Suggested Pap Smear Referral Guidelines (Dec 2007)

(Prepared by HMC Ambulatory Care Medical Directors)

Pap screening begins 3 years after onset of sexual activity or at age 21. Pap screening may end at age 70 if Pap history is unremarkable and patient is low risk.
Annual Pap smears up to age 30. After age 30, q2-3 years if 3 previous negatives, annual screening or Pap with HPV DNA test (if both negative then screen q3
years). Risk factors that should be considered are HPV infection, STDs, smoking, new sex partners, previous SIL or immunosuppression.
When absent endocervical cells is reported, the Pap may be repeated in one year unless patient is high risk or abnormal cells are identified.
After hysterectomy for benign causes, women need not undergo routine Pap smears unless symptomatic or history of SIL.
HPV testing (high risk types) is preferred method for triage of ASCUS results using liquid cytology. Suggest no HPV testing for adolescents age 20 and younger.
Please consult www.asccp.org for complete 2007 Consensus guidelines for management of cervical cytological abnormalities, Am J Ob Gyn 2007: 346-355 or
ACOG guidelines for cervical cancer screening, Obstet Gynecol 2006; 107(4)963-8.

ASCUS (Atypical Squamous Cells

of Undetermined Significance)

HPV not
done
Repeat Pap 6
months
Adolescents*
may repeat
q12 months x
2 years

HPV-

Perform Pap Smear

If Abnormal

If Unsatisfactory Repeat

ASC-H (Atypical Squamous Cells

rule out High Grade)
AGC (Atypical Glandular Cells)
HSIL (High Grade Squamous
Intraepithelial Lesion)

LSIL (Low Grade Squamous

Intraepithelial Lesion)

HPV+

All Others
Refer for Colposcopy

Treat infection
or atrophy if
indicated and
repeat screen
one year

Adolescents* (with ASCUS) may

repeat Pap q12 months x 2 years
before referral regardless of HPV
result

If abnormal
*Adolescents refers to women 20 years or younger

Select Patients

Adolescents*: repeat Pap q 12

months refer to colposcopy for
persistent atypia or LSIL >2year
Postmenopausal women: consider
estrogen therapy and repeat Pap
6-12 months refer to colposcopy if
persistent changes