ASC-US and HPV testing in women aged 40 years and over

High-risk human papillomavirus (HPV) DNA triage is commonly performed for cervical cytology specimens interpreted as atypical squamous cells of undetermined significance (ASC-US), but little is known about testing results in women > or =40 yr of age. The extent to which clinical follow-up after HPV testing reflects the most recent management guidelines is unknown also. Data from 108 patients > or =40 yr of age with concurrent (93 patients) or recent (15 patients) ASC-US interpretations and HPV testing were reviewed. Twenty-five (23.1%) of these patients were positive for high-risk HPV. The HPV(+) rate was higher in women with a current interpretation of ASC-US (26.9%) compared with those with a previous ASC-US result (0%). Many patients were not managed exactly according to the "2001 Consensus Guidelines for the Management of Women with Cervical Cytologic Abnormalities." The majority (52.6%) of women with HPV(+) ASC-US did not receive colposcopy in our institution, and 41.3% of women with HPV(-) ASC-US received follow-up testing within 8 mo. These results show the potential for inadequate evaluation of women with HPV(+) ASC-US, as well as unnecessary early repeat cytology in HPV(-) ASC-US patients. Therefore, additional clinician education and reminders to correlate cytology and HPV test results may be warranted to optimize patient care.