Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. In this case, the patient had an ASCUS pap test result and a positive high risk test results. The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Reflex testing: this means that laboratories should perform a specific additional triage test in the setting cotesting with HPV testing and cervical cytology, and cervical cytology alone. 17-19 Patients with a history of abnormal test results require more frequent testing as recommended by the ASCCP. your express consent. Provide more appropriate intervention for high-risk individuals (detect and treat more precancer) Recommend less intervention for low-risk individuals (decrease testing and treatment that won't prevent cancer and may cause . 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17: S1-S27. Allow for a more complete and precise estimation of risk, Provide more appropriate intervention for high-risk individuals, Recommend less intervention for low-risk individuals, Allow for the future addition of new risk modifiers and screening and management technologies. evaluating histologic specimens obtained via colposcopic biopsy. Available at: ASCCP management guidelines app quick start guide. 0 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors J Low Genit Tract Dis . -, Huh WK, Ault KA, Chelmow D, et al. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert An official website of the United States government. Guidelines cannot cover all clinical situations and clinical judgment is advised, especially in those circumstances which are not covered by the 2019 guidelines.Perkins RB, Guido RS, Castle PE, et al. /+=jYOu3jz;?oVX'm6HtW|`k* 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. and patient advocates, convened by ASCCP; they are designed to safely triage individuals with abnormal cervical New evidence indicates that risk remains elevated for at least 25 years, with no evidence that treated patients ever return to risk levels compatible with 5-year intervals. 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. CIN 3+ Risk Thresholds for Management. Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. 21 to 29 years of age *. Copyright 2023 American Academy of Family Physicians. All 3 platforms show high . J Low Genit Tract Dis 2020;24:10231. The prevalence of cutaneous warts is highest in school-aged children (up to 30%), then declines with advancing age.2 HPV infection is the most common sexually transmitted infection in the United States. 4) Notice now we've moved to a screen where we can enter testing results. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to HPV testing or cotesting at more frequent intervals than are recommended for screening. screening for surveillance after abnormalities. However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . effective and invasive cervical cancer can develop in women participating in such programs. 1176 0 obj <> endobj these guidelines. variables to consider, the 2019 guidelines further align management recommendations with current understanding of the 2019 ASCCP risk-based management consensus guidelines. Because the new Risk-Based International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. Disclaimer: The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the National Cancer Institute. For individuals aged 25 or older screened with cytology alone, the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 are recommended for management of abnormal results. Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return Future guideline updates will be disseminated quickly by the apps and web-based tool as well as through clinical guidance documents. We don't have any prior history in this particular case. Patients with symptoms such as abnormal uterine or vaginal bleeding or a visibly abnormal-appearing cervix require appropriate diagnostic testing as this may be a sign of cancer. Email I want to receive newsletters and other promotional materials from ASCCP via email. Table 1. 8600 Rockville Pike 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. J Low Genit Tract Dis. defined risk thresholds to guide management are designed to continue functioning appropriately when population-level HPV vaccination is not routinely recommended in individuals 27 years or older. Risk estimation will use technology, such as a smartphone application or website. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk Provide more appropriate intervention for high-risk individuals (detect and treat more. 140, Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. 2020 Oct;24(4):427. doi: 10.1097/LGT.0000000000000563. MT]y_o. Participating organizations supported travel for their participating representatives. In additional to enabling the provision of more individualized clinical care, the new risk-based management paradigm will facilitate the incorporation of new screening and management technologies into clinical decision making and accommodate changes in disease prevalence over time. This site needs JavaScript to work properly. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, Perkins RB, Guido RS, Castle PE, et al. J Low Genit Tract Dis 2020;24:10231. 