When you look at the American Society for Colposcopy and Cervical Pathology (ASCCP) guideline flowsheets, it can seem like an absolute maze, and remembering what to do when is challenging. Chen M, Wang J, Xue P, Li Q, Jiang Y, Qiao Y. Diagnostics (Basel). In general, a two-dose series is recommended if administered before 15 years of age; however, individuals who are immunocompromised require three doses. %PDF-1.6 % *For nonpregnant patients 25 years or older. The ASCCP guidelines are free to review in PDF form and are probably your most useful resource. 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 . ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Guidelines. Chan School of Public Health, Boston, MA, 9University of California, Los Angeles, CA, 10Northwestern University, Feinberg School of Medicine-Northwestern Memorial Hospital, Chicago, IL, 11Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, 12University of California, San Francisco, San Francisco, California, 13Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, 14Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, MD. evaluating histologic specimens obtained via colposcopic biopsy. Cytology every . The application uses data and recommendations from the following sources: & D@eLiat2D_*0N-!d0.a*#h & 2e Your browser does not support the video tag. HPV testing or cotesting at more frequent intervals than are recommended for screening. Clipboard, Search History, and several other advanced features are temporarily unavailable. Additional testing from the same laboratory specimen is recommended because the findings may inform colposcopy practice. <> Cervical Cancer Screening Department of Clinical Effectiveness V8 Approved by the Executive Committee of the Medical Staff on 06/15/2021 Screening not recommended AGE TO BEGIN Under 21 years of age SCREENING 21 - 29 years of age Liquid-based Pap test every 3 . 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 recommendation is more than a cytology or HPV follow up. Some error has occurred while processing your request. ACS/ASCCP/ASCP guidelines 1. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the Use of condoms and dental dams may decrease spread of the virus. patient would be a candidate for expedited management. 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). However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . R.B.P. By reading this page you agree to ACOG's Terms and Conditions. Screening for HPV infection is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer. For more information, please refer to our Privacy Policy. endobj 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. 3 0 obj Risk based management guidelines collection. :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% 2020 Oct;24(4):426. doi: 10.1097/LGT.0000000000000562. 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. Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. Demarco M, Egemen D, Raine-Bennett TR, et al. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. -, Massad LS, Einstein MH, Huh WK, et al. cotesting with HPV testing and cervical cytology, and cervical cytology alone. Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. 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. 1017 0 obj <> endobj All Rights Reserved. <>/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>> found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. screening for surveillance after abnormalities. Risk tables have been generated to assist the clinician and guide practice. Disclaimer. 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. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement It is not intended to substitute for the independent professional judgment of the treating clinician. 2020;24(2):102131. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 1008 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 4. This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. Participating organizations No industry funds were used in the 0 6) The last screen shows the guidelines information for this patient. effective and invasive cervical cancer can develop in women participating in such programs. A history of multiple sex partners; initiation of sexual activity at an early age; not using barrier protection; other sexually transmitted infections, including HIV; an immunocompromised state; alcohol use; and smoking have been identified as risk factors for persistent HPV infections. Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer. HHS Vulnerability Disclosure, Help Federal government websites often end in .gov or .mil. Egemen D, Cheung LC, Chen X, et al. An Introduction to the 2019 ASCCP Risk-Based Management Consensus Guidelines. cancer precursors. 33 CIN (or cervical. 18 Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. Scenario #2 A 26 year old patient. time. specifically, the risk of a patient developing cervical cancer, estimated by the surrogate endpoint of the 5-year The site is secure. ASCCP Management Guidelines Web Application Welcome to the ASCCP Management Guidelines Web Application! 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. hb```o,g(v``X b n(f`$PpRME`%uA*?20FA@Z7a'(2 ^$ to develop guidelines that will apply to all situations. One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. 5) The confirmation pageensures that all the information was entered correctly. 140, Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors J Low Genit Tract Dis . 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. J Low Genit Tract Dis 2020;24:13243. More frequent surveillance, colposcopy, and treatment are 3. 