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Cervical Cancer Screening Among Women by Hysterectomy Status and Among Women Aged ≥65 Years — United States, 2000–2010

Please note: An erratum has been published for this article. To view the erratum, please click here.

Since 2003, major U.S. organizations consistently have recommended against screening most women for cervical cancer after a total hysterectomy for benign disease. Starting in 2003 and becoming consistent across organizations in 2012, guidelines also state that women with a history of adequate screening no longer should be screened after age 65 years. Reports have shown that many of those women continue to receive Papanicolaou (Pap) testing, contrary to recommendations. To measure recent screening behaviors and trends in accordance with evidence-based recommendations, biennial cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) on women aged ≥30 years were analyzed and stratified by hysterectomy status and by age (30–64 years and ≥65 years). The proportion of women reporting having had a hysterectomy who reported a recent (within 3 years) Pap test declined from 73.3% in 2000 to 58.7% in 2010. Declines among women having had a hysterectomy were significant among those aged 30–64 years, from 81.0% in 2000 to 68.5% in 2010, and among those aged ≥65 years, from 62.0% to 45.0%. Among women aged ≥65 years with no history of hysterectomy, recent Pap testing also declined significantly, from 73.5% to 64.5%. Although recommendations have resulted in reductions in screening posthysterectomy and of those aged ≥65 years, many women still are being screened who will not benefit from it.

Routine screening for cervical cancer by Pap testing is no longer recommended for women who have undergone a total hysterectomy (the removal of the uterus, including the cervix) or for adequately screened women after age 65 years.* Before 2003, the American College of Obstetricians and Gynecologists (ACOG) recommended regular screening be continued posthysterectomy, the American Cancer Society (ACS) did not address screening posthysterectomy, and the U.S. Preventive Services Task Force (USPSTF) stated that most women did not benefit from posthysterectomy screening (Table 1). In late 2002 and 2003, when the three organizations updated their guidelines, they all recommended that most women having had total hysterectomies for benign reasons should no longer be screened regularly, and USPSTF recommended that women aged >65 years with a history of normal screening results should no longer be routinely screened (Table 1). Updates in 2009 and 2012 did not significantly change recommendations not to screen women posthysterectomy, and as of 2012, ACOG and ACS also recommended against routinely screening women aged >65 years with a history of normal screening results. Biennial cross-sectional data from BRFSS were analyzed to measure recent screening behaviors and trends in accordance with evidence-based recommendations on screening.

BRFSS is a state-based, random-digit–dialed telephone survey of the noninstitutionalized, U.S. civilian adult population aged ≥18 years. Trained interviewers ask questions about general health status and healthy behaviors. The BRFSS questionnaire is comprised of core questions and optional modules. The Women's Health section is included in the core questions biennially; during 2000–2010, each adult female respondent was asked whether she had ever had a Pap smear or test, (described as "a test for cancer of the cervix"). Respondents also were asked, "How long has it been since you had your last Pap test?" and if they had had a hysterectomy. Overall survey response rates ranged between 46.0% and 55.7% over the 10 years.§ Of the sample population, 97.8% responded to the question "have you ever had a Pap smear/test?" and 97.4% responded to the question "have you had a hysterectomy?" No questions were asked about the reason for the hysterectomy or whether the cervix was removed.

Weighted analyses were performed to account for the complex sampling design. Percentages and 95% confidence intervals (CIs) were calculated for women aged ≥30 years reporting a recent Pap test (defined as a Pap test within the past 3 years), and were stratified by hysterectomy status and age. Unadjusted logistic regression models were used to test for differences in Pap testing behaviors over the 10-year period, with the year treated as a categorical variable. Statistically significant differences from 2000 to 2010 had a p-value <0.05. Age was limited to ≥30 years, because only 1.6% of women aged <30 years reported hysterectomies. These proportions were then examined according to race/ethnicity (white, non-Hispanic, black, non-Hispanic, other/multiracial, and Hispanic), U.S. Census region (Northeast, Midwest, South, and West), and health-care coverage (covered by insurance or another payer, and not covered).

