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A cross-sectional study of more than 5000 cytology tests among women older than 50 years found that identification of vaginal intraepithelial neoplasia and cancer was rare in this age group after hysterectomy. 63 In a second study of more than 10,000 Pap tests performed over 2 years in 6265 women who had a hysterectomy with removal of the cervix, screening yielded 104 abnormal Pap test results and no cases of cervical cancer; in addition, 6 cases of high-grade vaginal lesions were detected, but it is not known whether detection of these cases improved clinical outcomes. 64
Screening with cervical cytology and hrHPV testing can lead to harms, including more frequent follow-up testing and invasive diagnostic procedures (eg, colposcopy and cervical biopsy), as well as unnecessary treatment in women with false-positive results. Evidence from RCTs and observational studies indicate that harms from diagnostic procedures include vaginal bleeding, pain, infection, and failure to diagnose (due to inadequate sampling). Abnormal screening test results are also associated with psychological harms. In particular, women who received positive hrHPV results reported greater distress and lower satisfaction with past and current sexual partners than women who received abnormal cytology results.
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