How should I manage a patient with abnormal cervical screening results, specifically regarding colposcopy referral criteria?

Management of a patient with abnormal cervical screening results involves assessing the high-risk human papillomavirus (hrHPV) status and cytology results to determine the need for referral to colposcopy. Referral to colposcopy is indicated if:

• The patient tests positive for hrHPV with abnormal cytology at 12 or 24 months.
• There are 2 consecutive hrHPV results unavailable or inadequate cytology results in any combination.
• Cytology shows high-grade dyskaryosis (moderate or severe), glandular neoplasia, or invasive squamous cell carcinoma.
• There is inadequate cytology at the 24-month repeat test.
• Persistent hrHPV positivity at 24 months despite negative or borderline cytology.

For patients who are hrHPV positive but have negative cytology, repeat hrHPV testing is done at 12 and 24 months; referral to colposcopy is made if hrHPV remains positive at 24 months. If colposcopy is normal and adequate, follow-up in the community at 12 months is appropriate, with return to routine recall if hrHPV is negative at that time. If colposcopy is inadequate, repeat screening and colposcopy in 12 months is advised.

In pregnancy, colposcopy referral should not be delayed if abnormal screening results are present, to exclude invasive cancer, although treatment may be deferred until after delivery for low-grade changes.

These criteria ensure timely identification and management of pre-cancerous and cancerous cervical lesions.

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