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

Obstet Gynecol. 2001 Aug;98(2):269-78. doi: 10.1016/s0029-7844(01)01447-8.


Objective: To evaluate the potential overuse of Papanicolaou smears among women who have had a hysterectomy.

Methods: We analyzed two surveys of US women aged 18 years or older, the Behavioral Risk Factor Surveillance System (1992-1997) and the National Health Interview Survey (1993-1994), and one survey of US hospitals (National Hospital Discharge Survey, 1980-1997). We examined the number of women who have 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 Papanicolaou 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 hysterectomy, 78.3% had a recent Papanicolaou smear. Among those reporting no hysterectomy, 82.1% had a recent Papanicolaou smear. Estimates from the National Health Interview Survey were similar. From the National Hospital Discharge Survey, an estimated 6.7% to 15.4% of women with a history of hysterectomy would require a subsequent Papanicolaou smear because they had a diagnosis related to cervical neoplasia or because they had undergone a supracervical hysterectomy. For an estimated 10.6-11.6 million of the 12.5 million women who had a hysterectomy and a recent Papanicolaou smear, that test could be considered unnecessary.

Conclusion: Continued Papanicolaou screening of women without an intact uteri may result in excessive use of resources in time and money with minimal impact on decreasing cervical cancer.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Data Collection
  • Female
  • Health Behavior
  • Health Services Misuse*
  • Humans
  • Hysterectomy*
  • Middle Aged
  • Papanicolaou Test*
  • Risk Factors
  • Socioeconomic Factors
  • United States
  • Vaginal Smears / statistics & numerical data*