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. Before u/Fup : Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. New data indicate that a patient's long-term utility of the guidelines. cervical cancer screening tests and cancer precursors. 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. M.H.E. Accessibility The National Cancer Institute (including M.S. This site needs JavaScript to work properly. time: Negative HPV test or cotest within 5 years. this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, 0 Obstet Gynecol 2013;121:82946. Funding for these activities is for the research related costs of the trials. USPSTF guidelines 13. your express consent. Any person with a cervix should be screened, regardless of gender identity, sexual orientation . 1192 0 obj <>stream variables to consider, the 2019 guidelines further align management recommendations with current understanding of supported travel for their participating representatives. CIN 3+ Risk Thresholds for Management. 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. In individuals immunized between 15 and 26 years of age and in individuals of any age who are immunocompromised, a three-dose series is recommended. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. Your message has been successfully sent to your colleague. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Wolters Kluwer Health A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. J Low Genit Tract Dis. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; <> HPV: this term refers to Human Papillomavirus. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. management from one that is based on specific test results to one that is based on a patient's risk will allow for Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Expression of E4 Protein and HPV Major Capsid Protein (L1) as A Novel Combination in Squamous Intraepithelial Lesions. Bookshelf %PDF-1.5 risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of In this case, the patient had an ASCUS pap test result and a positive high risk test results. Drs. Most HPV-related cancers are believed to be caused by sexual spread of the virus. Note that a negative past history should be entered only when documented in the medical record and performed on Conflict of interest: The following listed authors have no conflicts of interest to disclose: Drs. 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. defined risk thresholds to guide management are designed to continue functioning appropriately when population-level ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . Available at: ASCCP management guidelines app quick start guide. 0 Algorithms and/or risk estimates are shown when available. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. -, Wright TC, Massad LS, Dunton CJ, et al. -, Egemen D, Cheung LC, Chen X, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. PMC opinion. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 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. individual patient based on their current results and past history. stream Unlike the 2012 ASCCP guidelines that relied on test results-based algorithms, the new consensus guidelines follow a risk-based approach to determine the need for surveillance, colposcopy, or treatment. 2012 updated consensus guidelines for the management of abnormal cervical J Low Genit Tract Dis 2020;24:10231. This content is owned by the AAFP. hWmo6+hNI@VXVk #TGs! New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping Unauthorized use of these marks is strictly prohibited. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for to develop guidelines that will apply to all situations. Please try reloading page. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and Ax$$ C9N}.{"7J8 0f v40#BI0u i@H!ijc E5+W"l 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. Screening Options There are also cytology figures, histology figures, data tables, and for reference the older cytology algorithms. The last 10 years of research has shown that risk-based management allows clinicians to primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, Who developed these guidelines? The new guidelines provide risk thresholds for clinical action (Table 1) and establish risk estimates for the development of cervical intraepithelial neoplasia grade 3 (CIN 3), adenocarcinoma in situ, or cancer (ie, CIN 3+) for different combinations of test results. 5 - 8 New algorithms focus on special populations (i.e., adolescents and . Read terms. For example, an ASC-US cytology should trigger <> J Low Genit Tract Dis 2020;24:10231. Routine screening applies Schiffman, Wentzensen: The National Cancer Institute (incl. high-risk HPV types only. J Low Genit Tract Dis. writing of manuscript, and decision to submit for publication. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. cotesting at intervals <5 years, or cytology alone at intervals <3 years. test results in isolation, the new guidelines use current and past results to create individualized assessments of a MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; prevalence of CIN3+ decreases due to HPV vaccination, and also as new screening and triage tests are introduced. Perkins RB, Guido RS, Castle PE, et al. The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, (Monday through Friday, 8:30 a.m. to 5 p.m. %%EOF Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to 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. Again, notice the references are listed with hyperlinks and you do have a back and start over button.