Screening of Women Who Reported Having Had
a Hysterectomy

Numbers of women reporting a recent Pap test were stratified by hysterectomy status, age, race/ethnicity, U.S. Census region, and health-care coverage (Table 2). The proportion of women aged 30–64 years who reported both a recent Pap test and having had a hysterectomy declined significantly, from 81.0% (CI = 79.8%–82.1%) in 2000 to 68.5% (CI = 67.7%–69.3%) in 2010 (Figure). Women aged 30–64 years of all races/ethnicities who had a hysterectomy reported fewer recent Pap tests in 2010 than in 2000. The proportion of women aged 30–64 years who had a hysterectomy and who reported recent Pap testing declined significantly in all U.S. Census regions, with the steepest drop (15.6%) in the West. Steep declines in recent screening among women aged ≥65 years who had a hysterectomy also were observed, although 45.0% of these women still reported a recent Pap test in 2010.

Screening of Women Who Did Not Report Having Had a Hysterectomy

Among women of all ages without a hysterectomy, the proportion of women reporting a recent Pap test fell. The greatest decline was among women aged ≥65 years, from 73.5% (CI = 72.0%–74.9%) in 2000 to 64.5% (CI = 63.8%–65.3%) in 2010 (Table 2). Among women aged 30–64 years, with no history of hysterectomy, and who therefore should be screened, slight but statistically significant decreases in recent Pap testing occurred for white women and black women, and across all U.S. Census regions. Women aged 30–64 years who did not have health-care coverage and had not had a hysterectomy were less likely to have a recent Pap test in 2010 (68.7%) than in 2000 (74.4%).

Reported by

Meg Watson, MPH, Jessica King, MPH, Umed Ajani, MBBS, Keisha A. Houston, DrPH, Mona Saraiya, MD, Div of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: Meg Watson, eze5@cdc.gov, 770-488-3097.

Editorial Note

Cervical cancer screening has resulted in well-documented declines in cervical cancer incidence and mortality (1). However, the net benefits of screening some women, particularly women who have undergone hysterectomy and adequately screened women aged >65 years, might be outweighed by the net harm (e.g., false-positive tests leading to needless patient anxiety and invasive procedures) (2). Despite consistent guidelines by three national organizations (USPSTF, ACS, and ACOG) recommending against routine screening for cervical cancer posthysterectomy, the proportion of women aged <30 years who have had a hysterectomy and recently have been screened declined only 15 percentage points, and approximately 59% of these women still reported recent (in the past 3 years) Pap testing in 2010.

Analyses conducted before current recommendations were in place showed that many women who had hysterectomies continued to receive cervical cancer screening. A 2001 analysis found that 78% of women who had hysterectomies reported recent screening (3). A more recent study suggested that physicians were continuing to recommend Pap tests posthysterectomy in 2006 and 2007, despite guidelines recommending against such testing (4). Proponents of continued screening after hysterectomy have raised concerns about vaginal cancer and its precursors (5). However, vaginal cancer is rare, and the value of cytology tests to detect vaginal cancer in the absence of a cervix is unknown (6). Approximately 90% of hysterectomies are conducted for benign reasons, and the cervix is removed in approximately 94% of hysterectomies, so only a small proportion of women need continued screening after a hysterectomy (3,7). In addition, the positive predictive value of screening among adequately screened postmenopausal women is low, and lesions detected and treated among this population are unlikely to progress to cancer (2).

Some groups of women are not screened as often as they should be. Of particular concern, one third of women aged 30–64 years with no health-care coverage and no history of hysterectomy reported not having a recent Pap test in 2010. Women not receiving recommended screening and followup are at increased risk for cervical cancer mortality (1). Underscreening among women with less education, no usual source of health care, and no health-care coverage is well-documented and a persistent cause of health disparities (8).

The findings in this report are subject to at least five limitations. First, validation studies of self-reported Pap test data have shown that women might over-report being screened with a Pap test and under-report the time since the last test (9), but self-reported hysterectomy status generally is reliable (10). Second, information on the timing of recent Pap tests relative to the timing of hysterectomy is not available, so a small number of hysterectomies could have been performed after the Pap test (7). Third, BRFSS data do not contain information on reasons for hysterectomy, whether the cervix was removed with the uterus or not, whether women had normal screening histories in the past 10 years, whether women had high-grade precancer, or other reasons for which women might need continued screening. Fourth, the survey response rates were low, ranging from 40.0% to 55.7%. Finally, BRFSS is limited to noninstitutionalized populations and, during the period studied, used only landline telephones.

