Effectiveness of vaginal Papanicolaou smear screening after total hysterectomy for benign disease.
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.


METHODS
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).


METHODS
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.


METHODS
Descriptive and analytic data from each study were abstracted.


RESULTS
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.
Fetters
M D
MD
Department of Family Practice, University of Michigan, Ann Arbor, 48109-0708, USA.
Fischer
G
G
Reed
B D
BD
D002278:Carcinoma in Situ / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000592:standards; D008403:Mass Screening / Q000592:standards; D065006:Papanicolaou Test; D017410:Practice Guidelines as Topic; D011230:Precancerous Conditions / Q000175:diagnosis / Q000209:etiology*; D012306:Risk; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000209:etiology; D014621:Vagina / Q000473:pathology*; D014625:Vaginal Neoplasms / Q000175:diagnosis / Q000209:etiology*; D014626:Vaginal Smears / Q000592:standards