Objective. Atypical squamous cells of undetermined significance (ASCUS) cells, occurring in organized cytological screening, may be either high‐risk human papillomavirus (HPV) positive or negative. To refine the assessment of women with ASCUS, a high‐risk HPV‐DNA test is recommended as triage in Sweden. Methods. A total of 197 consecutive women (mean age 39 years, range 21–60) with a diagnosis of ASCUS from the primary screening were selected for triage. Their cervical smears were collected and evaluated by using conventional cytological examination in combination with a high‐risk HPV‐DNA test (hybrid capture 2). The women were categorized into four groups: Group A, Cytology + /HPV +; Group B, Cytology–/HPV +; Group C, Cytology + /HPV–; and Group D, Cytology–/ HPV–. Women within Groups A–C were admitted for colposcopy and cervical biopsy. The women in Group D were considered as a low‐risk group for tumor development, and were re‐examined after three years in the next round of the organized screening. Results. In women in Group A (n = 58) the prevalence of histological verified CIN2–3 was 41%, in Group B (n = 41) 20%, and in Group C (n = 9) 0%. In Group D (n = 89), repeated primary screening three years later revealed CIN2–3 in two biopsies from 74 women studied (Conclusions. Adding a high‐risk HPV test in secondary screening increased the identification of women with CIN2–3 lesions by 33% in comparison with repeat cytology (p = 0.01). The clinical significance of the ASCUS diagnosis varied with age of the women.