Review Question - QID 106992

Patients presenting with ASCUS and a positive HPV test should undergo colposcopy.

Recommended frequencies for Pap smears have been reduced significantly over the past several decades. Currently, Pap smears are not recommended for patients under the age of 21, regardless of sexual activity, and normal Pap smears do not need to be repeated for 3 years. The ideal treatment of ASCUS is not well-known, however current recommendations separate treatment based on age. Patients with ASCUS and an adequate sample who are under 30 should undergo a repeat Pap smear in 1 year. In contrast, in patients who are 30 years or older with ASCUS, reflex HPV testing should be performed. Those patients who have a positive HPV test should undergo colposcopy.

The US Preventive Task Force issued a new recommendation for Pap smear testing in 2012. They note that women over 65 who have had prior negative screening and lack risk factors for cervical cancer do not need to undergo Pap smears. In addition, patients without a history of high-risk Pap smears who have had a hysterectomy that included cervical excision do not need to undergo a Pap smear.

Kepka et al. evaluate the overuse of Pap smears among patients over age 65 and those who have had a complete hysterectomy. They find that more than 14 million women in the United States underwent an unneeded Pap smear within the previous 3 years. They suggest that use of electronic medical records may reduce the incidence of unneeded Pap smears.

Incorrect Answers:
Answer 1: Patients >30 years old with a negative Pap smear and HPV should have a repeat Pap smear and HPV test in 5 years.
Asnwer 2: Patients >30 who have a negative Pap smear without an HPV test should have a repeat Pap smear in 3 years.
Answer 3: Patients <30 who present with ASCUS should undergo a repeat Pap smear in 1 year.
Answer 5: LEEP should be reserved for patients with a concerning result after colposcopy.