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In Reply: Drs Dandolu and Harmanli are correct that the use of self-reported data are likely to have led to an overestimate of screening, a limitation that we acknowledged in our article. However, this limitation affects neither our finding that the 1996 US Preventive Services Task Force recommendation had no impact, nor our conclusion that millions of women are being screened unnecessarily. Their observation that physicians may sometimes perform a Pap smear because they are unaware of the indication for a woman’s hysterectomy is probably true. However, their suggestion that the Pap smear may be a good way to bring women in for general preventive health care strikes us as poor justification for the continued use of a test without value.

We agree wholeheartedly with Dr Castle that unnecessary Pap smear screening of women who have undergone hysterectomy represents a waste of resources. We would ar gue that the . . . [Full Text of this Article]

Brenda Sirovich, MD, MS
brenda.sirovich@dartmouth.edu

H. Gilbert Welch, MD, MPH
VA Outcomes Group
Department of Veterans Affairs Medical Center
White River Junction, Vt