From the Guidelines
For a 21-year-old patient with ASCUS Pap result, the recommended next step is to consider three options for follow-up management: 1) prompt colposcopy, 2) repeat Pap tests at 6 and 12 months, and 3) a high-risk HR HPV DNA test. According to the guidelines from 1, these options are available for women aged ≥21 years with a Pap test report of ASC-US. The choice of management depends on various factors, including the provider's concerns about adherence with recommended follow-up or concerns about other clinical indications.
- Repeat Pap tests at 6 and 12 months is a reasonable approach, as it allows for monitoring of the condition without immediate invasive procedures.
- High-risk HR HPV DNA testing can also be considered, as a negative result would lead to a repeat Pap test at 12 months, while a positive result would prompt immediate referral for colposcopy.
- Prompt colposcopy may be appropriate if there are concerns about adherence with recommended follow-up or other clinical indications. It is essential to note that the management approach should balance the need to identify potentially significant lesions while avoiding unnecessary procedures in young women where cervical cancer is rare and most HPV infections are transient, as indicated by 1. The patient should be reassured that ASCUS is not cancer but represents minor cellular changes that warrant follow-up.
From the Research
Next Steps for ASCUS Pap Test
- The patient had an ASCUS (Atypical Squamous Cells of Undetermined Significance) Pap test at 21, which is a common abnormal Pap test result 2.
- According to the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines, patients with an ASCUS Pap test should undergo HPV cotesting to determine the presence of high-risk HPV types 3, 4.
- If the HPV test is negative, the patient can return to routine screening, as the risk of high-grade cervical intraepithelial neoplasia (CIN) or cancer is low 3, 5.
- However, if the HPV test is positive, especially for HPV types 16 or 18, the patient should be referred for colposcopy, a diagnostic procedure to evaluate for cervical dysplasia 6, 4.
- Colposcopy may involve biopsy and endocervical sampling to determine the presence and severity of CIN or cancer 4.
Considerations for Young Women
- Young women, especially those under 25, have a higher likelihood of clearing HPV infections on their own, and the risk of CIN or cancer is lower in this age group 2, 4.
- However, it is essential to follow ASCCP guidelines and consider individual risk factors, such as HPV subtype and persistence of infection, when determining the next steps for management 4.
Importance of Follow-up
- Regular follow-up is crucial for patients with abnormal Pap test results, including ASCUS, to ensure timely detection and treatment of any potential CIN or cancer 3, 4.
- Primary care clinicians should develop clinic-based systems to ensure appropriate follow-up of abnormal cytology, positive high-risk HPV testing, diagnosed CIN, and cervical cancer 4.