> The Pap Test is unnecessary after a hysterectomy

An expert consulted by Medscape Medical News has warned that the data from the CDC were based on self-evaluations of women that may be distorted in part.

The expert has also suggested that some of the tests that are not needed, which in any way are inconsistent with the guidelines that have existed for a decade, may be due to the confusion created by the educational campaigns to the vaccine against the human papilloma Gardasil (of Merk & Co)

The CDC has analyzed data collected between 2000 and 2010 from the Surveillance System on the Behavioural Risk factors (Behavioral Risk Factor Surveillance System on screening for cancer of the cervical in the test Papanicolau.

In one of the articles published in the journal Morbility and Mortality the CDC has stressed the fact that during the period studied, the screening of women who had had a hysterectomy was dropped from 73.3% in 2000 to 58.7% in 2010.

But this means that in each case more than 50% of women are still doing a Pap Test is not necessary since the hysterectomy involves the surgical removal of the neck of the uterus in the majority of cases (94% of the cases, according to estimates by the CDC).

These women do not need screening for cancer of the cervix, and this practice is specifically discouraged in the guidelines of all major organisations since 2002/2003

Many reports have pointed out these data and have emphasized that these practices involve a high number of economic resources, and funding that are wasted.

The same CDC has commented that in this population any benefit had from the screening should be balanced in the net of the damage caused.

These damages include the test false positive that they induce in patients ansietà, and lead them to accept invasive procedures.

Il tasso di falsi positivi costituisce, senza dubbio, un grande danno per le donne ed un costo rilevante per la sanità pubblica secondo quanto detto da Diane Harper, MD,Professor of Community and Family Medicine/Obstetrics and Gynecology at Dartmouth Medical School, in Hanover, New Hampshire, and Director of the Gynecologic Cancer Prevention Research Group at the Norris Cotton Cancer Center.

Medscape Medical News contacted the  Dr. Harper to discuss some of the results that emerged from the research.


The dr.ssa Harper emphasized that the data are  based on self-assessment and, as such, are  subject to error.

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altresì said: “we have ample evidence that show us that women of all età are not perfectly aware of what a Pap Test. Many women believe that whenever they are subjected to a pelvic exam,a speculum or no, they have done a Pap Test”.

He added: “Thereò è been proven with various studies and research, and raises the issue of the validityà data coming from car evaluations, such as è in the investigations of the CDC. So what should really be evaluated è the abilityà of women know of having had  a Pap Test according to the new guidelines”.

“The second question with respect to CDC is that the responses to the Pap Test that women can remember are difficult to store for women date, frequency  exam

the majority of women are able to distinguish between the concept of never and always, and many women can distinguish between thinking of what happened in the last twelve months.

But for frequencies in excess of a year, the ability to remember is; poor quality, leading to serious errors in the interpretation of the data.


Commenting on specifically the data on Pap Tests done after hysterectomy , Dr. ssa Harper has blamed the educational campaign by Merck to market Gardasil, and on the fact that è was  an emphasis on the fact that the Papilloma Virus (HPV) è linked to cancers of the anus, vulva, and cervix.

These campaigns have “left a large part of the population as well as the gynecologists, and midwives, as well as  the doctors, very confused about the abilityà to identify the always più frequent cancers related to HPV,” said Dr. ssa Harper to Medscape Medical News.

“I am Not surprised that physicians have understood the risks from exposure to HPV (number of sexual partners or previous infections by HPV), and stated that even in women with Hysterectomy for reasons different from the HPV, not c’è is another way that a Pap Test to determine that a cancer is in the initial phase”.

“There are a number of assumptions not correct in that way of thinking, but that way of thinking,  è was created from the advertising campaign that Merck has undertaken for its vaccine for HPV,” says Dr. ssa Harper.

In its report, the CDC has also mentioned the cancer of the cervix as a reason cited by those who propose to do to continue screening after hysterectomy. “In every way the cancer of the vagina is rare, and the validityà of the test the cytology in determining the vaginal cancer in the absence of a cervix is unknown,” said the CDC.

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the investigations of The CDC have also indicated that other groups of women undergo screening for cancer of the cervical spine are not needed, and contrary to the guidelines.

  if there have been some changes in recommendations made by different organizations in the past, the  updated guidelines, released by the American Cancer Society, the American College of Obstetricians and Gynecologists, and finally from the US Preventive Service last year, show a convergence of opinions and recommendations very similar to each other.

In the new guidelines there are specific recommendations on the fact that the screening of cancer of the cervix should begin at the age of 21 years and not before, despite the fact that thereò data from the CDC suggest that the Pap test is performed among women between the ages of 18 and 21 years.

This is not; the case, explained Dr. ssa Harper, to which these young women between 18 and 21 years of age, report that they have been checked for the Chlamydia through  the Pap Test “that is one of the prime causes of the disease in this group of età”.

Even if può test urine, the test for Chlamydia is often done via cervical (for example in a pelvic examination with a speculum), explained Harper. “Then a woman from 18 to 21 years è was subjected to screening  for Chlamydia might say  that she also did a Pap test not knowing really if he did or not. Many times the nurse or the doctor that performed the tests simply report that the test was normal and does not specify with clarity that the test for Chlamydia was negative, and cytology showed no abnormal cells”

“The other reason “hidden” is related to the incidence of cancer of the cervix in american women under 21 years old; of 1.7/100.000.

And this is a real number, and means that the young real women have cancer of the cervix, and some of them die,” adds Harper.

However, cytology is the only examination in the condition  to reduce the incidence of cancer of the cervix at 2.8/100,000, and by doing so, the Pap Test puts us in a condition to diagnose, this is a small but real number of women with cancer of the cervix.

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Add test HPV to cytology in this group of età, only serves to create a high number of false positività.

and Then the realityà è that we do not have a perfect system – the test Gardasil può only reduce the incidence of cancer of the cervix from 14/100.000, which is worse than what you have with the Pap test, and not è a way to protect all of the 1.7/100.000 adolescents from cancer of the cervix.

Then we have to accept that some cancers of the cervix are not able to locate them in a  time”.


another discovery that comes from the investigations of the CDC is that the data suggest that women between 22 and 39 years of age perform a Pap Test annually instead of every three years as recommended the new guidelines.

This as well as other  findings, suggest that it will takeà the first recommendation of the new guidelines are accepted in the medical practice common.

Dr. ssa  Harper presents  a few hypotheses that explain whyé this happens :


  • doctors may not have understood well the importance of the changes in recommendations for screenings;
  • The tests are still refunded.
  • The patients feel at risk and require frequent checks (“I would like the same test that he did to my sister”);
  • The nursing staff that is in charge of the organization of outpatient clinics, does not understand or does not accept the change in the guidelines.

“All of the analysis previously made have shown that it takes about 10 years before the changes proposed by the new recommendations are put in place by the medici”

Source: Medscape Medical News


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