This study used a large, state-based national survey to document 10-year trends in Pap testing among women aged ≥30 years, by hysterectomy status and age. Declines in Pap testing among women having had a hysterectomy and among women aged ≥65 years showed improved concordance between guidelines and practice. However, estimates of the BRFSS data show that nearly 22 million women with hysterectomies might have received unnecessary screening, contrary to consistent recommendations by USPSTF, ACS, and ACOG that have been in place for nearly a decade. Research is needed to determine how to further reduce unnecessary screening. Monitoring Pap test prevalence among U.S. women is important to ensure that resources are targeted to women with the most need.

References

  1. Freeman H, Wingrove B. Excess cervical cancer mortality: a marker for low access to health care in poor communities. Rockville, MD: National Cancer Institute; 2005. Available at https://pubs.cancer.gov/ncipl/detail.aspx?prodid=t077. Accessed December 18, 2012.
  2. Sawaya GF, Grady D, Kerlikowske K, et al. The positive predictive value of cervical smears in previously screened postmenopausal women: the heart and estrogen/progestin replacement study (HERS). Ann Intern Med 2000;133:942–50.
  3. Saraiya M, Lee NC, Blackman D, Smith M-J, Morrow B, McKenna MA. Self-reported Papanicolaou smears and hysterectomies among women in the United States. Obstet Gynecol 2001;98:269–78.
  4. Yabroff KR, Saraiya M, Meissner HI, et al. Specialty differences in primary care physician reports of Papanicolaou test screening practices: a national survey, 2006 to 2007. Ann Intern Med 2009;151:602–11.
  5. American College of Obstetricians and Gynecologists, Committee on Gynecologic Practice. ACOG committee opinion. Recommendations on frequency of Pap test screening: number 152—March 1995. Int J Gynecol Obstet 1995;49:210–1.
  6. Stokes-Lampard H, Wilson S, Waddell C, Ryan A, Holder R, Kehoe S. Vaginal vault smears after hysterectomy for reasons other than malignancy: a systematic review of the literature. BJOG 2006;113:1354–65.
  7. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Obstet Gynecol 2007;110:1091–5.
  8. CDC. Cancer screening—United States, 2010. MMWR 2012;61:41–5.
  9. Rauscher GH, Johnson TP, Cho YI, Walk JA. Accuracy of self-reported cancer-screening histories: a meta-analysis. Cancer Epidemiol Biomarkers Prev 2008;17:748–57.
  10. Brett K, Madans J. Hysterectomy use: the correspondence between self-reports and hospital records. Am J Public Health 1994;84:3.

* Adequate screening is defined by American College of Obstetricians and Gynecologists and American Cancer Society guidelines as women who have had three consecutive negative cytology results or two consecutive negative co-test results within the 10 years before stopping screening, with the most recent test occurring within the past 5 years. The U.S. Preventive Services Task Force does not define adequate screening. Continued screening is recommended for women at increased risk, such as women with a history of invasive cervical cancer or high-grade cervical neoplasia, diethylstilbestrol (DES) exposure, or immunosuppression.

BRFSS language for questions on Pap exams was changed from "Pap smear" in 2000 and 2002 to "Pap test" in 2004, 2006, 2008, and 2010.

§ Data available at http://www.cdc.gov/brfss/technical_infodata/quality.htm.


What is already known on this topic?

Since 2003, major U.S. organizations consistently have recommended against screening women for cervical cancer posthysterectomy and after age 65 years, but reports have shown that many of those women continue to receive Papanicolaou (Pap) testing, contrary to recommendations.

What is added by this report?

Pap test use among women who have had a hysterectomy has declined by 15 percentage points from 2000 to 2010. However 60% of women who have had a hysterectomy still report recent Pap testing, indicating unnecessary screening a majority of this population.

What are the implications for public health practice?

Health-care providers and the public need to know that most women do not need cervical cancer screening after a hysterectomy or after age 65 years, so that women are not harmed by unnecessary treatment.


TABLE 1. Evolution of cervical cancer screening recommendations, based on hysterectomy* status and age — American Cancer Society, American College of Obstetricians and Gynecologists, and U.S. Preventive Services Task Force, 1995–2012

Category

Recommendation

Before 2002/2003

2002/2003

Current (2012)

American Cancer Society (ACS)

Screening after total hysterectomy

No mention made of screening posthysterectomy.

"All women who are, or have been, sexually active, or have reached age 18 should have an annual Pap test and pelvic examination. After a woman has had more than 3 consecutive satisfactory normal annual examinations, the Pap test may be performed less frequently at the discretion of the physician."

