The 2012 consensus guidelines were the first to be based on the principle of equal management for equal risk, 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. The new guidelines rely on individualized assessment of risk taking into account past history and current results. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, MeSH Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. Excisional treatment: this term includes procedures that remove the transformation zone and produce a One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. p16 and Other Epithelial Cancer Biomarkers. Note that a negative past history should be entered only when documented in the medical record and performed on Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. stream
& D@eLiat2D_*0N-!d0.a*#h & 2e Egemen D, Cheung LC, Chen X, Demarco M, Perkins RB, Kinney W, Poitras N, Befano B, Locke A, Guido RS, Wiser AL, Gage JC, Katki HA, Wentzensen N, Castle PE, Schiffman M, Lorey TS. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for Management Guidelines will be electronic, updates and new technologies will be incorporated at a much faster rate 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. risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of All Rights Reserved. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to On June 12, 2020, the U.S. Food and Drug Administration approved adding the prevention of head and neck cancers caused by HPV as an indication for the nonavalent HPV vaccine (Gardasil 9). A.-B.M. 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. 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. stream
Among patients who have undergone hysterectomy but either have no previous diagnosis of CIN 2+ within the previous 25 years or have completed the 25 year surveillance period, screening is generally not recommended. Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Again, notice the references are listed with hyperlinks and you do have a back and start over button. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 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 high-risk HPV types only. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . Clinical Practice Listserv (Members Only). While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. 3 0 obj
The 2019 ASCCP Risk-Based Management Consensus Guidelines 1 represent a paradigm shift from using primarily results-based algorithms to using risk-based management based on a combination of current screening test results and past screening history. Egemen D, Cheung LC, Chen X, et al. Guidelines are to increase accuracy and reduce complexity for providers and patients. As of April 2021, the cost for the mobile app is $10. Age/population. hb```b``a`O@(E$0v
"b$3A{fn8EXZ3N?v[U}?{P_n\e 18 _amTYC@ 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 2020;24:10231. For example, those HPV-16 positive HSIL cytology qualify for expedited treatment. In addition, several new recommendations for
PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; *For nonpregnant patients 25 years or older. Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors J Low Genit Tract Dis . For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. patient's risk of progressing to precancer or cancer. 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. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; to routine screening. Expedited treatment was an option for patients with high-grade squamous intraepithelial lesion (HSIL) cytology in the 2012 guidelines; this guidance is now better defined. 2022 Dec 13;3(1):130. doi: 10.1186/s43058-022-00382-3. individual patient based on their current results and past history. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. Obstet Gynecol 2013;121:82946. Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and -, Massad LS, Einstein MH, Huh WK, et al. For all management indications, HPV mRNA and HPV DNA tests without FDA approval for primary screening alone should only be used as a cotest with cytology, unless sufficient, rigorous data are available to support use of these particular tests in management. Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. of a positive screening test to inform the next steps in management. Why were the guidelines revised now? Colposcopic examination confirming CIN1 or less within 1 year. By reading this page you agree to ACOG's Terms and Conditions. 2020 Jul-Aug;9(4):291-303. doi: 10.1016/j.jasc.2020.05.002. 6) The last screen shows the guidelines information for this patient. doi: 10.1093/jncics/pkac086. The corresponding authors had final responsibility for the submission decision. time: Negative HPV test or cotest within 5 years. <>
Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. 5 - 8 New algorithms focus on special populations (i.e., adolescents and . 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. Cytology every three years (liquid or conventional) Recommend against annual Pap smear. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. In some patients, persistent infection with high-risk mucosal types, especially HPV-16 and HPV-18, causes anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers. hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w
The recommendation is for colposcopy. During pregnancy, this organ holds and nourishes the fetus. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping endobj
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 . The National Cancer Institute (including M.S. <>>>
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J Low Genit Tract Dis. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; 1. Schiffman M, Wentzensen N, Perkins RB, Guido RS. Note that a negative past history should be entered only when documented in the medical record and performed on Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible CIN 3+ Risk Thresholds for Management. 2020 Oct;24(4):427. doi: 10.1097/LGT.0000000000000563. W.K.H. Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). This site needs JavaScript to work properly. 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. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. Perkins RB, Guido RL, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya G, Wentzensen N, Schiffman M. J Low Genit Tract Dis. The treat). is an ASCCP consultant of Inovio Pharmaceuticals DSMB. Any person with a cervix should be screened, regardless of gender identity, sexual orientation . Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. If HPV testing is not performed on ASC-US results, then repeat cytology in 6 to 12 months is recommended, with colposcopy referral for ASC-US or higher. 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