treat). Who developed these guidelines? Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited References to the published guideline information is also shown. MeSH 6) The last screen shows the guidelines information for this patient. ACS/ASCCP/ASCP guidelines 1. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. Participating organizations supported travel for their participating representatives. This information is not intended for use without professional advice. An Introduction to the 2019 ASCCP Risk-Based Management Consensus Guidelines. The ASCCP guidelines are free to review in PDF form and are probably your most useful resource. Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. 1. 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 The 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). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 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. Gynecol Oncol 2015;136:17882. 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. 3 0 obj
Specifically, the 2012 guidelines recommend colposcopy for all cytology results of low grade squamous intraepithelial lesion (LSIL) or higher for individuals aged 25 and above. 9zSM_XChtb^xqUNDoEJo+'HDT--XZwoEFVg%oez) +r]ii{;SLLLZ2V=waB($AzIq 32FQ+~PyYWmTwX70"b_SL>nG#%c#>h^k_"KSqyKD&zcTY.0CM[oBN!rx#jRw;44 .8+Nd6o52 //i\`ycq/ &!s 2023 Jan 3;7(1):pkac086. 18 Available at. if <25yo Dysplasia - & D@eLiat2D_*0N-!d0.a*#h & 2e found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. HPV testing and positive HPV results discussed throughout this document, refer to Disclaimer. Use of condoms and dental dams may decrease spread of the virus. The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. CIN 3+ Risk Thresholds for Management. endobj
variables to consider, the 2019 guidelines further align management recommendations with current understanding of Funding for these activities is for the research related costs of the trials. ET). Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. More frequent surveillance, colposcopy, and treatment are Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. In addition, changing the paradigm of A.-B.M. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below :RKA\U]57D~EGjU5=f8aiQ5\v8r*\|$;%/Se1}{W1G_I}%%[oa/UEwd\qrq^V>5^N^moO.J}].Jdw[ou+w\HY Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. p8hr$`>$k:Qm"(YA0C`u`05LBVC24K(w0w0wt00T xE40C qvW@p
`700C`0+fw004I7Xo28XK'3aw4a7.2t1lepa1k1n In addition, several new recommendations for specifically, the risk of a patient developing cervical cancer, estimated by the surrogate endpoint of the 5-year 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. 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. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Within this text, HPV refers specifically to high-risk HPV as Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. Am J Obstet Gynecol 2007;197:34655. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement 33 CIN (or cervical. Refers to immediate CIN 3+ risk. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. With a more nuanced understanding of how prior results affect risk, and more 4) Notice now we've moved to a screen where we can enter testing results. your express consent. 2 0 obj
gZRUH6hE?>7uKwH%;^@-QzqY3hqq\?8qZpyn)Q.gse6dY(nkY\mld\ G[6+;7+k[(pvqRR+({gIlOz+rH}=p+n@ opinion. 17-19 Patients with a history of abnormal test results require more frequent testing as recommended by the ASCCP. Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). is an advisory board member of Merck and GSK. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; 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. Algorithms and/or risk estimates are shown when available. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, An official website of the United States government. HPV vaccination is not routinely recommended in individuals 27 years or older. P.E.C. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. 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. /+=jYOu3jz;?oVX'm6HtW|`k* Xiaojian Chen MS; Li Cheung PhD; Kim Choma, DNP; Megan Clarke, PhD; Christine Conageski, MD; Miriam Cremer, MD, MPH; Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented Schiffman, Wentzensen: The National Cancer Institute (incl. Please try after some time. All participating consensus organizations, including the primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, writing of manuscript, and decision to submit for publication. 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. Scenario #2 A 26 year old patient. It is also important to recognize that these guidelines should never substitute for clinical judgment. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; J Low Genit Tract Dis 2020;24:13243. In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. 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). Management Consensus Guidelines Committee includes: 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. 2020;24(2):102131. Federal government websites often end in .gov or .mil. cancer screening results. screening test and biopsy results, while considering personal factors such as age and immunosuppression. Excisional treatment: this term includes procedures that remove the transformation zone and produce a The National Cancer Institute (including M.S. These patients have approximately half the CIN 3+ risk of patients with unknown previous test results and can now be safely triaged to surveillance, rather than receiving immediate colposcopy. opinion. Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. Expression of E4 Protein and HPV Major Capsid Protein (L1) as A Novel Combination in Squamous Intraepithelial Lesions. Clipboard, Search History, and several other advanced features are temporarily unavailable. Evaluating the Feasibility of Machine-Learning-Based Predictive Models for Precancerous Cervical Lesions in Patients Referred for Colposcopy. J Low Genit Tract Dis 2020;24:10231. 21 to 29 years of age *. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. J Low Genit Tract Dis 2020;24:10231. R.S.G. Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. 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. Egemen D, Cheung LC, Chen X, et al. A Practice Advisory is a brief, focused statement issued within 24-48 hours of the release of this evolving information and constitutes ACOG clinical guidance. J Low Genit Tract Dis 2020;24:10231. Consider management according to the highest-grade abnormality The web-based tool is free to use. Click the "next" button. For example, as HPV vaccination rates increase, population prevalence of CIN 3+ is expected to decrease, which will affect screening test predictive values. 1044 0 obj
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Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based %PDF-1.5
In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 is acceptable. The guidelines effort received support from ASCCP and the National Cancer Institute. Routine screening applies "m&"h-B5c;[. 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 . 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. Furthermore, since prior test results affect risk, patients with prior abnormalities often require surveillance with 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. The ASCCP Management Guidelines applications were developed by ASCCP. There will be an option available at no cost. endobj
Reflex testing: this means that laboratories should perform a specific additional triage test in the setting National Library of Medicine recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. Introduction of risk- based guidelines in 2012 was a conceptual 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. HHS Vulnerability Disclosure, Help 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. J Low Genit Tract Dis. 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 . sharing sensitive information, make sure youre on a federal 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. <>
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. -, Massad LS, Einstein MH, Huh WK, et al. is connected with Inovio Pharmaceuticals DSMB. Bethesda, MD 20894, Web Policies Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. 1. The recommendation is for colposcopy. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented 0
In addition, the guidelines now recommend consideration of a patients screening history, along with current test results, to guide clinical decision making. The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients. Bulk pricing was not found for item. Because the new Risk-Based 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, an ASC-US cytology should trigger International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. endstream
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The risk database will continue to be updated as new testing methods and follow-up data emerge, and the new framework will allow management to be adjusted accordingly and consistently. Clinical Action Threshold: this term refers to risk levels that prompt different clinical management Egemen PhD; Mark Einstein, MD; Carol Eisenhut, MD, MBA; Tamika Felder; Sarah Feldman, MD, MPH; Francisco Garcia, MD; In the middle of the page, you'll notice that the patient's immediate risk is shown and it's shown in relation to a risk bar with different sorts of followup activities listed. Unauthorized use of these marks is strictly prohibited. www.acog.org, American College of Obstetricians and Gynecologists Kelly Welch; Nicolas Wentzensen, PhD; Claudia Werner, MD; Amy Wiser, MD; Rosemary Zuna, MD. Human Papillomavirus (HPV) Vaccine Guidelines The American Cancer Society recommends HPV vaccination for boys and girls between ages 9 and 12. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for Repeat Pap 12 m if referral Pap was LSIL Preferred Approach Colposcopy @ 6 m if referral Pap was ASC-H or moderate Treatment: Decision to treat is based on patient and provider preferences Negative or CIN 1 Discharge, Repeat Pap @ 12 months Moderate or marked referral Pap - see Guideline Ib. time. USPSTF guidelines 13. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. Please contact [emailprotected] with any questions. endobj
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