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October 6, 2004

Cervical Cancer Screening Among Women Without a Cervix

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(13):1550-1552. doi:10.1001/jama.292.13.1551-b

To the Editor: Drs Sirovich and Welch1 speculate that performance measures may be one reason why women who have had a hysterectomy continue to get screened with a Pap test. One performance measure, the Health Plan Employer Data and Information Set (HEDIS), does specify 1 exclusion, albeit optional, for calculating cervical cancer screening rates. The HEDIS technical specifications state that women should be excluded if they have no residual cervix after hysterectomy.2 The documentation advises managed care organizations to look for evidence of a hysterectomy as far back as possible in the patient’s history, through either administrative data or a medical record review, and provides a list of current procedural terminology codes and International Classification of Diseases, Ninth Edition codes for hysterectomy. Although this might be burdensome for managed care organizations, making this exclusion a requirement rather than an option might ensure that the Pap test HEDIS measure is more meaningful. Moreover, it would be reasonable forHEDIS to consider Pap tests conducted in women after hysterectomy for benign reasons a measure of poor performance.

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