Debate surrounds the need for Pap test after hysterectomy
DEAR DR. ROACH: Could you please address the subject of the need for Pap tests after a hysterectomy? I had a total hysterectomy (uterus, cervix, fallopian tubes and ovaries) several years ago, in my late 50s, due to cancer, and I go for internal examinations regularly to both my general physician and the oncologist, but no further Pap tests have ever been done. I was told that once you have your cervix removed, there is no need for a Pap test. Several women I know continue to have Pap tests even after a hysterectomy. Why the discrepancy in the recommendation for this procedure? Thank you for your input. -- Anonymous
DEAR DR. ROACH: No woman, after a pelvic clean-out, should get a Pap. -- A.F.S., M.D., M.P.H.
ANSWER: The guidelines are clear that women who have had a total hysterectomy for cervical cancer should continue to have close follow-up, including a speculum and bimanual gynecologic exam as part of the complete physical exam. This is not the case for women who had a total hysterectomy for non-cancer reasons, such as fibroids; these women do not need Pap smears.
I agree with Dr. A.F.S. in that adding cervical cytology (the Pap smear) to the gynecologic exam may not add much benefit: In a recent study, only 6 percent of women with a recurrence of cervical cancer were diagnosed by the results of the Pap test. However, it seems to me, as a non-specialist, that it may still be worthwhile to obtain the Pap smear during the speculum exam, as even a 6 percent improvement means that some women will be diagnosed earlier than they otherwise would.
My strongly held opinion is that women with a history of cervical cancer continue to need screening for some period of time after treatment. This includes a complete gynecologic exam. Most experts feel that this should be done at least annually for at least five years (some groups recommend lifelong screening). I would leave the decision to obtain cervical cytology to the gynecologic oncologist treating the patient.
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