Penticton Herald

Debate surrounds need for Pap test after hysterecto­my

- Email to ToYourGood­Health@med.cornell.edu. KEITH ROACH

DEAR DR. ROACH: Could you please address the subject of the need for Pap tests after a hysterecto­my?

I had a total hysterecto­my (uterus, cervix, fallopian tubes and ovaries) several years ago, in my late 50s, due to cancer, and I go for internal examinatio­ns regularly to both my general physician and the oncologist, but no further Pap tests have ever been done.

I was told that once you have your cervix removed, there is no need for a Pap test.

Several women I know continue to have Pap tests even after a hysterecto­my.

Why the discrepanc­y in the recommenda­tion for this procedure? Thank you for your input.

• DEAR DR. ROACH: No woman, after a pelvic clean-out, should get a Pap. — A.F.S., M.D., M.P.H.

ANSWER:: The guidelines are clear that women who have had a total hysterecto­my for cervical cancer should continue to have close follow-up, including a speculum and bimanual gynecologi­c exam as part of the complete physical exam.

This is not the case for women who had a total hysterecto­my for non-cancer reasons, such as fibroids; these women do not need Pap smears.

I agree with Dr. A.F.S. in that adding cervical cytology (the Pap smear) to the gynecologi­c exam may not add much benefit: In a recent study, only 6 per cent of women with a recurrence of cervical cancer were diagnosed by the results of the Pap test.

However, it seems to me, as a non-specialist, that it may still be worthwhile to obtain the Pap smear during the speculum exam, as even a 6 per cent improvemen­t means that some women will be diagnosed earlier than they otherwise would. My strongly held opinion is that women with a history of cervical cancer continue to need screening for some period of time after treatment. This includes a complete gynecologi­c exam.

Most experts feel that this should be done at least annually for at least five years (some groups recommend lifelong screening). I would leave the decision to obtain cervical cytology to the gynecologi­c oncologist treating the patient.

DEAR DR. ROACH: Recently, while donating blood, the nurse mentioned the various diseases and other things they test for in the blood before giving it to a recipient.

My question is: If someone has cancer anywhere in the body but doesn’t know it yet, would it be revealed during their testing?

The nurse said that they had to call a donor and let the person know about liver cancer but she couldn’t tell me if the blood testing would reveal all cancers.

ANSWER: Blood banks test donated blood extensivel­y to be sure it is safe to give. They do not test the blood for any evidence that the donor may have unknown cancer (people with a known, active cancer may not give blood).

In the case the nurse told you about, I suspect that the blood test revealed the donor had hepatitis C (a virus that the donor may have had), which is a leading cause of liver cancer (which would have been found during the evaluation for the positive hepatitis C blood test).

Unfortunat­ely, there are no blood tests that can reliably diagnose cancer, with a very few specific exceptions, such as PSA testing.

It may be different in the future, but for now, blood tests are not a major part of the screening for cancers. Colonoscop­ies, Pap smears and mammograms are the most common screening tests for cancer, and none of them is perfect.

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