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March 27, 1996

Effectiveness of Vaginal Papanicolaou Smear Screening After Total Hysterectomy for Benign Disease

Author Affiliations

From the Department of Family Practice, University of Michigan, Ann Arbor. Ms Fischer is now a medical student at the University of Rochester (NY) School of Medicine and Dentistry.

JAMA. 1996;275(12):940-947. doi:10.1001/jama.1996.03530360050038

Objective.  —Using literature review, we assessed (1) Papanicolaou smear screening recommendations after hysterectomy for benign disease, (2) total hysterectomy for benign disease as a risk for vaginal dysplasia or carcinoma, and (3) effectiveness of screening for vaginal carcinoma after total hysterectomy for benign disease.

Data Sources.  —We considered (1) organizations' recommendations about screening, (2) references from major textbooks of gynecology, and (3) MEDLINE searches of English-language studies published from 1966 through 1995 using the search strategy (hysterectomy and vaginal smears) or (vaginal smears and vaginal neoplasms).

Study Selection.  —Published or verbal confirmations of screening recommendations were eligible. Criteria for assessing risk of vaginal dysplasia or carcinoma included original research, documented reports of hysterectomy as an exposure, and evidence of preinvasive vaginal disease or vaginal carcinoma outcomes. We sought data assessing burden of suffering, screening efficacy, and effectiveness of early detection.

Data Extraction.  —Descriptive and analytic data from each study were abstracted.

Data Synthesis.  —Screening recommendations were categorized by the organizations' positions: two opposed screening, two supported screening, and six lacked specific guidelines. Data on the risk between total hysterectomy for benign disease and subsequent vaginal carcinoma were organized by study design (three case control, two cohort, and 13 case series) and described. Data on screening effectiveness were organized to address the criteria advocated by the US Preventive Services Task Force.

Conclusions.  —There are conflicting guidelines on screening after hysterectomy and conflicting data on the risk of vaginal carcinoma after total hysterectomy for benign disease, though the best-designed research suggests no association. There is insufficient evidence to recommend routine vaginal smear screening in women after total hysterectomy for benign disease.(JAMA. 1996;275:940-947)