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Am J Public Health. 2016 Nov;106(11):2005-2011. Epub 2016 Sep 15.

Roles of Health Care Providers and Patients in Initiation of Unnecessary Papanicolaou Testing After Total Hysterectomy.

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Fangjian Guo is with the Department of Obstetrics & Gynecology and the Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch, Galveston. Yong-Fang Kuo is with the Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch.



To assess Papanicolaou (Pap) testing use among US adult women with a history of a total hysterectomy for a benign condition and the roles of health care providers and patients in the initiation of screening Pap tests.


We used 2000 to 2013 data from the National Health Interview Survey on women aged 20 years or older who had undergone a hysterectomy (n = 11 616) to estimate unnecessary Pap test use.


The percentage of self-reported Pap testing in the preceding 3 years among women who had undergone a hysterectomy decreased from 72.2% in 2000 to 53.3% in 2013. In 2013, 42.4% of women who had undergone a hysterectomy reported receiving recommendations for screening from a health care provider in the past year (32% of which were unnecessary), and 32.1% reported undergoing Pap tests in the preceding year (22.1% of which were unnecessary). Although the majority of Pap tests were performed at a clinician's recommendation, approximately one fourth were initiated by patients without clinician recommendations.


Health care providers should advise women who have had a total hysterectomy for a benign condition on appropriate use of screening services.

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