Management of Abnormal Cervical Screening Results in Women Over 60

Recommended Management Algorithm

For a 60-year-old female with ASCUS and positive non-high-risk HPV, the American Cancer Society recommends follow-up with repeat co-testing (Pap and HPV) in 3 years, and she should not exit screening at age 65 without additional negative tests 1, 2, 3
The risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) in women with HPV-negative ASCUS is higher than with negative cytology alone, and this risk is even more concerning in women over 60 years of age, according to the National Comprehensive Cancer Network 3, 4

Women with ASCUS and non-high-risk HPV-positive results should return for screening in 3 years with co-testing (Pap and HPV testing), as recommended by the American Cancer Society 1, 2, 3
The 3-year interval recommendation is based on data from Kaiser Permanente Northern California (KPNC) showing that women with HPV-negative ASCUS have a higher risk than those with negative co-testing 3, 5

Women who reach age 65 with an HPV-positive ASCUS result should not exit screening, according to the National Comprehensive Cancer Network, and continued surveillance is necessary until the patient has 2 consecutive negative co-tests or 3 consecutive negative Pap tests 4, 6
KPNC data show that although dysplasia risk may be low after HPV-negative ASCUS in women over 60, cancer risk is disproportionately high 4

The American Cancer Society recommendation for 3-year follow-up is graded as "weak" due to limited data, but represents the most current consensus, and is based on analysis of approximately 1.1 million women from KPNC with extended follow-up 1, 2
The principle of "equal management of equal risks" guides these recommendations - women with HPV-positive ASCUS have risk profiles requiring standardized follow-up, as stated by the American Cancer Society 3, 5

Women over 60 years with HPV-positive ASCUS may have a higher risk for cervical cancer during follow-up than women with negative co-test results, according to the American Cancer Society and the National Comprehensive Cancer Network 1, 4
Risk estimates for cancer among women with HPV-positive ASCUS test results in this age group are based on limited data, but suggest caution is warranted, as noted by the American Cancer Society 1, 2
Approximately 0.5% to 1.0% of all women in their 60s will have an HPV-negative ASCUS result, and the risk is higher for HPV-positive results, according to the American Cancer Society 1

The National Comprehensive Cancer Network recommends not allowing exit from screening at age 65 with a recent HPV-positive ASCUS result, as this is insufficient for exiting screening 4, 6
The American Cancer Society recommends not extending screening interval beyond 3 years, as the previous 5-year interval recommendation has been revised based on newer evidence 1, 2, 3
The National Comprehensive Cancer Network recommends not using HPV 16/18 genotyping to further assess women with ASCUS Pap test results, as this does not alter management in this context 4