- The Washington Times - Tuesday, June 22, 2004

Nearly half of the 22 million American women who have had their cervix removed during a hysterectomy continue to get unnecessary Pap smears to test for cervical cancer, a study has found.

“This a problem because Pap smears are uncomfortable, and we don’t want them for women who can’t benefit,” said Brenda E. Sirovich, who co-authored the study published in this week’s issue of the Journal of the American Medical Association (JAMA).

It is not clear why about 10 million women without cervices were administered the test, but the researchers suspect “physicians are largely responsible” and testing is continued to meet screening benchmarks set by insurers or health maintenance organizations, said Dr. Sirovich, an assistant professor at the Dartmouth Medical School and staff physician with the Department of Veterans Affairs medical center in White River Junction, Vt.

She said women might be demanding the needless screenings to reassure themselves they don’t have cervical cancer, or might not realize they no longer have a cervix or understand what the test detects.

The study shows the U.S. Preventive Services Task Force’s 1996 recommendations against Pap screening for women who did not have cervical cancer when undergoing a complete hysterectomy “have not been heard or have been ignored.”

The report in JAMA found that one in five U.S. women 18 and older have undergone hysterectomies, the surgical removal of the uterus, or womb. It also found that most of them had their cervix removed.

About 10 percent undergo hysterectomies for cancer or for precancerous lesions, with the “top diagnosis” for the procedure being uterine fibroids, or benign growths, said the American College of Obstetrics and Gynecology.

Dr. Sirovich said the study she wrote with Dr. H. Gilbert Welch, who is also with the VA center at White River Junction, was designed to find out what, if any, influence the federal recommendations against unnecessary Pap smears have had on the numbers being performed.

The investigation found that the proportion of women who reported a current Pap smear, or having had one in the past three years, “did not change during the 10-year study period.” The study period included the four years before 1996 and six years afterward, Dr. Sirovich said.

In 1992, four years before the federal task force’s recommendations, 68.5 percent of women who had hysterectomies reported having had Pap smears in the past three years. In 2002, 69.1 percent who had undergone hysterectomies also said they had current Pap smears.

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