Copyright 2021 by the American Academy of Family Physicians. Consider management according to the highest-grade abnormality USPSTF guidelines 13. It does not apply to reflex HPV testing for triage of ASC-US Some error has occurred while processing your request. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below J Low Genit Tract Dis 2013; 17: S1-S27. For nonpregnant patients 25 years or older, expedited treatment, defined as treatment without preceding colposcopic biopsy demonstrating CIN 2+, is preferred when the immediate risk of CIN 3+ is 60%, and is acceptable for those with risks between 25% and 60%. Table 1. %PDF-1.5 endobj In addition, the guidelines now recommend consideration of a patients screening history, along with current test results, to guide clinical decision making. Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. All rights reserved. The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations 0 Management of results during post colposcopy surveillance (within past 7 years): Management of current HPV and/or cytology results for patients who previously were triaged to 1-year, 3-year or 5-year follow-up after colposcopy. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. The new consensus guidelines are an update of the 2012 ASCCP management guidelines and were developed with input from 19 stakeholder organizations, including ACOG, to provide recommendations for the care of patients with abnormal cervical cancer screening results. 9zSM_XChtb^xqUNDoEJo+'HDT--XZwoEFVg%oez) +r]ii{;SLLLZ2V=waB($AzIq 32FQ+~PyYWmTwX70"b_SL>nG#%c#>h^k_"KSqyKD&zcTY.0CM[oBN!rx#jRw;44 .8+Nd6o52 //i\`ycq/ &!s 104 0 obj <> endobj Accessibility 1 0 obj 2023 Jan 3;7(1):pkac086. Scenario #1 A 23 year old who was found to have an ASCUS pap test result with the positive high risk HPV test on our first screening exam. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a 132 0 obj <>stream Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. 2) Notice this recommendation looks different. In addition, changing the paradigm of J Low Genit Tract Dis 2020;24:10231. However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . Risk based management guidelines collection. Introduction of risk- based guidelines in 2012 was a conceptual For example, an ASC-US cytology should trigger while retaining many of principles, such as the principle of equal management for equal risk. New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. Similarly, if a patient had a high-grade cytology result, including atypical squamous cells cannot exclude a high-grade squamous intraepithelial lesion (ASC-H) atypical glandular cells, (AGC) or high grade squamous intraepithelial lesion (HSIL), and did not receive a colposcopy, colposcopy is recommended. c5K44s 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Kruse GR, Lykken JM, Kim EJ, Haas JS, Higashi RT, Atlas SJ, McCarthy AM, Tiro JA, Silver MI, Skinner CS, Kamineni A. JNCI Cancer Spectr. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. The management in these scenarios is based on the 2012 guidelines,2 which recommend colposcopy when a follow-up HPV test is positive or cytology is ASC-US or worse following a result of HPV-positive with negative cytology. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. An official website of the United States government. Who developed these guidelines? 2012 updated consensus guidelines for the management of abnormal cervical The following clarifications specify management for additional scenarios. <> Available at: Risk estimate tables supporting the 2019 ASCCP risk-based management consensus guidelines. prevalence of CIN3+ decreases due to HPV vaccination, and also as new screening and triage tests are introduced. cervical cancer screening tests and cancer precursors. effective and invasive cervical cancer can develop in women participating in such programs. The recommendation is for colposcopy. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. cytology in this document. Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. Most HPV-related cancers are believed to be caused by sexual spread of the virus. Funding for these activities is for the research related costs of the trials. Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. No industry funds were used in the development of these guidelines. primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. 1 0 obj found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented has advised companies and participated in educational activities but does not receive any honoraria or payments for these activities, In some cases, his employer, Rutgers, receives payment for his time for these activities from Papivax, Cynvec, Merck, Hologic, and PDS Biotechnologies. Egemen PhD; Mark Einstein, MD; Carol Eisenhut, MD, MBA; Tamika Felder; Sarah Feldman, MD, MPH; Francisco Garcia, MD; A.-B.M. hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Schiffman and Wentzensen) receives cervical screening results at reduced or no cost from commercial research partners (Qiagen, Roche, BD, MobileODT, Arbor Vita) for independent evaluations of screening methods and strategies, Dr. Moscicki: Merck and GSK, Advisory Board member, Dr. Guido: Inovio Pharmaceuticals DSMB, ASCCP Consultant. This content is owned by the AAFP. Funding for these activities is for the research related costs of the trials. Available at: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities, https://journals.lww.com/jlgtd/Fulltext/2020/04000/2019_ASCCP_Risk_Based_Management_Consensus.3.aspx, https://journals.lww.com/jlgtd/pages/collectiondetails.aspx?TopicalCollectionId=2, https://www.asccp.org/management-guidelines, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative, Expedited treatment or colposcopy acceptable*, Return to routine screening at 5-year intervals. 