2 0 obj recommendations for the practice of colposcopy. No industry funds were used in the development of For example, those HPV-16 positive HSIL cytology qualify for expedited treatment. endstream endobj startxref This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based 21 Clearly defined risk thresholds based on the results of HPV tests, alone or in conjunction with cytology, are used to guide management (more or . hb```o,g(v``X b n(f`$PpRME`%uA*?20FA@Z7a'(2 ^$ Transformation Zone (LLETZ), and cold knife conization. government site. <>>> PMC Refers to immediate CIN 3+ risk. It is also important to recognize that these guidelines should never substitute for clinical judgment. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 17 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> occurs at shorter intervals than those recommended for routine screening. 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. Terminology for pap results NIL- no cell lesions or malignancy noted ASCUS- atypical cells of undetermined significance LSIL- low-grade squamous intraepithelial lesion ASC-H- changes in cervical cells have been seen, cannot rule out HSIL HSIL- high-grade intraepithelial lesion AGUS- atypical glandular cells of undetermined significance which test combinations yielded this risk level. Colleen Stockdale, MD, MS; Sana Tabbara, MD; Deanna Teoh, MD, MS; Elizabeth Unger, PhD, MD; Alan Waxman, MD, MPH; endobj cervical cancer screening have come out since 2012, such as primary HPV as a screening option for patients 25 years 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. 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. 2012 updated consensus guidelines for the management of abnormal cervical Do not perform annual cervical cytology (Pap test) or annual HPV screening in immunocompetent women with a history of negative screening. Cytology every . 2020;24(2):102131. 2012 ASCCP Consensus Guidelines Conference. a reflex HPV test. www.acog.org, American College of Obstetricians and Gynecologists 3. -, Egemen D, Cheung LC, Chen X, et al. Bethesda, MD 20894, Web Policies Evaluating the Feasibility of Machine-Learning-Based Predictive Models for Precancerous Cervical Lesions in Patients Referred for Colposcopy. The following clarifications specify management for additional scenarios. Perkins RB, Guido RS, Castle PE, et al. The corresponding authors had final responsibility for the submission decision. Clinical Practice Listserv (Members Only). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 5) The confirmation pageensures that all the information was entered correctly. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. strategies. 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). In cases where a colposcopy was previously recommended but not completed, if on repeat testing the patient has a persistent HPV-positive result and/or persistent cytologic abnormality (atypical squamous cells of uncertain significance, ASC-US, or higher), colposcopy is recommended. The site is secure. contributed equally to the development of this manuscript and are co-first authors. defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a The .gov means its official. ScreeningCervical cancer screening and abnormal result management recommendations for immunocompromised individuals without HIV use the guidelines developed for people living with HIV144: Cytology only screening should begin within 1 year of first insertional sexual activity Continue cytology only annually for 3 years Continue every 3 years (cytology only) until the age of 30 years Cytology alone or cotesting every 3 years after the age of 30 years for the patient's lifetime.Management of Abnormal ResultsIn immunocompromised patients of any age, colposcopy referral is recommended for all results of HPV-positive ASC-US or higher. In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. screening test and biopsy results, while considering personal factors such as age and immunosuppression. supported travel for their participating representatives. There will be an option available at no cost. and R.S.G. 6) The last screen shows the guidelines information for this patient. This algorithm should not be used to treat pregnant women. -. ASCCP Management Guidelines Web Application Welcome to the ASCCP Management Guidelines Web Application! hbbd``b`qkA,` $E@!$tDS Eb``D'u` # In addition, the guidelines now recommend consideration of a patients screening history, along with current test results, to guide clinical decision making. Repeat human papillomavirus (HPV) testing or cotesting at 1 year is recommended for patients with minor screening abnormalities indicating HPV infection with low risk of underlying CIN 3+ (eg, HPV-positive, low-grade cytologic abnormalities after a documented negative screening HPV test or cotest). Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. J Low Genit Tract Dis. incorporated past screening history. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . hbbd``b`Z$EA/@H+/H@O@Y> t( 2020;24(2):102131. Read terms. accommodate the three available cervical screening strategies: primary human papillomavirus (HPV) screening, MeSH endobj Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. 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