Followup advisable after hysterectomy; Pap smear debatable
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.
Anonymous Dear Dr. Roach: No woman, after a pelvic clean-out, should get a Pap.
A.F.S., M.D., M.P.H.
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 six 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 six 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 I was 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.
D.L. 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.