What is the first step for managing ASCUS in women aged 21?

The first step in managing atypical squamous cells of uncertain significance (ASCUS) in women aged 21 is to rescreen with cytology every three years. This recommendation is aligned with guidelines from organizations such as the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Colposcopy and Cervical Pathology (ASCCP).

In women within this age group, a conservative approach is taken because the potential for spontaneous regression of mild abnormalities is high. By rescreening with cytology every three years, healthcare providers ensure that any significant changes in cervical cell status are monitored without the need for invasive procedures such as colposcopy, which is more appropriate for older women or in cases where high-grade lesions are suspected.

While performing a colposcopy directly is a more immediate investigation for ASCUS, it is not the recommended first step for women aged 21, as many of these cases could resolve without intervention. Additionally, initiating HPV vaccination is important for prevention but does not address the immediate management of ASCUS findings. Referring to a specialist immediately may be warranted in certain circumstances, but it is not the standard first response for ASCUS in this age demographic. Thus, the emphasis on routine surveillance