Q: If I’ve had a hysterectomy, do I still need to be screened for cervical cancer?
A: It depends in large part on what type of hysterectomy you had: partial or total. In a partial (also called subtotal or supracervical) hysterectomy, most of the uterus is removed but the cervix (the lower part of the uterus that connects it to the vagina) is left intact. In a total hysterectomy, the cervix is removed along with the rest of the uterus.
If you had a partial hysterectomy and are at average risk for cervical cancer, you should follow the same screening recommendations as the general population. The most common options are a Pap test every three years, or, for women ages 30 and older, “co-testing” with a human papillomavirus (HPV) test and Pap test every five years. If you had a partial hysterectomy and are at increased risk for cervical cancer—for instance, due to being immunocompromised, being infected with a high-risk strain of HPV, or having a history of precancerous growths on the cervix—you may need more frequent screening; talk to your doctor.
If you had a total hysterectomy and it was not due to cervical cancer or high-grade precancerous lesions (but rather due, for example, to endometriosis or uterine fibroids), you can stop having cervical cancer screenings, according to 2018 recommendations from the U.S. Preventive Services Task Force (USPSTF).
Less clear is what you should do if you had a total hysterectomy because of cervical cancer or a high-grade precancerous lesion. To be on the safe side, the USPSTF and the American College of Obstetricians and Gynecologists recommend that women in this group continue with regular Pap tests for up to 20 years after the hysterectomy. That’s because cervical cells could still remain in the upper region of the vagina (referred to as the vaginal cuff ), and a Pap test (which would be done in this area, since there is no longer a cervix from which to swipe cells) can detect abnormal changes in them.
Most women at average risk for cervical cancer can stop screening after age 65 if they’ve been adequately screened during the past decade and had no abnormal results. If you’re not in this group you should have “catch-up screening” after age 65. Adequate screening with normal results means three consecutive Pap results or two consecutive “co-test” results (Pap plus HPV test) within the previous 10 years, with the most recent test done within the past five years.
This article first appeared in the UC Berkeley Wellness Letter.