Pap Smear After Hysterectomy and Cervical Cancer Screening Guidelines

Dear Dr. Dave and Dr. Dee,

I am 45 years old and had a hysterectomy. When I went to a doctor last year for my yearly Pap smear, she said I did not need one. However, my friends who have had hysterectomies say that they still have yearly Pap exams.

Signed,

Can you clarify the confusion?

Dear Can you clarify the confusion,

A Pap smear is an important screening test for early diagnosis of cervical cancer. Abnormal cells can bet detected before a tumor becomes invasive. Cervical cancer affects the reproductive organs and has a high cure rate if detected early.

Named after Dr. George Papanicolaou who developed the test, the Pap smear is a simple procedure that collects cells from the cervix.

If you had a total or complete hysterectomy which involved removal of your uterus and cervix, then you would not need a pap smear.

However, if a partial or subtotal hysterectomy removed the uterus but not the cervix, then Pap smears would be obtained.

Annual routine pelvic exams are still important no matter the type of hysterectomy.

The American Cancer Society (www.cancer.org) recommends the following screening for cervical cancer:

1. Cervical cancer screening (testing) should begin at age 21.

2. Women between ages 21 and 29 should have a Pap test every 3 years.

3. Women between the ages of 30 and 65 should have a Pap test plus an HPV test (called “co-testing”) every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.

4. Women over age 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past age 65.

5. A woman who has had her uterus removed (and also her cervix) for reasons not related to cervical cancer and who has no history of cervical cancer or serious pre-cancer should not be tested.