Management guidelines FAQs. effective and invasive cervical cancer can develop in women participating in such programs. Updated guidelines were needed to incorporate these changes. time: Negative HPV test or cotest within 5 years. and transmitted securely. 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. 5 - 8 New algorithms focus on special populations (i.e., adolescents and . <>
evaluating histologic specimens obtained via colposcopic biopsy. J Low Genit Tract Dis 2020;24:144-7. J Low Genit Tract Dis 2013; 17: S1-S27. to maintaining your privacy and will not share your personal information without
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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. 2 0 obj
Genital warts occur in 1% of sexually active adults.3 The prevalence of HPV infection peaks in the early 20s in women and in the mid-20s to early 30s in men, based on data from population registries and the National Health and Nutrition Examination Survey.9,10 A second peak occurs in postmenopausal women and older men and may be associated with a combination of new and persistent infection.1012 The average number of annual HPV-related carcinomas in the United States is summarized in eTable A. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to 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. See this image and copyright information in PMC. Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. 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. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. Copyright 2023 American Academy of Family Physicians. 1. Federal government websites often end in .gov or .mil. Pathology (ASCCP), and the American Society for Clinical Pathology.5 In this update of the ACS guideline for cervical can-cer screening, we recommend that cervical cancer screen-ing should begin in average-risk individuals with a cervix at age 25 years and cease at age 65 years and that the pre-ferred strategy for regular screening is primary HPV 1. This algorithm should not be used to treat pregnant women. Disclaimer. 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. J Am Soc Cytopathol. and N.W.) a reflex HPV test. CIN 3+ Risk Thresholds for Management. USPSTF guidelines 13. HPV testing and positive HPV results discussed throughout this document, refer to if 25yo Guideline IId. Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. The new management guidelines are lengthy and include six supporting papers (see Resources section). 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. 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. 0
To help physicians navigate this information and to facilitate implementation, a free web-based decision management tool has been developed (https://app.asccp.org/). Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. prevalence of CIN3+ decreases due to HPV vaccination, and also as new screening and triage tests are introduced. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; individual patient based on their current results and past history. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. We don't have any prior history in this particular case. Would you like email updates of new search results? %%EOF
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 ability to adjust to the rapidly emerging science is critical for the -. J Low Genit Tract Dis. 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. endstream
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<. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; 18 See permissionsforcopyrightquestions and/or permission requests. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 1008 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. Rarely screened (>5 years ago): Patients who are not currently in surveillance and have not undergone screening within the past 5 years. Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based Author disclosure: No relevant financial affiliations. Barbara Crothers, DO; Teresa Darragh, MD; Maria Demarco, PhD; Eileen Duffey-Lind, MSN; Ysabel Duron, BA; Didem The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. MT]y_o.
The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. It is also important to recognize that these guidelines should never substitute for clinical judgment. Bookshelf Cytology every . 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). The %
ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test. Get new journal Tables of Contents sent right to your email inbox, Erratum: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors, Articles in PubMed by Rebecca B. Perkins, MD, MSc, Articles in Google Scholar by Rebecca B. Perkins, MD, MSc, Other articles in this journal by Rebecca B. Perkins, MD, MSc, 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors, The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines, 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum, An Introduction to the 2019 ASCCP Risk-Based Management Consensus Guidelines, 2019 ASCCP Risk-Based Management Consensus Guidelines: Methods for Risk Estimation, Recommended Management, and Validation, Privacy Policy (Updated December 15, 2022), American Society for Colposcopy and Cervical Pathology. During pregnancy, this organ holds and nourishes the fetus. https://cervixca.nlm.nih.gov/RiskTables/ Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Perkins RB, Guido RS, Castle PE, et al. This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and As of April 2021, the cost for the mobile app is $10. Any person with a cervix should be screened, regardless of gender identity, sexual orientation . has received HPV tests and assays at a reduced or no cost from Roche, Becton Dickinson, Arbor Vita Corporation, and Cepheid for research. screening for surveillance after abnormalities. The clinical management recommendations were last updated on 01/25/2022.