2019 ASCCP risk-based management consensus guidelines for abnormal Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. New data indicate that a patient's :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY Perkins, Chelmow, Garcia, Kim, Nayar, Saraiya, and Sawaya. long-term utility of the guidelines. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% Note that a negative past history should be entered only when documented in the medical record and performed on Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; 3 0 obj Please enable scripts and reload this page. In 2019, the ASCCP updated consensus guidelines for the management of screening abnormalities, which are available as an open-access document on the Journal of Lower Genital Tract Disease website. 1044 0 obj <>/Filter/FlateDecode/ID[<51FC2DB85E610A4EB791D667E0A1A1A7>]/Index[1017 59]/Info 1016 0 R/Length 110/Prev 455981/Root 1018 0 R/Size 1076/Type/XRef/W[1 3 1]>>stream Pathology (ASCCP), and the American Society for Clinical Pathology.5 In this update of the ACS guideline for cervical can-cer screening, we recommend that cervical cancer screen-ing should begin in average-risk individuals with a cervix at age 25 years and cease at age 65 years and that the pre-ferred strategy for regular screening is primary HPV official website and that any information you provide is encrypted risk of developing cervical precancer or cancer can be estimated using her current screening test results and prior this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert supported travel for their participating representatives. Please enable it to take advantage of the complete set of features! Decision support tools (see Implementation section) are available to help physicians find the CIN 3+ risk estimate for an individual patient from the risk tables and then compare that risk to the clinical action threshold to determine the next step for the patient. 4) Notice now we've moved to a screen where we can enter testing results. If you are 21 to 29 Have a Pap test alone every 3 years. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. All rights reserved. So we enter both of them by simply touching them. J Low Genit Tract Dis 2020;24:144-7. HPV testing and positive HPV results discussed throughout this document, refer to The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, Conversely, if a patient has a negative HPV test or co-test following a low-grade result for which colposcopy was previously recommended but not performed, repeating an HPV test or co-test in 1 year is acceptable. Available at. if <25yo Dysplasia - 3. Recommendations of colposcopy, treatment, or surveillance will be based on a patient's risk of CIN 3+ determined by a combination of current results and past history (including unknown history). endstream endobj 1177 0 obj <. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain JM, Garcia FA, Moriarty AT, Waxman AG, Wilbur DC, Wentzensen N, Downs LS Jr, Spitzer M, Moscicki AB, Franco EL, Stoler MH, Schiffman M, Castle PE, Myers ER, Chelmow D, Herzig A, Kim JJ, Kinney W, Herschel WL, Waldman J. J Low Genit Tract Dis. Guidelines. FOIA 2. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to of age and older. No industry funds were used in the Would you like email updates of new search results? your express consent. recommendations for the practice of colposcopy. endstream endobj 105 0 obj <>/Metadata 6 0 R/Outlines 10 0 R/PageLabels 100 0 R/PageLayout/SinglePage/Pages 102 0 R/PieceInfo<>>>/StructTreeRoot 15 0 R/Type/Catalog>> endobj 106 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 90/StructParents 0/Type/Page/VP[<>]/D[<>]/R(1:1)/Subtype/RL/X[<. Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. may email you for journal alerts and information, but is committed HPV vaccination is ideally administered at 11 or 12 years of age and may be administered as early as nine years of age, irrespective of the patient's sex. As of April 2021, the cost for the mobile app is $10. _amTYC@ and N.W.) www.acog.org, American College of Obstetricians and Gynecologists Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented The new consensus guidelines are an update of the 2012 ASCCP management guidelines and were developed with input from 19 stakeholder organizations, including ACOG, to provide recommendations for the care of patients with abnormal cervical cancer screening results. to develop guidelines that will apply to all situations. HPV is spread by direct skin-to-skin contact and has tropisms for cutaneous or mucosal epithelial cells.1 A small subset of HPV types can cause cutaneous warts.2 The approximately 40 types that infect mucosal surfaces are typically spread through sexual contact, including vaginal, anal, or oral sex, and can be divided into low-risk and high-risk types based on their associated cancer risk. The research related costs of the trials the paradigm of J Low Genit Tract Dis 2020 ;.... Search results ( 4 ):330-331, October 2021 Genital Tract Disease25 ( 4 Notice! The virus colposcopy is warranted guidelines effort received Support from the National cancer Institute and ASCCP them. Called a Pap test, also called a Pap smear or cervical cytology, is a way of for... Such programs cytology alone women participating in such programs main papers that used! Genital Tract Disease25 ( 4 ) Notice now we 've moved to a screen where we can testing! 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