"Cervical cancer screening is not indicated for women who have had a total hysterectomy (with removal of the cervix) for benign gynecologic disease. Women with a history of CIN2/3, or for whom it is not possible to document the absence of CIN2/3 prior to/or as the indication for the hysterectomy, should be screened until three normal/negative cervical cytology tests and no abnormal/positive cytology tests (within a 10-year period) are achieved."

"Women at any age following a hysterectomy with removal of the cervix who have no history of CIN2+ should not be screened for vaginal cancer using any modality. Evidence of adequate negative prior screening is not required."

Age limits on screening

No mention made of an upper age limit.

"Women with an intact cervix who are age 70 and older may elect to cease cervical cancer screening if they have had both three or more negative cervical cytology tests, and have had no abnormal/positive cytology tests within the 10-year period prior to age 70."

"Women aged older than 65 years with evidence of adequate negative prior screening and no history of CIN2+ within the last 20 years should not be screened for cervical cancer. Following spontaneous regression or appropriate management of CIN2, CIN3, or adenocarcinoma in situ, routine screening should continue for at least 20 years (even if this extends screening past age 65 years)."

American College of Obstetricians and Gynecologists (ACOG)

Screening after total hysterectomy

"The cost-effectiveness of cytologic screening for vaginal neoplasia after removal of the cervix for benign disease has not been demonstrated. Nonetheless, periodic cytologic evaluation of the vagina in such cases, based on the above risk factors, is warranted."

"Women who have undergone hysterectomy with removal of the cervix for benign indications and who have no prior history of CIN2 or CIN3 or worse may discontinue routine cytology testing."

"In women who have had a hysterectomy with removal of the cervix (total hysterectomy) and have never had CIN 2 or higher, routine cytology screening and HPV testing should be discontinued and not restarted for any reason."

Age limits on screening

No mention made of an upper age limit.

"Evidence is inconclusive to establish an upper age limit for cervical cancer screening. If screening is discontinued, risk factors should be assessed during the annual examination to determine if reinitiating screening is appropriate."

"Screening by any modality should be discontinued after age 65 years in women with evidence of adequate negative prior screening results and no history of CIN 2 or higher."

U.S. Preventive Services Task Force (USPSTF)

Screening after total hysterectomy

"Women who have undergone a hysterectomy in which the cervix was removed do not require Pap testing, unless it was performed because of cervical cancer or its precursors."

"The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease."

(D recommendation)

"The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and who do not have a history of a high-grade precancerous lesion (cervical intraepithelial neoplasia [CIN] grade 2 or 3) or cervical cancer."

(D recommendation)

Age limits on screening

"There is insufficient evidence to recommend for or against an upper age limit for Pap testing, but recommendations can be made on other grounds to discontinue regular testing after age 65 in women who have had regular previous screenings in which the smears have been consistently normal."

(C recommendation)

"The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer."

(D recommendation)

"The USPSTF recommends against screening for cervical cancer in women older than age 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer."

(D recommendation)


TABLE 1. (Continued) Evolution of cervical cancer screening recommendations, based on hysterectomy* status and age — American Cancer Society, American College of Obstetricians and Gynecologists, and U.S. Preventive Services Task Force, 1995–2012

Abbreviation: Pap = Papanicolau; CIN = cervical intraepithelial neoplasia.

Sources:

ACS recommendations:

Before 2002/2003: Smith RA, Mettlin CJ, Davis KH, Eyre H. American Cancer Society guidelines for early detection of cancer. CA Cancer J Clin 2000;50:34–49.

2002/2003: Saslow D, Runowicz CD, Solomon D, et al. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002;52:342–62.

Current (2012): Saslow D, Solomon D, Lawson HW, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA Cancer J Clin 2012;62:147–72.

ACOG recommendations:

Before 2002/2003: American College of Obstetricians and Gynecologists Committee. ACOG committee opinion number 152: recommendations on frequency of Pap test screening. Int J Gynaecol Obstet 1995;49:2.

2003: American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 45. Cervical cytology screening. Int J Gynaecol Obstet 2003;83:237–47.

Current (2012): ACOG Committee on Practice Bulletins—Gynecology. ACOG practice bulletin no. 131. Screening for cervical cancer. Obstet Gynecol 2012;120:1222–38.

USPSTF recommendations:

Before 2002/2003: US Preventive Services Task Force. Guide to clinical preventive services, 2nd ed. Alexandria, VA: International Medical Publishing; 1996. Available at http://odphp.osophs.dhhs.gov/pubs/guidecps.

