What is the recommended repeat interval for cervical cancer screening for a 35-year-old female with a negative result for intraepithelial lesions or malignancy and a negative Human Papillomavirus (HPV) test?

Cervical Cancer Screening Interval for 35-Year-Old Female with Negative Cytology and Negative HPV

For a 35-year-old woman with negative cytology (negative for intraepithelial lesion or malignancy) and negative HPV test results, the recommended screening interval is 5 years.

Rationale for 5-Year Screening Interval

The most recent evidence strongly supports extending the screening interval to 5 years in women with negative co-testing results (negative cytology and negative HPV):

• For women aged 30 years and older with normal cytology and negative HPV testing, the screening interval can be safely extended to 5 years 1
• The risk of developing CIN3+ after a negative HPV test is significantly lower compared to after negative cytology alone, supporting longer screening intervals 2
• The 2022 BMJ study specifically found that the risk of CIN3+ detected at the second screening round five years after a negative HPV test in women younger than 50 years was very low (1.21/1000 women screened) 2

Risk Assessment Based on Current Results

Your patient has several favorable factors:

• Age 35 (appropriate for extended interval screening)
• Current negative cytology result
• Current negative HPV test
• Previous negative cytology in 2020 (although with positive HPV at that time)

Management Algorithm

1. Current result (2023): Negative cytology and negative HPV

   • Recommended action: Schedule next screening in 5 years (2028)

2. Special considerations:

   • Previous HPV positive result in 2020 but now negative suggests viral clearance
   • Natural clearance of HPV infection occurs in approximately 64% of women within 12 months 3
   • The negative HPV test now indicates significantly reduced risk of developing high-grade cervical lesions

3. Risk stratification:

   • Women with negative HPV tests have extremely low risk of developing CIN3+ within 5 years
   • The concordance of negative HPV testing results with those on follow-up satisfactory cervical cytology is very high (96.3%) 4

Important Caveats

• If the patient develops symptoms such as abnormal bleeding or discharge before the next scheduled screening, she should be evaluated regardless of the screening interval
• This recommendation assumes the patient has no other risk factors such as immunosuppression or prior history of high-grade cervical lesions
• The high negative predictive value of HPV testing is what allows for the extended screening interval

Evidence Quality Assessment

The recommendation for a 5-year interval is supported by high-quality evidence, including recent observational studies with large cohorts 2. The 2022 BMJ study specifically examined over 1.3 million women and found that extending screening intervals to 5 years after a negative HPV test was safe for women under 50 years of age, with even longer intervals potentially appropriate for women over 50.

This approach balances the benefits of avoiding unnecessary procedures while maintaining excellent protection against cervical cancer development, prioritizing both mortality reduction and quality of life.