A cross-sectional study was conducted using data from the 2010 National Health Interview Survey (NHIS). The NHIS is a nationally representative survey of the civilian non-institutionalized population of the United States that uses a random, stratified, multistage cluster sampling design. Analyses of public use data are considered exempt by the institutional review board (IRB) of the National Cancer Institute; IRB approval and informed consent were obtained in the original study. In 2010, the NHIS included a Cancer Control Supplement, which is the most recently available national data set that includes detailed items on cervical cancer screening and hysterectomy status, including, for the first time, questions to assess date of self-reported hysterectomy. The Cancer Control Supplement, fielded to adults 18 years and older, had a response rate of 60.8%.⁴ Because women younger than 30 years are less likely to have undergone a hysterectomy, our study sample includes women 30 years and older from NHIS 2010 who responded to questions about Papanicolaou test use and hysterectomy status and reported that their Papanicolaou test was for screening purposes (“part of a routine exam”) (N = 9494).

We examined sociodemographic characteristics for our study sample by hysterectomy status and age. We then investigated timing of most recent Papanicolaou test (within the past year, 1–3 years ago, >3 years ago) by sociodemographic characteristics and by hysterectomy status. National estimates of Papanicolaou testing overuse were calculated using the population weights from the 2010 NHIS. Women who reported a history of cervical cancer, an abnormal Papanicolaou test result within the past 3 years, or whose last Papanicolaou test was not part of a routine test were excluded from the results used to generate the national estimates. SAS-callable SUDAAN, version 9.2, was used in all analyses to account for the stratification and clustering of data within the complex survey design of the NHIS.

Among women reporting a hysterectomy, 34.1%(95% CI, 31.7%–36.6%) reported a Papanicolau test in the past year (Table 1).A total of 64.8%(95% CI, 62.2%–67.3%) of women reporting a hysterectomy also reported a recent Papanicolaou test since their hysterectomy, and among women 65 years and older without a hysterectomy, 58.4% (95% CI, 55.3%–61.4%) reported receipt of a Papanicolaou test in the past 3 years (Table 2), together representing approximately 14 million women.

For more than a decade, the US Preventive Services Task Force (USPSTF) has recommended that women discontinue Papanicolaou testing if they have received a total hysterectomy and have no history of cervical cancer or if they are older than 65 years and have ongoing and recent normal Papanicolaou test results.⁵ Nevertheless, in 2010, nearly two-thirds of women reported a Papanicolaou test since their hysterectomy and approximately one-half of women older than 65 years reported a Papanicolaou test in the past 3 years. With the implementation of the Affordable Care Act, the use of electronic medical records, health care provider reminder systems, decision support, and new strategies to improve quality of care may improve guideline-consistent practices among clinicians.⁶

Limitations of this study are the use of self-reported data to obtain information on Papanicolaou testing and the lack of detail on type of hysterectomy received and on whether older women were adequately screened prior to stopping use of the test.

Misuse of Papanicolaou testing continues despite USPSTF recommendations, and health care resources could be spent better elsewhere. Targeted efforts are needed to reduce unnecessary testing among older women and women without a cervix in compliance with clinical recommendations for cervical cancer prevention.