2003: US Preventive Services Task Force. Screening for cervical cancer: recommendations and rationale. In: Guide to clinical preventive services, 3rd ed. Rockville, MD: US Preventive Services Task Force; 2003. Available at http://www.uspreventiveservicestaskforce.org/3rduspstf/cervcan/cervcanrr.pdf.

Current (2012): US Preventive Services Task Force. Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement 2012. Rockville, MD: US Preventive Services Task Force; 2012. Available at http://www.uspreventiveservicestaskforce.org/uspstf11/cervcancer/cervcancerrs.htm.

* Total hysterectomy, defined as the removal of the uterus, including the uterine cervix.

USPSTF strength of recommendation: C = insufficient evidence to recommend for or against the inclusion of the condition in a periodic health examination, but recommendations may be made on other grounds; D = fair evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.


TABLE 2. Percentage of women reporting recent Papanicolaou (Pap) test (within 3 years), by selected characteristics and hysterectomy status — Behavioral Risk Factor Surveillance System, 2000–2010*

Characteristic

Recent Pap test (within 3 yrs)

Total % reporting hysterectomy

Recent Pap test (within 3 yrs)

No hysterectomy

Hysterectomy

2000
(N = 54,349)

2010
(N = 130,749)

Absolute difference, 2000–2010

2000
(N = 16,970)

2010
(N = 42,653)

Absolute difference, 2000–2010

%

(95% CI)

%

(95% CI)

2000

2010

%

(95% CI)

%

(95% CI)

%

Total

86.4

(85.9–86.8)

83.9

(83.6–84.2)

-2.5

27.3

25.3

73.3

(72.3–74.2)

58.7

(58.1–59.3)

-14.6

Age group (yrs) 

30–39

91.2

(90.5–91.9)

90.6

(90.0–91.2)

-0.6

6.2

5.3

83.4

(77.7–87.9)

80.1

(76.7–83.2)

-3.3

40–49

88.7

(87.8–89.6)

87.7

(87.1–88.3)

-1.0

19.0

15.6

83.4

(81.4–85.1)

75.6

(73.9–77.3)

-7.8

50–64

87.2

(86.2–88.1)

84.3

(83.7–84.8)

-2.9

38.3

31.9

79.4

(78.1–80.8)

64.2

(63.3–65.2)

-15.2

≥65

73.5

(72.0–74.9)

64.5

(63.8–65.3)

-9.0

45.2

46.7

62.0

(60.4–63.6)

45.0

(44.2–45.8)

-17.0

Age 30–64 yrs

(n = 46,069)

(n = 101,572)

 

(n = 11,430)

(n = 24,443)

 

Total

89.3

(88.8–89.8)

87.6

(87.3–87.9)

-1.7

21.4

18.9

81.0

(79.8–82.1)

68.5

(67.7–69.3)

-12.5

Race/Ethnicity 

White/non-Hispanic

90.0

(89.4–90.4)

88.1

(87.8–88.5)

-1.9

21.8

19.5

79.2

(77.9–80.4)

66.6

(65.6–67.5)

-12.6

Black/non-Hispanic

90.7

(89.2–92.0)

88.8

(87.7–89.8)

-1.9

23.6

22.7

88.4

(85.9–90.5)

77.3

(75.1–79.3)

-11.1

Other/Multiracial

83.4

(80.0–86.3)

81.1

(79.2–82.8)

-2.3 

16.6

14.4

79.9

(71.9–86.1)

62.1

(57.4–66.5)

-17.8

Hispanic

86.3

(84.2–88.2)

87.3

(86.2–88.4)

1.0 

18.2

14.4

86.4

(81.6–90.1)

73.7

(70.2–76.9)

-12.7

U.S. Census region 

Northeast

90.8

(89.8–91.7)

89.3

(88.7–90.0)

-1.5

14.6

12.4

82.5

(79.7–85.0)

71.6

(69.4–73.6)

-10.9

Midwest

89.3

(88.4–90.2)

88.3

(87.6–88.9)

-1.0

20.5

18.8

80.9

(78.8–82.8)

66.5

(64.7–68.3)

-14.4

South

88.8

(88.0–89.5)

86.2

(85.6–86.8)

-2.6

26.0

23.3

82.3

(80.9–83.6)

71.4

(70.2–72.6)

-10.9

West

88.6

(87.3–89.9)

87.5

(86.8–88.1)

-1.1

20.8

17.0

77.5

(73.9–80.8)

61.9

(59.9–63.8)

