Millions of Unnecessary Pap Tests

Cervical cancer screenings were still given to women without cervixes and older women

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) If a woman has had a hysterectomy, does she still need to have Pap smears? It would stand to reason that she doesn’t since the test screens for cervical cancer and a hysterectomy removes the cervix in nearly all of these procedures.

Despite this fact, nearly two thirds of the women who’d had a hysterectomy reported they had recently had a Pap test in a national health survey, a new study found.

And more than half of the women over the age of 65 with no history of cervical cancer also said they’d had Pap tests recently. Cervical cancer screenings are not usually recommended for women in this age group.

Altogether, the researchers estimated that about 14 million women had unnecessary cervical cancer screenings.

"Establish a cancer screening program with your doctor."

Deanna Kepka, PhD, MPH, a researcher at the Huntsman Cancer Institute at the University of Utah and assistant professor in the College of Nursing at the University of Utah, and colleagues sought to evaluate cervical cancer screening patterns among older women and those who'd had hysterectomies.

These researchers examined data from the 2010 National Health Interview Survey (NHIS), which has been tracking the health of the US population since 1957. The 2010 report has the most recent cervical cancer screening data.

In 2003, the US Preventive Services Task Force (USPSTF) recommended against cervical cancer screenings of women who had undergone hysterectomies and of women over the age of 65.

Women who’ve had hysterectomies do not benefit from the screening because in most cases, the cervix (which is the opening of the uterus) is surgically removed. 

Cervical cancer is a slow-growing cancer that’s very unlikely to develop later in life. For this reason, the USPSTF does not recommend Pap tests for women over the age of 65 who have no history of cervical cancer or pre-cancerous conditions.

For this study, the researchers reviewed data from 9,494 women over the age of 30 who responded to the 2010 NHIS and reported their Pap test history and hysterectomy status.

Of the women who’d had a hysterectomy, 34.1 percent reported having a Pap test in the previous year.

Of all the women who had undergone hysterectomy, 64.8 percent said they had recent Pap tests following the surgery.

Among women aged 65 and older, 58.4 percent said they had received a Pap smear in the past three years.

The researchers used “population weights" from the 2010 NHIS to calculate that Pap tests had been unnecessarily given to some 14 million women.

"We knew there would be overuse of Pap tests, because the few studies of cervical cancer screening showed overuse ten years ago," Dr. Kepka said in a statement. "But we were shocked to see so little change over the past ten years [since the USPSTF recommendations]."

According to the authors of this study, “Targeted efforts are needed to reduce unnecessary testing among older women and women without a cervix in compliance with clinical recommendations for cervical cancer prevention."

This study was published November 25 in JAMA Internal Medicine.

No conflicts of interest were reported.

Review Date: 
November 25, 2013
Last Updated:
December 30, 2013