No real need to screen women for vaginal cancer after hysterectomy for benign disease -
Hysterectomy, usually for benign conditions like fibromas, is one of the commonest surgical
procedures in the US. Typically these women continue to have routine Pap smears. Is there
need to take regular Pap smears from women who have no uterine cervix, especially if they were
not operated on for cancer? The November 21, 1996 issue of the New England Journal of
Medicine included an article and an editorial on this topic. The Pap smear can only detect
vaginal cancer in these women, and this is the least common form of gynecologic cancer. In
fact, researchers from the Louisiana State University Medical Center in New Orleans found that
the probability of finding an abnormal smear was only 1.1% as judged from examination of
9,610 smears from 5,682 women who had undergone hysterectomy for benign disease. The
abnormal smears were what are termed low-grade or early intraepithelial conditions, and there
were no biopsy-proved cases of vaginal cancer. The predictive value of the smear for vaginal
cancer was zero, and the editorial recommended relieving women of unnecessary discomfort and
anxiety by abandoning the practice of regular Pap smears in this population. (Pearce, New Engl
J Med 335, 1996 - Pearce p.1559 and editorial p.1599)
Editor's Comment: - This study is important in providing an answer to a troubling problem. No
one wants to abandon a measure that provides cancer prevention, but if the measure clearly does
not provide such prevention it is not needed, and women should be spared needless discomfort
and anxiety by discontinuing the practice.
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