-15.6

Health-care coverage 

Covered

91.6

(91.1–92.0)

90.9

(90.6–91.2)

-0.7

21.6

19.1

81.9

(80.7–83.0)

71.0

(70.2–71.9)

-10.9

Not covered

74.4

(72.5–76.3)

68.7

(67.4–70.0)

-5.7

19.7

17.9

74.5

(70.8–77.8)

52.8

(50.2–55.5)

-21.7

Age ≥65 yrs

(n = 8,280)

(n = 29,177)

 

 

 

(n = 5,540)

(n = 18,210)

 

Total

73.5

(72.0–74.9)

64.5

(63.8–65.3)

-9.0

45.2

46.7

62.0

(60.4–63.6)

45.0

(44.2–45.8)

-17.0

Race/Ethnicity 

White/non-Hispanic

73.6

(72.1–75.1)

64.0

(63.3–64.8)

-9.6

45.7

46.5

60.4

(58.7–62.1)

43.1

(42.3–43.9)

-17.3

Black/non-Hispanic

70.2

(63.9–75.8)

69.1

(66.0–72.0)

-1.1 

47.3

52.5

75.9

(70.3–80.7)

57.3

(54.4–60.2)

-18.6

Other/Multiracial

67.6

(50.5–80.9)

62.5

(58.1–66.7)

-5.1 

31.2

42.0

62.9

(47.3–76.2)

42.4

(37.4–47.6)

-20.5

Hispanic

79.3

(70.9–85.8)

68.9

(64.7–72.8)

-10.4 

40.6

44.4

67.4

(57.6–75.9)

53.1

(48.3–57.8)

-14.3 

U.S. Census region 

Northeast

69.9

(66.4–73.2)

66.3

(64.8–67.8)

-3.6

37.5

36.5

61.1

(57.0–65.2)

49.1

(47.1–51.1)

-12.0

Midwest

71.9

(69.3–74.3)

61.5

(60.0–62.9)

-10.4

41.3

46.3

56.5

(53.3–59.7)

40.9

(39.3–42.6)

-15.6

South

75.0

(73.0–76.9)

66.2

(64.9–67.4)

-8.8

49.8

52.1

64.7

(62.5–66.9)

49.1

(47.9–50.3)

-15.6

West

77.7

(73.2–81.6)

63.3

(61.6–64.9)

-14.4

50.0

47.1

63.4

(59.2–67.3)

37.9

(36.1–39.8)

-25.5

Health-care coverage 

Covered

73.9

(72.4–75.3)

64.9

(64.1–65.6)

-9.0

45.4

46.8

62.1

(60.5–63.7)

45.0

(44.2–45.8)

-17.1

Not covered

54.4

(43.1–65.3)

49.3

(42.1–56.5)

-5.1

37.7

39.4

54.2

(40.9–66.9)

43.8

(35.8–52.1)

-10.4

Abbreviation: CI = confidence interval.

* Unknown and missing values not included. Among respondents, 595 women with complete Pap test data did not have information on hysterectomy status. Race/ethnicity information was missing for 1,943 women with no hysterectomy and 1,027 women with a hysterectomy; health insurance information was missing for 296 women with no hysterectomy and 156 women with a hysterectomy.

Denotes statistically significant (p<0.05) trend for even years 2000–2010.


FIGURE. Percentage of women who had a recent Papanicolaou (Pap) test (within 3 years), by hysterectomy status and age group — Behavioral Risk Factor Surveillance System, United States, 2000–2010*

The figure shows the percentage of women with and without hysterectomy who had a recent Papanicolaou (Pap) test (within 3 years), by age group in the United States during 2000-2010. The proportion of women aged 30-64 years who reported both a recent Pap test and having had a hysterectomy declined significantly, from 81.0% in 2000 to 68.5% in 2010.

* Even years only. All trends are statistically significant using linear test of trend (p<0.05). Percentages are weighted to the noninstitutionalized, U.S. civilian population.

2002 American Cancer Society, 2003 American College of Obstetricians and Gynecologists, and 2003 U.S. Preventive Services Task Force Pap test guidelines published.

Alternate Text: The figure above shows the percentage of women with and without hysterectomy who had a recent Papanicolaou (Pap) test (within 3 years), by age group in the United States during 2000-2010. The proportion of women aged 30-64 years who reported both a recent Pap test and having had a hysterectomy declined significantly, from 81.0% in 2000 to 68.5% in 2010.


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