Management of ASCUS Pap and HPV Negative Results

Understanding the Risk Profile

The American Cancer Society recommends that a patient with ASCUS Pap result and negative HPV testing has a low risk of precancer or cancer, with a category of morphologic uncertainty 1

The American Cancer Society recommends repeat Pap testing in 12 months for a patient with ASCUS Pap result and negative HPV testing, with a recommendation that aligns with updated guidelines from a 5-year to a 3-year interval 1, 2
The Centers for Disease Control and Prevention recommends that if repeat Pap test is normal, the patient should return to routine screening 3
The Centers for Disease Control and Prevention recommends that if repeat Pap tests show ASC or more serious condition, the patient should follow management according to the specific abnormality found 3
The Centers for Disease Control and Prevention recommends continue repeat testing at 6- and 12-month intervals until two consecutive negative results are obtained 4

High-grade histological changes after colposcopic evaluation for ASCUS Pap test reports are typically detected in less than 12% of cases 3

For women aged 30-65 years, cotesting with HPV and cytology is the preferred approach for routine screening, with a 5-year interval if both tests are negative 5
The American Cancer Society recommends that when ASCUS is found with negative HPV, the recommended follow-up interval is shortened to 12 months 1

The American Cancer Society recommends avoiding returning to screening too soon (before 12 months) as it is unnecessary and may lead to overtreatment 1
The American Cancer Society recommends avoiding waiting too long (5 years) between screenings after HPV-negative ASCUS as the risk is higher than after a completely negative cotest 1
The Centers for Disease Control and Prevention recommends avoiding performing colposcopy immediately for all ASCUS results regardless of HPV status as it can lead to unnecessary procedures 3
The National Comprehensive Cancer Network recommends avoiding failing to recognize that HPV-negative ASCUS results are not sufficiently reassuring to allow women to stop undergoing screening at age 65 years 2

The risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) after an HPV-negative/ASCUS result is higher than after a completely negative cotest but remains relatively low, with the American Cancer Society updating their recommendation to a 3-year interval for HPV-negative ASCUS results based on expanded data analysis 6
The American Cancer Society recommendation is based on expanded data from a large cohort of women, including 1.1 million women with extended follow-up, supporting a 3-year rather than 5-year interval for HPV-negative ASCUS results 6
The principle of "similar management of similar risks" supports this approach, as the risk profile of HPV-negative ASCUS is closer to that of a negative Pap test alone, with a 5-year CIN3+ risk of 0.48% 6
Do not assume that an HPV-negative ASCUS result carries the same ultralow risk as a negative cotest (HPV-negative/cytology-negative), as the risk is higher than after a completely negative cotest 6