Management of ASC-US with Negative HPV
Return for repeat co-testing (Pap and HPV) in 3 years—colposcopy is not indicated for this low-risk result. 1
Primary Management Recommendation
Women with ASC-US cytology and negative high-risk HPV testing should return in 3 years for repeat Pap and HPV co-testing, not the standard 5-year interval used for completely negative co-tests. 1
The 3-year interval (rather than 5 years) is based on analysis of over 1.1 million women showing that HPV-negative ASC-US carries slightly higher risk than negative co-testing, though still very low in absolute terms. 1, 2
The 5-year cumulative risk of CIN3+ after HPV-negative ASC-US is 0.48%, compared to 0.11% after negative co-testing and 0.31% after negative Pap alone, placing this result closer to the risk profile of a negative Pap test. 2
What NOT to Do
Do not refer to colposcopy—the current risk for CIN3+ is below the threshold for colposcopy, and immediate colposcopy would lead to overtreatment in this low-risk population. 1
Do not perform HPV 16/18 genotyping, as it does not alter management and adds unnecessary cost. 1
Do not allow this patient to exit screening if she is between ages 60-65, as women in this age group with HPV-negative ASC-US have disproportionately higher cancer risk despite low precancer risk. 1
Special Considerations for Older Women
For women ages 60-65 with HPV-negative ASC-US, continue surveillance until achieving 2 consecutive negative co-tests or 3 consecutive negative Pap tests before allowing screening cessation. 1
This is critical because older women with this result pattern have elevated cancer risk even when precancer risk appears low. 1
Patient Communication Points
Explain that ASC-US means "atypical squamous cells of undetermined significance"—some cervical cells look slightly different than normal, but not abnormal enough to be concerning. 1
Reassure that this is not cancer or precancer, and the negative HPV test indicates very low risk. 1
Emphasize the importance of returning in 3 years (not 5 years) for repeat testing, as this slightly abnormal result requires closer monitoring than completely normal results. 1