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Follow-Up of Abnormal Screening Tests

Two case examples of follow-up for abnormal screening tests follow.

Case 1

Cervical cancer screening test results conducted in-clinic come back as atypical squamous cells of undetermined significance (ASCUS) and HPV-negative. What is your next step and when is the next cervical cancer screening test due?

For non-pregnant women between 25 and 65 years of age with ASCUS cytology who have not had HPV co-testing already, HPV testing is the preferred next step (high-risk HPV testing only). With a negative HPV test (either on co-test or after cytology), repeat co-testing every three years is recommended. For more information about special populations, including pregnant women and women 21 to 24 years of age, refer to the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines. [PDF-324KB]

For non-pregnant women between 25 and 65 years of age with ASC-US cytology, reflex HPV testing is preferred. For women with HPV-negative ASC-US, whether from reflex HPV testing or co-testing, repeat co-testing at 3 years is recommended. For women with HPV-positive ASC-US, whether from reflex HPV testing or co-testing, colposcopy is recommended. When colposcopy does not identify CIN in women with HPV-positive ASC-US, co-testing at 12 months is recommended. If the co-test is HPV negative and cytology negative, return for age-appropriate testing in 3 years is recommended. If all tests are negative at that time, routine screening is recommended. It is recommended that HPV testing in follow-up after colposcopy not be performed at intervals of less than 12 months. For women with ASC-US cytology and no HPV result, repeat cytology at 1 year is acceptable. If the result is ASC-US or worse, colposcopy is recommended; if the result is negative, return to cytology testing at 3-year intervals is recommended.

Reprinted from The Journal of Lower Genital Tract Disease Volume 17, Number 5, with the permission of ASCCP. © American Society for Colposcopy and Cervical Pathology 2013. No copies of the algorithms may be made without the prior consent of ASCCP.

Case 2

A 31-year-old patient’s cervical cancer screening test results come back as cytology negative and HPV-positive. What is your next step and when is the next cervical cancer screening test due?

Follow ASCCP guidance: repeat co-test in one year or do HPV DNA typing now.

For women 30 years of age and older with HPV-positive but cytology-negative co-testing, repeat co-testing at 1 year is acceptable. At the 1-year repeat co-test, if the HPV test is positive or cytology is ASC-US or worse, colposcopy is recommended. If the 1-year repeat co-test result is HPV negative and cytology negative, repeat co-testing in 3 years is recommended. HPV genotyping is also acceptable. If HPV-16 or HPV-18 tests are positive, colposcopy is recommended. If HPV-16 and HPV-18 tests are negative, repeat co-testing in 1 year is recommended.

Reprinted from The Journal of Lower Genital Tract Disease Volume 17, Number 5, with the permission of ASCCP. © American Society for Colposcopy and Cervical Pathology 2013. No copies of the algorithms may be made without the prior consent of ASCCP.

Summary of Cervical Cancer Screening Results and Management for Women 30 Years of Age or Older

Test Results What to Do Next
Normal Pap and Negative HPV Rescreen in 5 years.
Normal Pap and Positive HPV Repeat co-test in one year or do HPV DNA typing now (see ASCCP guidelines above).
ASCUS Pap, No HPV Test Repeat cytology in one year or do HPV test now (see ASCCP guidelines above).
ASCUS Pap and Negative HPV
LSIL Pap and Negative HPV		 Repeat Pap and co-test at interval as per ASCCP guidelines.
ASCUS Pap and Positive HPV
LSIL Pap and Positive or Unknown HPV
ASC-H Pap
HSIL Pap		 Colposcopy and/or referral to gynecologist.

Acronyms

ASCUS = Atypical squamous cells of undetermined significance
HSIL = High-grade squamous intraepithelial lesions
LSIL = Low-grade squamous intraepithelial lesions
ASC-H = Atypical squamous cells, cannot exclude HSIL

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