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 . 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. a reflex HPV test. Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. J Am Soc Cytopathol. Careers. 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. Please contact [emailprotected] with any questions. Management Consensus Guidelines Committee includes: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited 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[<. www.acog.org, American College of Obstetricians and Gynecologists that incorporation of the risk-based approach can provide more appropriate and personalized management for an For example, an ASC-US cytology should trigger 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. Ax$$ C9N}.{"7J8 0f v40#BI0u i@H!ijc E5+W"l 1 0 obj This information is not intended for use without professional advice. 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. Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. Egemen D, Cheung LC, Chen X, et al. cancer screening results. J Low Genit Tract Dis 2020;24:10231. Would you like email updates of new search results? This algorithm should not be used to treat pregnant women. INTRODUCTION. 21 to 29 years of age *. Obstet Gynecol 2013;121:82946. Data is temporarily unavailable. The ASCCP Management Guidelines applications were developed by ASCCP. and transmitted securely. Federal government websites often end in .gov or .mil. Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. The ASCCP guidelines are free to review in PDF form and are probably your most useful resource. Consider management according to the highest-grade abnormality In patients 30 to 65 years of age, cervical cancer screening should be performed every three years using cervical cytology alone, every five years using high-risk HPV testing alone, or every five years using cotesting. 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. HPV: this term refers to Human Papillomavirus. management from one that is based on specific test results to one that is based on a patient's risk will allow for cotesting at intervals <5 years, or cytology alone at intervals <3 years. In general, a two-dose series is recommended if administered before 15 years of age; however, individuals who are immunocompromised require three doses. <> :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY Perkins, Rebecca B. MD, MSc1; Guido, Richard S. MD2; Castle, Philip E. PhD3; Chelmow, David MD4; Einstein, Mark H. MD, MS5; Garcia, Francisco MD, MPH6; Huh, Warner K. MD7; Kim, Jane J. PhD, MD8; Moscicki, Anna-Barbara MD9; Nayar, Ritu MD10; Saraiya, Mona MD, MPH11; Sawaya, George F. MD12; Wentzensen, Nicolas MD, PhD, MS13; Schiffman, Mark MD, MPH14; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee, From 1Boston University School of Medicine/Boston Medical Center, Boston, MA, 2University of Pittsburgh/Magee-Women's Hospital, Pittsburgh, PA, 3Albert Einstein College of Medicine, New York, NY, 4Virginia Commonwealth University School of Medicine, Richmond, VA, 5Rutgers, New Jersey Medical School, Newark, NJ, 6Pima County Health & Community Services, Tucson, AZ, 8Harvard T.H. The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines. Screening for HPV infection is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer. Low-risk types cause warts, whereas the 15 high-risk types cause cervical intraepithelial neoplasia (CIN) and squamous cell carcinomas of the anogenital tract and oropharyngeal mucosa.3,4 Vertical or horizontal spread of HPV can occur during the perinatal period and is associated with oral infections and respiratory papillomatosis.5,6 Concomitant cervical and anal infections have been demonstrated in women without a history of anal intercourse and may be a result of autoinoculation.7. Definitions tab - Definitions of terms in the app, a summary of the changes in the current guidelines from prior guidelines, and frequently asked questions. <> ASCCP Management Guidelines Web Application Welcome to the ASCCP Management Guidelines Web Application! The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Consider management according to the highest-grade abnormality is connected with Inovio Pharmaceuticals DSMB. The following clarifications specify management for additional scenarios. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Disclaimer. Within this text, HPV refers specifically to high-risk HPV as Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible writing of manuscript, and decision to submit for publication. 3. In this case, the patient had an ASCUS pap test result and a positive high risk test results. J Low Genit Tract Dis 2020;24:10231. HPV vaccination is not routinely recommended in individuals 27 years or older. 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. "m&"h-B5c;[. endobj 2022 Dec 6;12(12):3066. doi: 10.3390/diagnostics12123066. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Unauthorized use of these marks is strictly prohibited. 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. 1017 0 obj <> endobj 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. ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . According to a 2018 Cochrane review, vaccinating women, with or without HPV exposure, between 15 and 26 years of age decreases the risk of cervical intraepithelial neoplasia 2 and 3, with a number needed to treat of 39. Histopathological follow-ups within six months were also reviewed for correlation. 2020;24(2):102131. In addition to test results, CIN 3+ risk was considered for a number of individual risk factors such as screening history, age, and immunosuppression, which were reviewed by the consensus panels. supported travel for their participating representatives. 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). government site. If HPV 16 or 18 testing is positive, and additional laboratory testing of the same sample is not feasible, the patient should proceed directly to colposcopy. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. 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 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. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 Funding for these activities is for the research related costs of the trials. high-risk HPV types only. 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. 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. After a diagnosis of high-grade histology or cytology, patients may undergo hysterectomy for reasons related or unrelated to their cervical abnormalities.If hysterectomy is performed for treatment, patients should have 3 consecutive annual HPV-based tests before entering long-term surveillance. Copyright 2023 American Academy of Family Physicians. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently HPV 16 or 18 infections have the highest risk for CIN 3 and occult cancer, so additional evaluation (eg, colposcopy with biopsy) is necessary even when cytology results are negative. 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. P.E.C. to develop guidelines that will apply to all situations. better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return 2f8 Hf8*@r9MXNw6JXbc```3=20(.bbc`Sb0 Z W.K.H. test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the References to the published guideline information is also shown. New data indicate that a patient's The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. 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. screening for surveillance after abnormalities. Clinical Action Threshold: this term refers to risk levels that prompt different clinical management HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV Author disclosure: No relevant financial affiliations. You may be trying to access this site from a secured browser on the server. Do the new guidelines still use algorithms? Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. By reading this page you agree to ACOG's Terms and Conditions. Vaccination is the primary method of prevention. % All rights reserved. 3. 3 0 obj 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. -, Egemen D, Cheung LC, Chen X, et al. Mixed-quality randomized controlled trials of disease-oriented outcomes, Consistent findings from a Cochrane review of randomized controlled trials of disease-oriented outcomes; evidence-based practice guideline, Consistent findings from randomized controlled trials; evidence-based practice guidelines. and N.W.) A Pap test looks for abnormal cells. 5. <>/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>> For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. sharing sensitive information, make sure youre on a federal %PDF-1.6 % 4) Notice now we've moved to a screen where we can enter testing results. 1. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; Table 1. of age and older. Additional testing from the same laboratory specimen is recommended because the findings may inform colposcopy practice. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. Read the new ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. See permissionsforcopyrightquestions and/or permission requests. -. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. J Low Genit Tract Dis 2020;24:102-31. 1075 0 obj <>stream 1192 0 obj <>stream Implement Sci Commun. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% 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. Reflex testing: this means that laboratories should perform a specific additional triage test in the setting this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, With a more nuanced understanding of how prior results affect risk, and more 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. Michael Gold, MD; Robert Goulart, MD; Richard Guido, MD; Paul Han, MD; Sally Hersh, DNP; Aimee Holland, DNP; Eric Penis: The male sex organ. 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. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. And are probably your most useful resource October 2021 on the American Cancer Society Updated Cancer. In a web-based Application and mobile apps for iPhone, iPad, Android! 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