• ASC-US, HPV negative: Atypical cells of undetermined significance (ASC-US) is a cytology testing finding that is not diagnostic and is clinically ambiguous, because it doesn’t represent a specific cytologic interpretation. Studies have shown that the risk of developing precancerous lesions from ASC-US is not different enough from a negative co-test to alter management. Thus, the recommendation is to continue screening per age-specific guidelines.
• ASC-US, HPV positive; LSIL; or more severe cytologic result regardless of HPV status: Conduct a colposcopic evaluation.
The Bottom Line:
Cervical cancer screening is an essential part of well-woman care. However, new recommendations stress maximizing benefit and minimizing harm by starting screening at age 21 years and by having screening intervals that are longer than annually and are determined by a woman’s age and previous cytology results. Screening recommendations do not change based on history of HPV vaccination.
Reference
• American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer (J. Low. Genit. Tract Dis. 2012;16:175-204).
Management guidelines and algorithms can be found at www.asccp.org.
Dr. Ward is a third-year resident in the ob.gyn. residency program at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.