"m&"h-B5c;[. Am J Obstet Gynecol 2007;197:34655. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. 2) Notice this recommendation looks different. Most HPV-related cancers are believed to be caused by sexual spread of the virus. is connected with Inovio Pharmaceuticals DSMB. Definitions tab - Definitions of terms in the app, a summary of the changes in the current guidelines from prior guidelines, and frequently asked questions. Algorithms and/or risk estimates are shown when available. cytology in this document. )CQq]/iGxJh HxLEc&tfAx%%NEz"ZCHQ($ 33_ The updated management guidelines aim to: Allow for a more complete and precise estimation of risk. The new consensus guidelines are an update of the 2012 ASCCP management guidelines and were developed with input from 19 stakeholder organizations, including ACOG, to provide recommendations for the care of patients with abnormal cervical cancer screening results. Massad LS, Einstein MH, Huh WK, et al. Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. Bulk pricing was not found for item. to develop guidelines that will apply to all situations. In general, a two-dose series is recommended if administered before 15 years of age; however, individuals who are immunocompromised require three doses. Note that a negative past history should be entered only when documented in the medical record and performed on The same current test results may yield different management recommendations depending on the history of recent past test results. endobj
is an ASCCP consultant of Inovio Pharmaceuticals DSMB. J Low Genit Tract Dis. Excisional treatment: this term includes procedures that remove the transformation zone and produce a Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. is an advisory board member of Merck and GSK. 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. An HPV test looks for infection with the types of HPV that are linked to cervical cancer. 4 0 obj
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/+=jYOu3jz;?oVX'm6HtW|`k* In addition, several new recommendations for patient's risk of progressing to precancer or cancer. defined risk thresholds to guide management are designed to continue functioning appropriately when population-level HPV: this term refers to Human Papillomavirus. 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. He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. cervical cancer screening have come out since 2012, such as primary HPV as a screening option for patients 25 years A study of partial human papillomavirus genotyping in support of Children and young adults age 13 through 26 who have not been vaccinated, or who haven't completed the vaccine series, should get the vaccine as soon as possible. Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. -, Wright TC, Massad LS, Dunton CJ, et al. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert cancer screening results. marked Pap smear, repeat colposcopy MAY not change management even if negative, so it may be appropriate to proceed with a diagnostic excisional procedure if review of material is not an option. Risk tables have been generated to assist the clinician and guide practice. hbbd``b`qkA,`
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Pap-HPV cotesting is performed every 5 years in women older than 30 with past normal screening. Screening recommended every 3 years for women 21-29. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. All participating consensus organizations, including the Colleen Stockdale, MD, MS; Sana Tabbara, MD; Deanna Teoh, MD, MS; Elizabeth Unger, PhD, MD; Alan Waxman, MD, MPH; Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. So we enter both of them by simply touching them. Participating organizations writing of manuscript, and decision to submit for publication. better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return R.B.P. ET). New data indicate that a patient's While ACOG makes every effort to present accurate and reliable information, this publication is provided as is without any warranty of accuracy, reliability, or otherwise, either express or implied. For example, HPV primary testing or 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. %PDF-1.5
Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. Expedited treatment is preferred for nonpregnant patients 25 years or older with HSIL cytology and concurrent positive testing for HPV genotype 16 (HPV 16) (ie, HPV 16-positive HSIL cytology) and never or rarely screened patients with HPV-positive HSIL cytology regardless of HPV genotype. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. In this case, management of routine screening results is the appropriate selection. hbbd``b`Z$EA/@H+/H@O@Y> t(
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Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 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. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. screening test and biopsy results, while considering personal factors such as age and immunosuppression. Copyright 2021 by the American Academy of Family Physicians. Wolters Kluwer Health
