Cervical cancer screening among women with and without hysterectomies

To compare the rate of Papanicolaou testing in a population-based sample of women with medical documentation of 1) total hysterectomy for benign conditions, 2) total hysterectomy for malignant conditions, and 3) hysterectomy with cervix intact to rates among women who had not had a hysterectomy.

The Marshfield Epidemiologic Study Area was used to identify a retrospective cohort of women with hysterectomies age-matched to women without hysterectomies. This study compares the Papanicolaou test rate per year (outcome) by hysterectomy status (exposure) for women with total hysterectomy for benign reasons (n=197), total hysterectomy for malignancy (n=75), supracervical hysterectomy (n=43), and no hysterectomy (n=315).

Compared with women who did not have a hysterectomy (nonexposed), women with a hysterectomy (exposed) for benign reasons had significantly fewer Papanicolaou tests; on average, one less test every 3 years (mean difference=-0.34 tests/year, P < .001). Contrary to this, women with a malignancy-related hysterectomy had significantly more tests than their nonexposed counterparts (mean difference=0.87 tests/year, P < .001); nearly one additional test per year. Finally, women with supracervical hysterectomies had the same rate of testing as their nonexposed counterparts (mean difference=-0.03 tests/year, P=.62); on average, one test every 2.5 years.

This study demonstrates that Papanicolaou testing rates vary by type and reason for hysterectomy. Women with hysterectomies for benign reasons may be receiving from two to three times as many tests as needed. Notably, women with intact cervices following hysterectomy have similar testing rates (one every 2.5 years) as women without hysterectomies. This has direct implications for leaving a woman's cervix intact given normal cytology at the time of hysterectomy.