Routine vaginal Pap test is not useful in women status‐post hysterectomy for benign disease

The US Preventive Services Task Force (USPTF) has recommended that routine vaginal Pap (V‐Pap) screening is unnecessary for women status‐post (S/P) total hysterectomy (T‐Hyst) for benign disease (Guide to Clinical Preventive Services. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996. p 105–118). However, many US women continue to have V‐Pap despite no risk for cervical cancer and minimal risk for primary vaginal cancer (JAMA 2004;291:2990). Herein, we report our experience with such patients. Computerized data of patients S/P T‐Hyst for benign conditions over a 6‐yr‐period were retrospectively evaluated. Pap diagnoses of epithelial abnormalities (Ep Abnl), negative for intraepithelial lesion or malignancy with/without nonneoplastic findings (NILM‐NN and NILM), were reviewed based on three age groups: group A, 18–44 yr; group B, 45–64 yr; and group C, ≥65 yr (JAMA 2004;291:2990). A control group was used. Of 1,860 T‐Hyst 1,303 (70%) were for benign disease. Of these 581/1303 (44.5%) patients had 819 current V‐Paps (range, 1–5; mean, 1.4). The 581 patients were group A, 288 (49.5%); group B, 272 (46.8%); and group C, 21 (3.6%). Overall, the 819 V‐Paps showed Ep Abnl, 28 (3.4%); NILM‐NN, 252 (30.7%); and NILM, 539 (65.8%). Of the 28 Ep Abnl, 19 (67.8%) were atypical squamous cells of undetermined significance (ASCUS), and 9 (32%) were low‐grade vaginal intraepithelial lesions (LG‐VAIN). The NILM‐NN findings included organisms, atrophy, and endometriosis. On the basis of individual age groups, Ep Abnl were only seen in V‐Paps of 7/288 (2%) of group A and 21/272 (8%) of group B patients. In 23 control patients, 7/71 (9.8%) current V‐Paps showed Ep Abnl (ASCUS, 4 (57%); LG‐VAIN, 3 (43%)). Continued V‐Pap in women S/P T‐Hyst for benign disease does not appear to be useful, particularly in those aged ≥65 yr. Diagn. Cytopathol. 2006;34:640–643. © 2006 Wiley–Liss, Inc.