From the Guidelines
Based on the most recent guidelines, a patient with a history of negative Pap tests for cellular changes and a previous non-high-risk HPV positive result that has now cleared, should return to routine cervical cancer screening, which typically involves a Pap test every 3 years, or co-testing (Pap plus HPV test) every 5 years if between 30-65 years old. The current guidelines, as outlined in the 2021 sexually transmitted infections treatment guidelines 1, emphasize the importance of risk-based management for abnormal cervical cancer screening tests and cancer precursors. Given the patient's history of negative Pap tests and the previous non-high-risk HPV positive result that has now cleared, the risk of developing cervical cancer in the near future is considered low. Key points to consider in this scenario include:
- The patient's previous non-high-risk HPV positive result has cleared, indicating the immune system has successfully eliminated the virus, which is a common occurrence as most HPV infections resolve on their own within 1-2 years 1.
- The current negative Pap test and HPV negative result support the decision to return to routine screening, as the risk of underlying high-grade disease is low in this context.
- It is essential to continue with regular screening as recommended by the healthcare provider, as early detection of any changes is crucial for preventing cervical cancer.
- If there are any additional risk factors, such as immunosuppression or previous abnormal results not mentioned, the provider might recommend more frequent screening, but based on the information provided, routine screening intervals are appropriate. The management approach should always prioritize the patient's individual risk factors and history, but in this case, returning to routine cervical cancer screening is the recommended course of action, based on the guidelines outlined in the 2021 sexually transmitted infections treatment guidelines 1.
From the Research
Screening Recommendations
- For women who test Pap-negative but are HPV-positive, current US guidelines recommend returning in 1 year, and those who remain HPV-positive or have low-grade squamous intraepithelial lesion (LSIL) or worse Pap results be referred for colposcopy 2.
- A study found that women with an unsatisfactory Papanicolaou (Pap) test and negative human papillomavirus (HPV) cotest may be safely called back at an interval longer than 4 months 3.
- HPV testing is recommended for women of any age for the clarification of atypical cells of undetermined significance (ASC-US) and as an option for follow-up of women with HPV-positive ASC-US, atypical squamous cells "cannot rule out high-grade," or low-grade squamous intraepithelial lesions not found to have CIN 2/3 4.
- Women testing HPV negative/ASC-US were found to have precancer/cancer risks that were more closely aligned with women with negative Pap test results, suggesting that women testing HPV negative/ASC-US should be managed similarly to women testing negative on Pap tests with a 3-year return for screening 5.
- The addition of an HPV test to the Pap test to screen women in their mid-30s for cervical cancer reduces the incidence of grade 2 or 3 cervical intraepithelial neoplasia or cancer detected by subsequent screening examinations 6.
Specific Screening Intervals
- Women who test Pap-negative and HPV-negative can return in 3 years for screening 5.
- Women who test Pap-negative but are HPV-positive should return in 1 year for screening 2.
- Women with an unsatisfactory Pap test and negative HPV cotest may be safely called back at an interval longer than 4 months 3.
Risk of Precancer/Cancer
- The 5-year CIN 3+ risk after an HPV-positive/Pap-negative cotest result was 4.5% (95% confidence interval [CI] = 4.2%-4.8%) 2.
- The 5-year cancer risk was 0.34% (95% CI = 0.26%-0.45%) 2.
- Women testing HPV negative/ASC-US were found to have precancer/cancer risks that were more closely aligned with women with negative Pap test results 5.