2020;24(2):102131. A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. -, Huh WK, Ault KA, Chelmow D, et al. Unauthorized use of these marks is strictly prohibited. Perkins RB, Guido RS, Castle PE, et al. 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. The overarching theme of the recommendations reflects a 'risk-based' strategy, rather than rigid focus on a particular result. 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. J Low Genit Tract Dis. "m&"h-B5c;[. Ax$$ C9N}.{"7J8 0f v40#BI0u i@H!ijc E5+W"l 3 0 obj J Low Genit Tract Dis 2013; 17: S1-S27. The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients. 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. 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 . -. endstream endobj startxref Updated United States consensus guidelines for management of cervical screening abnormalities are needed to This information is not intended for use without professional advice. Available at: ASCCP management guidelines app quick start guide. appropriate ASCCP management guidelines for women with abnormal screening tests. 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. x][s~wj- 3JJ$*H>LA7C@&=v"`g3~.J~zw$N_%(r[Tii^V_tD$D+Aw8Ry]Q/>*_c{I3&TMZ{u6t7J35Il]~5H"j4jP^M$:^#:_kz]H,T AmR-h6/~p|`_M,6e%cDvE8+"KT =5A7Bed,V9W#O=26TE"MWfg(IGcU|H^i\G \%?&tU bWiS ]LPI-jb0> Chen M, Wang J, Xue P, Li Q, Jiang Y, Qiao Y. Diagnostics (Basel). Refers to immediate CIN 3+ risk. J Low Genit Tract Dis 2020;24:144-7. breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently | Terms and Conditions of Use. International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. 21 to 29 years of age *. 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. Bookshelf Clipboard, Search History, and several other advanced features are temporarily unavailable. Table 1. primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Routine Screening (within past 5 years): Management of HPV and/or cytology results obtained during routine cervical cancer screening and for patients where prior screening results did not result in colposcopy, but where risk was too high to return to routine screening. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. endobj J Low Genit Tract Dis 2020;24:102-31. 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. Before 5) The confirmation pageensures that all the information was entered correctly. Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental HPV testing or cotesting at more frequent intervals than are recommended for screening. Pap-HPV cotesting is performed every 5 years in women older than 30 with past normal screening. J Low Genit Tract Dis 2020;24:10231. R.S.G. % a reflex HPV test. Perkins, Chelmow, Garcia, Kim, Nayar, Saraiya, and Sawaya. and R.S.G. incorporation of future technologies as well. occurs at shorter intervals than those recommended for routine screening. sharing sensitive information, make sure youre on a federal endstream endobj 1177 0 obj <. Copyright 2023 American Academy of Family Physicians. p16 and Other Epithelial Cancer Biomarkers. 8600 Rockville Pike Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. is an advisory board member of Merck and GSK. No industry funds were used in the development of Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey 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[<. Risk tables have been generated to assist the clinician and guide practice. Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. It is also important to recognize that these guidelines should never substitute for clinical judgment. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. 5. Available at. 2019 ASCCP risk-based management consensus guidelines for abnormal For example, an ASC-US cytology should trigger evaluating histologic specimens obtained via colposcopic biopsy. Age/population. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, %PDF-1.5 Dr. Einstein 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. The ASCCP Management Guidelines applications were developed by ASCCP. 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. P.E.C. and N.W.) Participating organizations supported travel for their participating representatives. In this case, the patient had an ASCUS pap test result and a positive high risk test results. Clinical Practice Listserv (Members Only). <> patient would be a candidate for expedited management. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. Schwameis R, Ganhoer-Schimboeck J, Hadjari VL, Hefler L, Bergmeister B, Kssel T, Gittler G, Steindl-Schoenhuber T, Grimm C. Cancers (Basel). 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. 1017 0 obj <> endobj 17-19 Patients with a history of abnormal test results require more frequent testing as recommended by the ASCCP. ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . <> through a program of screening and management of cervical precancer, no screening or treatment modality is 100% ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. You may be trying to access this site from a secured browser on the server. The goals of the ASCCP Risk-Based Management Consensus The https:// ensures that you are connecting to the This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. is an ASCCP consultant of Inovio Pharmaceuticals DSMB. This algorithm should not be used to treat pregnant women. defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a *For nonpregnant patients 25 years or older. CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. Federal government websites often end in .gov or .mil. Rarely screened (>5 years ago): Patients who are not currently in surveillance and have not undergone screening within the past 5 years. Read all of the Articles Read the Main Guideline Article Management Guidelines In this case, management of routine screening results is the appropriate selection. 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. For example, those HPV-16 positive HSIL cytology qualify for expedited treatment. This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. Screening recommended every 3 years for women 21-29. HPV natural history and cervical carcinogenesis. 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. Histopathological follow-ups within six months were also reviewed for correlation. Funding for these activities is for the research related costs of the trials. There are more than 200 types of human papillomavirus (HPV), a DNA virus that infects cutaneous and mucosal epithelial cells. if <25yo Dysplasia - Gynecol Oncol 2015;136:17882. J Low Genit Tract Dis 2020;24:10231. better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return CIN 3+ Risk Thresholds for Management. During pregnancy, this organ holds and nourishes the fetus. 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 . Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Please try again soon. 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. The following clarifications specify management for additional scenarios. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors have been published. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The application uses data and recommendations from the following sources: Use of condoms and dental dams may decrease spread of the virus. %PDF-1.6 % while retaining many of principles, such as the principle of equal management for equal risk. 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. Note that a negative past history should be entered only when documented in the medical record and performed on ACS/ASCCP/ASCP guidelines 1. Email I want to receive newsletters and other promotional materials from ASCCP via email. ET). Epub 2020 May 23. 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. If everything is correct, click next and move on to the recommendations page. that incorporation of the risk-based approach can provide more appropriate and personalized management for an If you are 21 to 29 Have a Pap test alone every 3 years. 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. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, endstream endobj 1018 0 obj <>/Metadata 94 0 R/OCProperties<>/OCGs[1045 0 R]>>/Outlines 114 0 R/PageLayout/SinglePage/Pages 1009 0 R/StructTreeRoot 177 0 R/Type/Catalog>> endobj 1019 0 obj <>/ExtGState<>/Font<>/Pattern<>/Properties<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1020 0 obj <>stream gZRUH6hE?>7uKwH%;^@-QzqY3hqq\?8qZpyn)Q.gse6dY(nkY\mld\ G[6+;7+k[(pvqRR+({gIlOz+rH}=p+n@ J Am Soc Cytopathol. :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY J Low Genit Tract Dis 2020;24:10231. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. For more information, please refer to our Privacy Policy. <>>> ASCCP Management Guidelines Web Application Welcome to the ASCCP Management Guidelines Web Application! The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. www.acog.org, American College of Obstetricians and Gynecologists 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. 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. Schiffman, Wentzensen: The National Cancer Institute (incl. 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. Risk factors for HPV infection include early sexual contact, having multiple sex partners, a history of other sexually transmitted infections, HIV infection, an immunocompromised state, and not using barrier protection during sex.3,13,14, Persistent oral and genital HPV infections are associated with alcohol use and smoking.15,16 There is some evidence that human leukocyte antigen type may impact an individual's ability to clear HPV viruses.17 Although several factors have been associated with an increased risk of progression to cervical disease (e.g., age, body mass index, income, oral contraceptive use, race/ethnicity, smoking), persistent high-risk HPV infection is the most significant risk factor for progression.18,19, Infection with a low-risk HPV type does not preclude infection with a concomitant high-risk type. Guidelines for women with abnormal screening tests and Cancer Precursors 1 1177 0 obj < patient! 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