Many women receive unnecessary Pap tests

As many as half to two-thirds of women who have undergone hysterectomies or are older than 65 years in the United States report receiving  Pap tests for cervical cancer. This prevalence is surprising in light of the 2003 U.S. Preventive Services Taskforce guidelines recommending that women discontinue Pap testing if they have received a total hysterectomy without a history of cervical cancer and if they are over age 65 years with ongoing and recent normal Pap test results.

Performing these unnecessary tests can result in stress for the patient, increased costs, and inefficient use of both provider and patient time, concludes a new study in the American Journal of Preventive Medicine.

"During this time of health care reform, we could probably use our resources more wisely," said corresponding author Deanna Kepka, Ph.D., M.P.H., assistant professor at the University of Utah's College of Nursing and Huntsman Cancer Institute."Other conditions and screenings should probably merit the attention of primary care providers, including obesity and cancer," she said, "especially in light of the newer 2012 cancer screening guidelines."

Kepka and her co-authors, who performed the study while at the National Cancer Institute, analyzed data from the 2010 National Health Interview Survey (NHIS) of women ages 30 and older. Participants answered questions about cervical cancer screening and hysterectomy status.

"We were surprised that so many women over age 65 reported a recent Pap test, and that two-thirds of women reported a Pap test after hysterectomy," she said.

Women with high incomes, especially those with private insurance, tended to have unnecessary Pap tests, Kepka said, as did non-White women. "A bit more surprising was that after hysterectomy, about 76 percent of Blacks and Hispanics had Pap tests and this also merits further research."

"Everyone always assumes that more cancer screening is better, but that's not true," said Jasmin A. Tiro, Ph.D., assistant professor in the division of behavioral and communication sciences at the University of Texas Southwestern Medical Center. "Every test has risks and benefits and most people focus on the benefits of screening. But the Pap test is not helpful for two groups of women: 1) women over age 65 with a history of normal Pap test results, and 2) women who have had a hysterectomy for a medical reason that is not cancer."

Those women may experience some harms from the Pap test such as unnecessary follow-up tests and feeling anxious while waiting to find out that the test result was a false-positive—When [in actuality] everything is normal, with no cancer, even though the test says differently, Tiro said.

"Right now, we don't have programs to prevent overuse of the Pap test and we need to develop them to help our health care systems, clinics, and providers," she added. "We also don't know the best way to explain the harms of screening tests to patients."