When should a 48‑year‑old woman with a normal Pap test showing benign endometrial cells and negative HPV, performed two years ago, have her next cervical cancer screening?

Cervical Cancer Screening Timing for 48-Year-Old Woman

This patient should have her next cervical cancer screening now, as she is overdue—screening should occur every 3 years with Pap test alone or every 5 years with co-testing (Pap plus HPV), and her last test was 2 years ago. 1, 2, 3

Understanding the Screening Interval

For women aged 30-65 years, including this 48-year-old patient, the American Cancer Society and USPSTF recommend two acceptable screening strategies: 1, 2, 3

• Preferred approach: Pap test plus HPV DNA co-testing every 5 years 1, 3
• Acceptable alternative: Pap test alone every 3 years 1, 3

Since her last screening was 2 years ago with negative HPV and normal Pap, she should return for screening based on whichever interval was initially established. If she was on a 3-year Pap-only schedule, she would be due in 1 more year. If she was on a 5-year co-testing schedule, she would be due in 3 more years. 1, 2

Important Clarification About "Benign Endometrial Hyperplasia"

The question states "benign endometrial hyperplasia" but this appears to be a misstatement—the Pap likely showed benign endometrial cells, not hyperplasia. Hyperplasia is a histologic diagnosis requiring endometrial biopsy, not a Pap test finding. 1

If Benign Endometrial Cells Were Present:

For a 48-year-old premenopausal woman with benign-appearing endometrial cells on Pap test: 1

• No additional evaluation is required if she is asymptomatic 1
• Benign endometrial cells in premenopausal women are rarely associated with underlying pathology 1
• The 2014 Bethesda System recommends reporting endometrial cells only in women ≥45 years, but clinical significance remains low in women under 50 years without symptoms 4, 5, 6
• Research shows that women aged 40-50 years with benign endometrial cells had no significant pathology in multiple studies unless additional clinical indicators were present 5, 6
• Endometrial sampling should only be performed if she has abnormal uterine bleeding, postmenopausal status, or other risk factors for endometrial cancer 1, 5, 6

Routine Cervical Cancer Screening Schedule

She should continue routine cervical cancer screening until age 65-70 years. 1, 2, 3

Screening may be discontinued after age 65 only if ALL of the following criteria are met: 1, 2, 3

• No abnormal/positive cytology tests within the 10-year period prior to age 65-70 1, 2, 3
• Documentation of 3 consecutive negative Pap tests 1, 2, 3
• Evidence of adequate negative prior screening 1, 2, 3
• No history of CIN2+ within the last 20 years 2, 3

Common Pitfalls to Avoid

• Do not screen annually—women at any age should not be screened annually by any screening method 1
• Do not confuse benign endometrial cells with endometrial hyperplasia—these are distinct findings with different management 1
• Do not perform endometrial sampling for benign endometrial cells in asymptomatic premenopausal women—this leads to unnecessary procedures 1, 5, 6
• Do not use single-sample FOBT during digital rectal exam—this is not recommended for any screening purpose 1