Long term follow up of women after hysterectomy with a history of pre-invasive cancer of the cervix



The conclusion by Wiener et al. (1992) that screening for carcinoma of the vagina should be performed on all women who had a hysterectomy for cervical intra-epithelial neoplasia (CIN) is not supported by their data. They report only two cases of carcinoma; in one the lesion was incompletely excised and the other occurred in the lower vagina and not at the vault. No cases of carcinoma were found in women who had CIN completely excised.

Gemmel et al. (1990) found that only one vaginal carcinoma in 60 cases over 15 years was associated with previous CIN and this had been incompletely excised at hysterectomy. Screening for vaginal carcinoma in women who have had CIN completely excised at hysterectomy is not an efficient use of resources. The recommendation from the NHS Cervical Screening Programme (March 1992) is that, for lesions that are completely excised, two follow up smears at 6 and 12 months should be performed. If these are normal, cytological surveillance can stop.