Objectives Despite limited evidence of benefit in using pap smears for surveillance of asymptomatic cervical cancer recurrence, gynecologic oncologists continue to perform this test annually. The objective of the study was to examine the utility of routine cervical cytology following cervical cancer treatment.

Methods An IRB-approved retrospective study was performed at a tertiary care center between 2004–2020. A total of 581 cervical cancer patients were identified, of which 211 were excluded due to loss of follow up or treatment at an outside facility. Manual data abstraction was performed.

Results of 370 patients in the cohort, 237/370 were identified in the surveillance period. 82/237 (34.5%) had at least one abnormal pap smear. 25/82(30.5%) underwent biopsy with 88% of biopsies negative for malignancy. 177/237(74.7%) women underwent radiation therapy: 67/177 (39.8%) had abnormal surveillance pap smears, with 8/177 (4.5%) subsequently diagnosed with local recurrence. Local recurrence was identified in 18/237 (7.6%) patients: 16/18 (88.9%) were symptomatic. of the symptomatic patients, 6/18 (33.3%) had normal surveillance cytology. Only one case of local, asymptomatic cervical cancer recurrence was detected on pap smear alone.

Conclusions Routine pap smears in surveillance of cervical cancer recurrence has limited clinical value. Consideration should be given to removing routine cytology from the surveillance recommendations.