OBJECTIVE: To evaluate the potential overuse of Papanicolaou smears among w
omen who have had a hysterectomy.
METHODS: We analyzed two surveys of US women aged 18 years or older, the Be
havioral Risk Factor Surveillance System (1992-1997) and the National Healt
h Interview Survey (1993-1994), and one survey of US hospitals (National Ho
spital Discharge Survey, 1980-1997). We examined die number of women who ha
ve had a hysterectomy who had a recent (within 3 years) Papanicolaou smear.
We also examined trends in the proportions and rates of hysterectomies by
diagnoses and type of procedure that potentially could require a Papanicola
RESULTS: From the Behavioral Risk Factor Surveillance System, an estimated
21.2% of US women have had a hysterectomy. Among women who have had a hyste
rectomy, 78.3% had a recent Papanicolaou smear. Among those reporting no hy
sterectomy, 82.1% had a recent papanicolaou smear. Estimates from the Natio
nal Health Interview Survey were similar. From the National Hospital Discha
rge Survey, an estimated 6.7% to 15.4% of women with a history of hysterect
omy would require a subsequent Papanicolaou smear because they had a diagno
sis related to cervical neoplasia or because they had undergone a supracerv
ical hysterectomy. For an estimated 10.6-11.6 million of the 12.5 million w
omen who had a hysterectomy and a recent Papanicolaou smear, that test coul
d be considered unnecessary.
CONCLUSION: Continued Papanicolaou screening of women without an intact ute
ri may result in excessive use of resources in time and money with minimal
impact on decreasing cervical cancer. (C) 2001 by the American College of O
bstetricians and Gynecologists.