Cervical Cancer Screening Among Women Without a Cervix

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. Previous Pap smear screening guidelines, including consensus guidelines issued in 1988, 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, 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. Although screening among women who had undergone hysterectomy was reported during the early 1990s, 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.