Can a patient with a history of Low-grade Squamous Intraepithelial Lesions (LSIL) and Atypical Squamous Cells of Undetermined Significance (ASCUS) on previous Papanicolaou (PAP) tests, a negative colposcopy, and a current negative High-Risk Human Papillomavirus (HPV) test qualify for HPV testing every 5 years?

Cervical Cancer Screening After LSIL/ASCUS History with Negative HPV Test

This patient does NOT qualify for 5-year HPV screening intervals and should instead undergo cotesting (HPV + Pap) at 3-year intervals. 1

Why 5-Year Screening Is Not Appropriate

The critical issue here is that a history of LSIL or ASCUS with negative HPV testing carries higher risk than routine negative cotesting results. 1

• Updated Kaiser Permanente Northern California (KPNC) cohort data demonstrated that the 5-year risk of CIN3+ after HPV-negative ASCUS (1.1%) is significantly higher than after negative cotesting (0.27%). 1
• This elevated risk profile means that women with prior ASCUS/LSIL abnormalities require more frequent surveillance even after achieving negative HPV results. 1
• The ASCCP consensus conference specifically changed their recommendation from 5-year to 3-year follow-up for HPV-negative ASCUS based on this risk stratification data. 1

Recommended Management Algorithm

Schedule cotesting (HPV + Pap) at 3-year intervals rather than HPV testing alone at 5-year intervals. 1

• The 3-year cotesting interval applies specifically because of the documented history of cytologic abnormalities (LSIL and ASCUS). 1
• This recommendation holds even though the colposcopy was negative and subsequent tests have been reassuring. 1
• The patient should continue this 3-year cotesting schedule until she has achieved either 2 consecutive negative cotests or 3 consecutive negative Pap tests over a 10-year period. 1

Risk Stratification Context

The evidence clearly stratifies risk levels:

• Negative cotesting (HPV-/Pap-): 0.27% 5-year risk of CIN3+ → qualifies for 5-year intervals 1
• HPV-negative ASCUS: 1.1% 5-year risk of CIN3+ → requires 3-year intervals 1
• HPV-negative LSIL: 5.1% 5-year risk of CIN3+ → requires 3-year intervals 2

Your patient's history of both LSIL and ASCUS places her in a higher-risk category that necessitates more frequent surveillance than standard negative cotesting. 1

Critical Pitfall to Avoid

Do not assume that a negative colposcopy and subsequent negative tests "reset" the patient to routine screening intervals. 1 The ASCCP guidelines specifically address this scenario and maintain that the history of cytologic abnormalities requires continued enhanced surveillance with 3-year cotesting until adequate negative screening history is established. 1

Special Consideration for Age 65 Screening Cessation

If this patient approaches age 65, she cannot discontinue screening based on an HPV-negative ASCUS or LSIL result alone. 1

• KPNC data show that although dysplasia risk is low after HPV-negative ASCUS in women ≥65 years, cancer risk remains disproportionately high. 1
• She must achieve either 2 consecutive negative cotests or 3 consecutive negative Pap tests before discontinuing screening at age 65. 1