PAP Smear Screening After Partial Hysterectomy with Cervix Retained
Yes, this patient absolutely requires continued PAP smear screening following the same guidelines as women who have not undergone hysterectomy, because a partial (subtotal/supracervical) hysterectomy leaves the cervix intact and at risk for cervical cancer. 1
Critical Distinction: Partial vs Total Hysterectomy
The key determining factor is whether the cervix was removed or retained during the hysterectomy procedure. 1
- Partial/subtotal/supracervical hysterectomy removes the uterine body but leaves the cervix in place - these women require continued screening 1
- Total hysterectomy removes both the uterus and cervix - these women generally do not require screening if performed for benign disease 1, 2
Average-risk women who have had a subtotal hysterectomy should be screened following the recommendations for average-risk women who have not undergone hysterectomy. 1
Recommended Screening Protocol for This Patient
Since this 26-year-old woman has a retained cervix, she should follow standard cervical cancer screening guidelines:
- Age 21-29 years: PAP smear every 3 years with cervical cytology alone 2
- Age 30-65 years: Either PAP smear every 3 years with cytology alone, OR every 5 years with high-risk HPV testing alone, OR every 5 years with HPV and cytology cotesting 1, 2
- Continue screening until age 65-70 years with adequate prior negative screening history 1
Common Pitfall to Avoid
The most critical error would be assuming that "hysterectomy" automatically means no PAP smears are needed. 2, 3
- Approximately 10 million US women are being screened unnecessarily after total hysterectomy for benign disease 3
- Conversely, women with retained cervices may incorrectly be told they don't need screening simply because they had a "hysterectomy" 1
- Always verify through operative reports whether the cervix was removed or retained 1
Documentation Requirements
Confirm the exact surgical procedure performed through review of operative notes or pathology reports to establish definitively whether cervical tissue remains. 1
- If operative records document "supracervical hysterectomy" or "subtotal hysterectomy," the cervix is present 1
- If records state "total hysterectomy" or "total abdominal hysterectomy," the cervix was removed 1
- Patient recall alone is insufficient - many women cannot accurately report whether their cervix was removed 3
Why This Patient Needs Screening
- The cervix remains at full risk for HPV infection and cervical dysplasia/cancer when retained during partial hysterectomy 1
- Having 6 pregnancies by age 26 does not eliminate cervical cancer risk 1
- The indication for hysterectomy (multiple pregnancies/childbearing) is a benign indication, but this does not change screening needs when the cervix is present 1