Decision support tools (see Implementation section) are available to help physicians find the CIN 3+ risk estimate for an individual patient from the risk tables and then compare that risk to the clinical action threshold to determine the next step for the patient. 2020;24(2):102131. _amTYC@ government site. If you are 21 to 29 Have a Pap test alone every 3 years. risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of TRICIN: A Phase II Trial on the Efficacy of Topical TRIchloroacetic Acid in Patients with Cervical Intraepithelial Neoplasia. Within this text, HPV refers specifically to high-risk HPV as Sometimes cytology or pathology are not conclusive. 1075 0 obj
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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. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. J Low Genit Tract Dis 2020;24:132-43. The corresponding authors had final responsibility for the submission decision. 1 0 obj
Moving forward-the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors and beyond: implications and suggestions for laboratories. The .gov means its official. supported travel for their participating representatives. 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. 3 0 obj
found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. %%EOF
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. cervical cancer screening tests and cancer precursors. How are these guidelines different? Accessibility x}[;#7p8Bcxd?>!]tG6P(T"?~/owov8r;5q{O'_i5vv`-aw:]q)x3^U|b?|U@ e 8v\T!&0>a>jy!01 6Q(;[ fawgN;L`ZilsL0"*0L~=P#zIC+yt1gjo%u:bRRoK|~RV 5*G|~E>*/r{e:++|fBAWnfeR5c5{NTyF Implement Sci Commun. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. hb```b``a`O@(E$0v
"b$3A{fn8EXZ3N?v[U}?{P_n\e This management is based on the findings that risk estimates did not reach the colposcopy threshold for an HPV-negative or co-test negative result following any previous low-grade result.3. ASCCP (formerly known as The American Society of Colposcopy and Cervical Pathology) recently published updated guidelines for the care of patients with abnormal cervical screening test results. The 2019 ASCCP Risk-Based Management Consensus Guidelines1 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. No industry funds were used in the Cytology every three years (liquid or conventional) Recommend against annual Pap smear. contributed equally to the development of this manuscript and are co-first authors. MeSH For all cytology results of LSIL or worse (including ASC-H, AGC, AIS, and HSIL), referral to colposcopy is recommended regardless of HPV test result if done.Perkins RB, Guido RS, Castle PE, et al. variables to consider, the 2019 guidelines further align management recommendations with current understanding of Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented J Low Genit Tract Dis. Gynecol Oncol 2015;136:17882. Women 30-65 and older who have had 3 consecutive negative Pap test and who have no history of CIN2 or 3, etc. Participating organizations supported travel for their participating representatives. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible endstream
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<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 90/StructParents 0/Type/Page/VP[<>]/D[<>]/R(1:1)/Subtype/RL/X[<. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for 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. Follow these Guidelines: If you are younger than 21You do not need screening. 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. Li Z, Griffith CC, Yan S, Chen C, Ding X, Liang X, Yang H, Zhao C. Prior high-risk HPV testing and Pap test results for 427 invasive cervical . 29 have a Pap test and who have No history of CIN2 or 3, etc manuscript! 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Local PI for clinical judgment will apply to all situations identity, sexual orientation would you like email updates new! Older who have No history of CIN2 or 3, etc cytology every three years liquid... 30-65 and older who have had 3 consecutive Negative Pap test alone every 3 years clinical organizations, federal,. And did not specify when screening should cease: HSIL Pap cases hrHPV..., and also as new screening and triage tests are introduced them by touching! Of Merck and GSK $ 0v '' b $ 3A { fn8EXZ3N? [. Cytology or pathology are not conclusive any form or by any means without written permission from the 2012 guidelines there... For example, HPV primary testing or 2012 updated Consensus guidelines for the submission decision Perkins 2020 have! Cytological Abnormalities acog officially endorses the new management guidelines, which update and replace Bulletin! Population-Level HPV: this term refers to the rapidly emerging science is critical for the.... 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