert tampons, suppositories or creams into the vagina two days before the study.

You should also abstain from sexual intercourse two days before visiting a gynecologist.

What the results say

As a rule, the results of the PAP test come to the doctor in 1–2 weeks.And, if atypical cells are found in them, this does not mean a sentence. The revealed deviation from the norm is just a call to be on the alert and undergo additional examinations. In this case, first of all, colposcopy is prescribed. This is a procedure for examining the vulva, vagina and cervix using a special device – a colposcope, which helps to identify the presence of lesions of the cervical epithelium and determine their nature. And already on the basis of this study, the doctor decides whether a cervical biopsy is needed.

Read on:

What tests should be taken regularly?

Why vaccinate adolescent girls against cervical cancer?

Read on social networks!

Liquid cytology.Examination of scraping of the cervix and cervical canal (Papanicolaou staining)

Cytological examination using a special method of staining the material, which allows with high sensitivity to identify atypical cells in the smear and diagnose early precancerous changes in the epithelium and cervical cancer.

Synonyms Russian

Pap smear, Pap test, smear for oncocytology.

Synonyms English

Pap smear, Papanicolaou Smear; Cervical Smear; Cervical Oncocytology.

Research method

Liquid cytology method.

Which biomaterial can be used for research?

Mixed smear from the cervical canal and the surface of the cervix.

General information about the study

Cervical cancer (CC) ranks third in prevalence among all malignant tumors in women (after breast cancer and colon cancer). The incidence of invasive cervical cancer worldwide is 15-25 per 100,000 women.Cervical neoplasms occur mainly in middle-aged women (35-55 years old), are rarely diagnosed under the age of 20, and in 20% of cases are detected over the age of 65.

The 5-year survival rate for localized (local, in situ) cervical cancer is 88%, while the survival rate for advanced cancer does not exceed 13%.

Risk factors for developing cervical cancer include human papillomavirus infection (oncogenic serotypes HPV 16, HPV 18, HPV 31, HPV 33, HPV 45, etc.), smoking, chlamydial or herpes infection, chronic inflammatory gynecological diseases, long-term use of contraceptives, cases of cervical cancer in the family, early onset of sexual activity, frequent change of sexual partners, insufficient intake of vitamins A and C, immunodeficiency and HIV infection …

According to international recommendations, all women should be screened (pre-symptomatic examination) for cervical cancer 3 years after the onset of sexual activity, but no later than 21 years.From the age of 30, patients who have 3 consecutive negative cervical smear results can be screened every 2-3 years. Women with risk factors (human papillomavirus infection, immunodeficiency states) should continue to be screened annually. Women 65 and older with 3 or more normal cervical smear results in the past 10 years may not be eligible for screening. Those who have had cervical cancer, have a papilloma virus infection or a weakened immune system, it is advisable to continue screening.Women who have undergone removal of the uterus and cervix may not have this test if the operation was not performed because of cancer or precancerous condition of the cervix. Those who had surgery only on the uterus, without removing the cervix, should continue to participate in the screening.

Liquid cytology – an innovative method of cytological examination, ideal for diagnosing neoplasms of the mucous membrane of the canal and the vaginal part of the uterine cervix; it is used when a patient suspects cancer or dysplasia.Thanks to it, cancer can be detected at the earliest stages of development.

After taking a smear for oncocytology, the biomaterial is placed in a liquid medium. With the help of a special centrifuge, cells (cytopreparations) are “washed”, which are concentrated in one place and form an even layer. In this case, the conclusion of a cytologist will be more accurate and informative than in conventional cytology, when the material taken for research is immediately applied to a medical glass for analysis.

The advantage of the PAP test is the high definition of the cell image.When using this technology, the resulting material is mixed with a special solution, which mechanically separates the epithelial cells from contamination. As a result, the number of false negative results is significantly reduced.

Cytological examination of material from the cervix and cervical canal, stained by the Papanicolaou method in compliance with the test method and conditions of preparation for analysis, allows with high sensitivity and reliability to identify atypical cells in the material, precancerous conditions (dysplasia, intraepithelial neoplasia of the cervix).Most often, a biomaterial obtained with a special cytobrush from two points (epithelium of the endocervix and exocervix) is examined. Material from the transformation zone should get into the smear, since about 90% of neoplastic conditions come from the junction zone of the squamous and cylindrical epithelium and only 10% from the cylindrical. This study can also reveal signs of infection, pathology of the endocervix and endometrium.

Screening and early diagnosis of precancerous conditions and early stages of cervical cancer allow timely effective treatment and prevent dangerous consequences.

What is the research used for?

• Screening and diagnosis of precancerous diseases of the cervix.
• Screening and diagnosis of cervical cancer.

When is the study scheduled?

• For periodic examination of girls and women 3 years after the onset of sexual activity, but no later than 21 years (it is recommended to take the analysis annually and at least every 3 years).
• Every 2 to 3 years from age 30 to 65 years with three consecutive negative results.
• Annually if you have human papillomavirus (HPV), if your immune system is weakened as a result of transplantation, chemotherapy, or prolonged use of steroid hormones.

What do the results mean?

Based on Bethesda classification “ The 2001 Bethesda System terminology ”

1. Amount of material

• Material full (adequate) – a good quality smear containing a sufficient number of appropriate cell types is considered a complete material.
• The material is insufficiently complete (insufficiently adequate) – there are no endocervical cells and / or metaplastic cells in the material, squamous epithelial cells are in sufficient quantity, or the cellular composition is poor.
• The material is defective (inadequate) – it is impossible to judge the presence or absence of pathological changes in the cervix by the material.

2. Interpretation of results:

• Negative Pap test – epithelial cells within normal limits, cytogram corresponds to age, normal.
• Benign changes – the presence of non-tumor cells, signs of inflammation (increased number of leukocytes), infection (a significant number of cocci, rods). It is possible to detect infectious agents (indicating the pathogen), for example Trichomonas, yeast.
• Changes in squamous epithelial cells (require increased attention, additional examination and if precancer or cancer is detected, treatment):

• atypical squamous epithelial cells of unclear significance;
• atypical squamous epithelial cells that do not exclude HSIL;
• squamous intraepithelial lesion;
• low degree of squamous intraepithelial lesion;
• high degree of squamous intraepithelial lesion;
• Cervical intraepithelial neoplasia of the 1st, 2nd or 3rd degree;
• carcinoma in situ;
• Squamous cell carcinoma is invasive cancer.