Value of Annual Pap Smears Questioned.

Many postmenopausal U.S. women are needlessly screened with an annual cervical smear.

When postmenopausal women have a cervical smear taken within 2 years of a previously normal smear, the problem is not just that the second smear wastes time and money. It also risks a false-positive result that leads to needless anxiety, follow-up tests, and cost.

"Postmenopausal women and their physicians should be aware that the risks of a false-positive finding from cervical smear screening are greater than the potential benefits" when the smear is done less than 2 years after a normal smear, Dr. George F. Sawaya, an ob.gyn, at the University of California, San Francisco, said in an interview.

Dr. Sawaya and his associates came to this conclusion after reviewing the smears and subsequent outcomes of 2,561 postmenopausal women who participated in the Heart and Estrogen/Progestin Replacement Study (HERS) (Ann. Intern. Med., 133[12]:942-50, 2000).

"Most U.S. gynecologists still recommend annual screening regardless of age or past Pap history," Dr. Evan R. Myers, an ob.gyn. at Duke University in Durham, N.C., told this newspaper.

Annual Pap smears remain the rule for postmenopausal women in the United States. Data collected by the Centers for Disease Control and Prevention in an annual telephone survey, the Behavioral Risk Factor Surveillance System, showed that in 1999, 68% of women aged 50-59 reported having a cervical smear taken within the past year. In addition, 63% of women aged 60-64 and 52% of women aged 65 or older also reported having a Pap smear within the past year. Data for 1997 and 1998 show that at least 50% of women in each of these age categories had a Pap smear within the last year, suggesting that many were undergoing the procedure annually.

In HERS, annual cervical smears were taken as part of the study protocol. Dr. Sawaya's analysis focused on the 2,561 women who had a normal smear taken at ...