Self-reported Papanicolaou smears and hysterectomies among women in the United States

OBJECTIVE: To evaluate the potential overuse of Papanicolaou smears among w omen who have had a hysterectomy. METHODS: We analyzed two surveys of US women aged 18 years or older, the Be havioral Risk Factor Surveillance System (1992-1997) and the National Healt h Interview Survey (1993-1994), and one survey of US hospitals (National Ho spital Discharge Survey, 1980-1997). We examined die number of women who ha ve 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 Papanicola ou 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 hyste rectomy, 78.3% had a recent Papanicolaou smear. Among those reporting no hy sterectomy, 82.1% had a recent papanicolaou smear. Estimates from the Natio nal Health Interview Survey were similar. From the National Hospital Discha rge Survey, an estimated 6.7% to 15.4% of women with a history of hysterect omy would require a subsequent Papanicolaou smear because they had a diagno sis related to cervical neoplasia or because they had undergone a supracerv ical hysterectomy. For an estimated 10.6-11.6 million of the 12.5 million w omen who had a hysterectomy and a recent Papanicolaou smear, that test coul d be considered unnecessary. CONCLUSION: Continued Papanicolaou screening of women without an intact ute ri may result in excessive use of resources in time and money with minimal impact on decreasing cervical cancer. (C) 2001 by the American College of O bstetricians and Gynecologists.