 |
|
Effectiveness of Vaginal Papanicolaou Smear Screening After Total Hysterectomy for Benign Disease
Michael D. Fetters, MD, MPH;
Gayle Fischer, MPH;
Barbara D. Reed, MD, MSPH
JAMA. 1996;275(12):940-947.
Abstract
| |
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)
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.
Footnotes
Reprint requests to Department of Family Practice, University of Michigan, 1018 Fuller St, Ann Arbor, Ml 48109-0708 (Dr Fetters).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Cervical Cancer Screening Among Women Without a Cervix
Sirovich and Welch
JAMA 2004;291:2990-2993.
ABSTRACT
| FULL TEXT
Recommendations for the Outpatient Surveillance of Renal Transplant Recipients
KASISKE et al.
J. Am. Soc. Nephrol. 2000;11
:S1-S86.
ABSTRACT
| FULL TEXT
Breast and Cervical Cancer Screening: Associations with Personal, Spouse's, and Combined Smoking Status
Clark et al.
Cancer Epidemiol. Biomarkers Prev. 2000;9:513-516.
ABSTRACT
| FULL TEXT
Can We Change Physicians' Practices in the Delivery of Cancer-Preventive Services?
Ruffin IV
Arch Fam Med 1998;7:317-319.
FULL TEXT
Ethical Considerations in the Provision of Controversial Screening Tests
Doukas et al.
Arch Fam Med 1997;6:486-490.
ABSTRACT
General Internal Medicine
Larson and Sheffield
JAMA 1997;277:1860-1861.
Cytopathological Findings on Vaginal Papanicolaou Smears after Hysterectomy for Benign Gynecologic Disease
Pearce et al.
NEJM 1996;335:1559-1562.
ABSTRACT
| FULL TEXT
Screening for Vaginal Cancer
Noller
NEJM 1996;335:1599-1600.
FULL TEXT
Pap Smears after Hysterectomy: Are They Really Necessary?
JWatch Women's Health 1996;1996:5-5.
FULL TEXT
|
