When should a 48-year-old woman with a prior atypical squamous cells of undetermined significance (ASC-US) Pap result and HPV-negative test four years ago have her next Pap test?

When Should This Patient Have Her Next Pap Test?

This 48-year-old woman with ASC-US four years ago and negative HPV testing at that time should have had her next Pap test three years after the negative HPV result, meaning she is now overdue for screening and should be screened immediately. 1

Current Screening Guidelines for Women Aged 30-65 Years

For women aged 30-65 years, the American Cancer Society recommends screening every 5 years with both HPV and Pap test (co-testing, preferred), or every 3 years with Pap test alone (acceptable). 1

• Women in this age group who have negative screening results can safely extend their screening intervals beyond annual testing 1
• The combination of negative HPV and negative cytology provides the lowest risk profile, allowing for 5-year intervals 1
• When Pap testing is used alone without HPV co-testing, the maximum safe interval is 3 years 1

Management After ASC-US with Negative HPV

Women with ASC-US and negative high-risk HPV testing have very low risk of subsequent high-grade disease and should return to routine screening intervals, not accelerated surveillance. 2, 3

• The 5-year risk of CIN3+ after HPV-negative/ASC-US is only 0.48%, which is closer to the risk after a negative Pap test (0.31%) than after a negative co-test (0.11%) 4
• Research demonstrates that only 1.4% of HPV-negative ASC-US women develop CIN3 or worse during follow-up, compared to 15.2% of HPV-positive ASC-US women 3
• The American Society for Colposcopy and Cervical Pathology confirms that women with ASC-US and negative HPV do not require immediate colposcopy or accelerated follow-up, as their risk is comparable to women with completely normal screening 2

Why This Patient Is Overdue

Since this patient had ASC-US with negative HPV four years ago, she should have returned for routine screening at 3 years (if using Pap alone) or could have waited up to 5 years (if co-testing was planned). 1, 4

• At four years post-screening, she has exceeded the 3-year interval for Pap-only screening 1
• The negative HPV result from four years ago effectively "reset" her risk to that of a woman with normal screening 2, 3
• Women aged 30 and older with negative HPV testing should not be rescreened before three years, but also should not exceed the recommended intervals 1

Important Clinical Considerations

The endometrial biopsy showing benign endometrial hyperplasia two years ago is irrelevant to cervical cancer screening intervals and does not change Pap test timing. 1

• Cervical cancer screening addresses cervical pathology, not endometrial pathology 1
• The presence of endometrial hyperplasia does not increase cervical cancer risk or alter screening recommendations 1

Common Pitfalls to Avoid

Do not assume that the prior ASC-US result requires more frequent screening than standard intervals once HPV negativity is established. 2, 3

• HPV-negative ASC-US should be managed identically to women with negative screening results 2
• Repeat HPV testing should not be performed before the next routine screening interval 2
• In perimenopausal and postmenopausal women (this patient is 48), approximately 73% of ASC-US cases are HPV-negative, often representing benign cellular changes rather than true dysplasia 5

Do not delay screening beyond recommended intervals based on the misconception that one abnormal result requires "waiting longer" before the next test. 1

• The negative HPV test effectively ruled out high-risk disease at that time 3
• Standard screening intervals apply after HPV-negative ASC-US 2, 4

Recommended Action Now

Schedule immediate cervical cancer screening with either co-testing (HPV + Pap, preferred) or Pap test alone. 1

• If co-testing is performed and both tests are negative, the next screening can be in 5 years 1
• If Pap alone is performed and negative, the next screening should be in 3 years 1
• Continue routine screening until age 65, at which point screening can be discontinued if she has had ≥3 consecutive negative Pap tests or ≥2 consecutive negative co-tests within the last 10 years, with the most recent test in the last 5 years 1