Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: Drs Sirovich and Welch1 report that approximately 10 million US women, or
almost half of those who have undergone a hysterectomy and therefore have
no cervix, are undergoing Pap smear screening for cancer of the cervix. They
have brought attention to a procedure that is unnecessary in women who are
no longer at risk of cervical cancer. Vaginal cancer is so rare that there
is virtually no secondary benefit of cytologic screening in these women. Thus,
either patients or the US health care system incurs costs for unnecessary
screening: conventional Pap smears cost $15 and new, more sensitive screening
methods such as liquid-based cytology ($28 per test) and human papillomavirus
(HPV) testing ($48.50 per test) are even more expensive.2 Eliminating
Pap smear screening in these women would be cost-effective.
Castle P. Cervical Cancer Screening Among Women Without a Cervix. JAMA. 2004;292(13):1550-1552. doi:10.1001/jama.292.13.1550-b