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Screening

I've had a hysterectomy. Do I still need cervical cancer screening?

Usually not — and in Korea, women aged 30 to 44 who have had the operation are screened more often than women who have not.

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Answer

Usually not. Cervical cancer screening is not recommended after hysterectomy in the absence of a history of cervical intraepithelial neoplasia grade 2 or higher, yet in the 2014 to 2016 Korean National Cancer Screening Survey of 6,807 women aged 30 to 74, 61.8 percent of women who had undergone a hysterectomy had been screened in the previous two years against 64.7 percent of women with an intact uterus — and among women aged 30 to 44 the position reversed outright, 77.8 percent of those with a hysterectomy against 57.1 percent of those without.

Key takeaways

  • Screening is not recommended after hysterectomy without a history of cervical intraepithelial neoplasia grade 2 or higher.
  • In a survey of 6,807 Korean women aged 30 to 74, 61.8 percent of those with a hysterectomy had been screened in the previous two years, against 64.7 percent of those without.
  • Among women aged 30 to 44 the rates reversed: 77.8 percent with a hysterectomy against 57.1 percent without.
  • The same reversal appeared among women with a family history of cancer: 75.0 against 67.1 percent.
  • Overall cervical screening in Korea rose until 2013 and has fallen since, at an annual percent change of −2.67, reaching 56.0 percent in 2020.
  • The fall was concentrated in women aged 40 and over, with lower education, and below middle-income level.
  • Whether screening remains appropriate depends on why the uterus was removed and whether the cervix was left in place, which a patient can establish from the operation record.

The rule is not complicated. Cervical screening looks for disease of the cervix, so after a hysterectomy that removed the cervix, and in the absence of a history of high-grade cervical disease, it is not recommended. Korean practice does not follow the rule.

What the national survey found

In the 2014 to 2016 Korean National Cancer Screening Survey, 61.8 percent of women who had undergone a hysterectomy reported being screened for cervical cancer in the previous two years. Among women with an intact uterus the figure was 64.7 percent — so the two groups were being screened at almost the same rate.

77.8% vs 57.1%

cervical cancer screening in the previous two years among Korean women aged 30 to 44, with a hysterectomy versus without oneShin JY et al., BMC Cancer, 2018

In the 30-to-44 band it is not "almost the same" but reversed. The women who cannot benefit from the test were getting it more often than the women who can. The same pattern appeared among women with a family history of cancer, 75.0 against 67.1 percent — that is, the reversal was strongest in exactly the groups most motivated to be thorough.

The other half of the problem

What to check before the next invitation

Two facts settle it, and both are in the operation record rather than in memory. Was the cervix removed — some hysterectomies leave it in place, and those women should continue screening. And was there a history of cervical intraepithelial neoplasia grade 2 or higher before the operation, in which case surveillance continues regardless.

Absent both, the invitation letter is arriving for a test that cannot find anything. Declining it is not cutting a corner, and a clinician who explains why is applying the guideline rather than departing from it.

Sources

  1. 1

    Shin JY, Choi KS, Suh M, Park B, Jun JK

    Comparison of cervical cancer screening among women with and without hysterectomies: a nationwide population-based study in Korea

    BMC Cancer 2018;18(1):810

    doi:10.1186/s12885-018-4723-9 · PMID:30098592

    https://doi.org/10.1186/s12885-018-4723-9
  2. 2

    Shin HY, Lee YY, Song SY, Park B, Suh M, Choi KS, Jun JK

    Trends in cervical cancer screening rates among Korean women: results of the Korean National Cancer Screening Survey, 2005-2020

    Journal of Gynecologic Oncology 2022;33(4):e39

    doi:10.3802/jgo.2022.33.e39 · PMID:35320888

    https://doi.org/10.3802/jgo.2022.33.e39