The Value of Continuing Regular Papanicolaou (Pap) Smears in Postmenopausal Women. Ann Intern Med. 2000;133:S61. doi: 10.7326/0003-4819-133-12-200012190-00004
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Published: Ann Intern Med. 2000;133(12):S61.
The recommended method of screening for cervical cancer in women before menopause is to do a Pap smear every 1 to 3 years. It is unclear whether continuing regular Pap smears in women after menopause is of value. Professional organizations' recommendations vary from continuing Pap smears throughout life to stopping them at age 65 in women whose Pap smears were previously normal. “False-positive” Pap smears are frequent in women after menopause; this means the test appears abnormal, but the woman does not have an important cervical problem. It makes sense to minimize the chances of false-positive test results because they lead to needless worry and follow-up testing. To complicate the issue, little is known about whether taking postmenopausal hormones influences Pap smear results.
To study the value of continuing to perform regular Pap smears after menopause for women with a recent normal test and to find out whether taking postmenopausal hormones influences the Pap smear results.
The study included 2561 women with a uterus and normal Pap smears at the start of the study. These women were participants in a larger study of heart disease and postmenopausal hormones.
Women in the study had Pap smears yearly during the study, and the researchers collected information about the results. They then determined what additional diagnostic tests were done to follow up on abnormal smears, and they determined the final outcome of the diagnostic evaluation; this allowed them to decide whether each abnormal result was a true- or false-positive one. Since all women were participating in a study of hormones, they received either hormone replacement (estrogen and progesterone) or placebo pills that looked like the hormones but contained no active ingredient.
Of the 4895 Pap smears done in the study, 110 were abnormal. Only 1 of these was true positive, however. Women taking hormones did not have a significantly higher frequency of abnormal Pap smears than women not taking hormones.
This study included women who were at low risk for cervical cancer and who had normal Pap smears at baseline. These findings do not apply to women at high risk for cervical cancer, those who have a history of abnormal Pap smears, or those who have never had Pap smears.
Regardless of whether women are taking postmenopausal hormones, continuing Pap smears after menopause for women who have a history of normal Pap smears appears to be of limited value. Most abnormal results in this group of women will prove to be false positive.
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The summary below is from the full report titled “The Positive Predictive Value of Cervical Smears in Previously Screened Postmenopausal Women: The Heart and Estrogen/progestin Replacement Study (HERS).” It is in the 19 December 2000 issue of Annals of Internal Medicine (volume 133, pages 942-950). The authors are GF Sawaya, D Grady, K Kerlikowske, J La Valleur, VM Barnabei, K Bass, TE Snyder, JH Pickar, SK Agarwal, and J Mandelblatt, for the Heart and Estrogen/progestin Replacement Study (HERS) Research Group.
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