A b s t r a c t Few studies have compared long-term follow-up and risk for invasive cancer in women with atypical squamous cells of undetermined significance (ASCUSFollow-up should depend on the relative risk in a woman with ASCUS to have or develop invasive cervical cancer. This risk depends primarily on the number of squamous intraepithelial lesions (SIL), in particular high-grade SIL (HSIL), that lurk in or develop from an ASCUS lesion. -10 If the number of SIL is high and these SIL would progress to invasive cancer before the next Pap smear, aggressive followup is warranted. Short-term follow-up studies (less than 2 years) demonstrate conflicting results, with follow-up SIL rates ranging from 10% to 40%. 2_1° Long-term populationbased follow-up studies measuring patient outcomes, not only including follow-up SIL rates but also per-patient costs and risk for HSIL, are lacking.We attempted to define the risks associated with an ASCUS diagnosis by measuring long-term follow-up (up to 6 years) in all women with Pap smears diagnosed as ASCUS at the University of Iowa during calender year 1992. Materials and MethodsIn 1992 at the University of Iowa, 19,912 cases were screened; the diagnoses" were 0.3% unsatisfactory for diagnosis, 88.5% benign, 5.0% atypical, 4% low-grade SIL

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