Next Screening Due in 3 Years
For this 45-year-old woman with three consecutive ASCUS results (each with negative HPV), the next Pap smear with HPV co-testing is due in 3 years from the most recent test. 1, 2
Rationale for 3-Year Interval
Women with HPV-negative ASCUS should return to routine screening intervals rather than accelerated surveillance, because their risk of high-grade disease is comparable to women with negative Pap tests alone. 1, 3
The absolute risk of developing CIN3+ over 5 years after HPV-negative ASCUS 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
The 3-year interval (rather than 5 years) is specifically recommended for HPV-negative ASCUS because while the risk is low, it remains slightly higher than completely negative co-testing results. 2, 4
Among HPV-negative ASCUS women, only 1.4% develop CIN3 or worse during follow-up, compared to 15.2% of HPV-positive ASCUS women. 3
Key Management Principles
Do not perform colposcopy for HPV-negative ASCUS, as the current risk for CIN3+ is below the threshold for colposcopy and would lead to overtreatment. 2
Do not repeat HPV testing before the 3-year interval, as transient cytologic abnormalities without HPV do not merit earlier surveillance. 1
The negative predictive value of HPV testing in ASCUS cases is 99.6% for high-grade lesions, confirming the safety of routine interval screening. 1, 3
Common Pitfalls to Avoid
Do not assume this patient can extend to a 5-year interval despite multiple negative HPV results—the ASCUS cytology finding mandates the shorter 3-year interval. 2, 4
Do not order HPV 16/18 genotyping, as it does not alter management and adds unnecessary cost in this scenario. 2
At age 45, this patient should continue routine screening until age 65, requiring ≥3 consecutive negative Pap tests or ≥2 consecutive negative co-tests within 10 years (with the most recent within 5 years) before discontinuing screening. 5, 2