Self-Reported Papanicolaou Smears and Hysterectomies Among Women in the United States

In Brief OBJECTIVE To evaluate the potential overuse of Papanicolaou smears among women who have had a hysterectomy. METHODS We analyzed two surveys of US women aged 18 years or older, the Behavioral Risk Factor Surveillance System (1992–1997) and the National Health Interview Survey (1993–1994), and one survey of US hospitals (National Hospital Discharge Survey, 1980–1997). We examined the number of women who have 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 Papanicolaou smear. 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 hysterectomy, 78.3% had a recent Papanicolaou smear. Among those reporting no hysterectomy, 82.1% had a recent Papanicolaou smear. Estimates from the National Health Interview Survey were similar. From the National Hospital Discharge Survey, an estimated 6.7% to 15.4% of women with a history of hysterectomy would require a subsequent Papanicolaou smear because they had a diagnosis related to cervical neoplasia or because they had undergone a supracervical hysterectomy. For an estimated 10.6–11.6 million of the 12.5 million women who had a hysterectomy and a recent Papanicolaou smear, that test could be considered unnecessary. CONCLUSION Continued Papanicolaou screening of women without an intact uteri may result in excessive use of resources in time and money with minimal impact on decreasing cervical cancer. Many women who have had a hysterectomy report a recent Papanicolaou smear, inconsistent with recommendations that most women do not need cervical cancer screening after a hysterectomy.