Choosing Wisely:

Don’t perform vaginal cytology (Pap test) or HPV screening in women who had hysterectomy (with removal of the cervix) for reasons other than high-grade cervical dysplasia (cervical intraepithelial neoplasia [CIN] 2/3) or cancer.

Rationale and Comments: Vaginal cancer after hysterectomy is very rare, less likely than breast cancer for men, for which screening is not recommended. Screening these women is more likely to discover benign changes that prompt invasive testing than to prevent cancer. Continued vaginal cytology (Pap test) is recommended for women who had a hysterectomy for the indication of high-grade cervical dysplasia or cancer, as their risk of vaginal cancer remains elevated. Vaginal assessment may also be indicated in the presence of HPV-associated vulvar cancer.
Sponsoring Organizations:
  • American Society for Colposcopy and Cervical Pathology
  • Sources:
  • American Cancer Society guidelines
  • Disciplines:
  • Gynecologic
  • Oncologic
  • Preventive Medicine
  • References: • American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER; American Cancer Society; American Society for Colposcopy and Cervical Pathology; American Society for Clinical Pathology.
    Am J Clin Pathol. 2012 Apr;137(4):516-42.
    CA Cancer J Clin. 2012 May-Jun;62(3):147-72.
    J Low Genit Tract Dis. 2012 Jul;16(3):175-204.
    • ACOG Committee on Practice Bulletins – Gynecology. Cervical Cancer Screening and Prevention. Practice Bulletin #157. Obstet Gynecol 2016;127:e1–20.

    Email Alerts

    Don't miss a single issue. Sign up for the free AFP email table of contents.

    Sign Up Now