What is the management approach for a patient with Atypical Squamous Cells of Undetermined Significance (ASC-US) but negative Human Papillomavirus (HPV) and negative Chlamydia and Gonorrhea results?

How to Communicate ASC-US with Negative HPV Results to Your Patient

Your patient's Pap smear shows minor cell changes (ASC-US), but the HPV test is negative, which means she is at very low risk for cervical cancer and does not need colposcopy—she should return for repeat Pap and HPV testing in 3 years. 1, 2

What to Tell the Patient

The Good News First

• Reassure her that she does NOT need colposcopy or any immediate procedures because the negative HPV test indicates very low risk for precancer or cancer 2, 3
• The STI tests (Chlamydia and Gonorrhea) are also negative, which is additional reassurance 2
• The risk of developing high-grade precancer (CIN3+) over the next 5 years is only 0.48%, which is very low 3

Explain What ASC-US Means

• ASC-US stands for "atypical squamous cells of undetermined significance"—this means some cervical cells look slightly different than normal, but not abnormal enough to be concerning 1, 2
• This is NOT cancer and NOT precancer—it represents a category of morphologic uncertainty that is very common, affecting over one million women annually 1
• The negative HPV test is the key finding that determines she is low-risk 2, 4

The Follow-Up Plan

• She needs to return in 3 years (not 5 years) for repeat Pap and HPV testing together 1, 2
• This 3-year interval is based on updated evidence showing that while her risk is low, it is slightly higher than women with completely negative results, so the shorter interval is safer 1, 3
• If both tests are negative at 3 years, she can return to routine screening intervals 2

Important Clinical Context

Why 3 Years Instead of 5 Years

The recommendation changed from 5 years to 3 years based on Kaiser Permanente Northern California data analyzing over 1.1 million women, which showed that HPV-negative ASC-US carries higher risk than negative co-testing (both Pap and HPV negative), though still very low in absolute terms 1, 3

Special Consideration for Older Women

• If your patient is approaching age 65, do NOT allow her to exit screening with this result 1, 2
• Women ages 60-65 with HPV-negative ASC-US have disproportionately higher cancer risk despite low precancer risk 1
• She must be retested at 3 years and continue surveillance until achieving 2 consecutive negative co-tests or 3 consecutive negative Pap tests 1, 2

Common Pitfalls to Avoid

Do Not Order Unnecessary Tests

• Do NOT perform HPV 16/18 genotyping—it does not alter management for ASC-US patients and adds unnecessary cost 1, 2
• Do NOT repeat testing earlier than 3 years unless she develops symptoms 1, 2

Do Not Refer to Colposcopy

• Colposcopy is NOT indicated for HPV-negative ASC-US because the current risk for CIN3+ is below the threshold for colposcopy 1, 2
• Immediate colposcopy would lead to overtreatment in this low-risk population 2

Ensure Proper Documentation

• Document clearly that she needs co-testing (both Pap AND HPV) in 3 years, not just a Pap smear alone 1, 2
• Set up a recall system to ensure she returns, as loss to follow-up rates can be as high as 27% 5