J Low Genit Tract Dis 2020;24:102-31. 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. 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 defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible HPV natural history and cervical carcinogenesis. J Low Genit Tract Dis 2020;24:10231. 21 to 29 years of age *. 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 . R.B.P. 2012 ASCCP Consensus Guidelines Conference. So we enter both of them by simply touching them. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping 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. breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors have been published. CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. This algorithm should not be used to treat pregnant women. Massad SL, Einstein MH, Huh WK, et al. 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. With more than 200 types identified, human papillomavirus (HPV) commonly causes infections of the skin and mucosa. opinion. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. ZKlX#`Q)s4 OhMaoJDk4*L!ivm *k^xtY3 u|yHU& Df3u Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. Do the new guidelines still use algorithms? revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental In patients 21 to 29 years of age, cervical cancer screening should be performed every three years using cervical cytology alone. 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. This site needs JavaScript to work properly. Reflex testing: this means that laboratories should perform a specific additional triage test in the setting One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. J Low Genit Tract Dis. There are more than 200 types of human papillomavirus (HPV), a DNA virus that infects cutaneous and mucosal epithelial cells. 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. 4 0 obj 4. 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. Clearly A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. hbbd``b`qkA,` $E@!$tDS Eb``D'u` # Refers to 5-year CIN 3+ risk. official website and that any information you provide is encrypted Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. <>>> Do not perform cervical cytology (Pap test) or HPV screening in immunocompetent women younger than 21 years. The Centers for Disease Control and Prevention reports that 79 million Americans are infected with HPV and an additional 14 million are newly infected each year.3 Data from early HPV vaccine trials suggest that the lifetime prevalence of the infection is 85% in women and 91% in men who have had at least one sex partner.8. a reflex HPV test. 117 0 obj <>/Filter/FlateDecode/ID[<2A3A72E8287AD77BE571CDCCA6D1568C><7C4167790C383844A9780EF022A9F20A>]/Index[104 29]/Info 103 0 R/Length 73/Prev 24323/Root 105 0 R/Size 133/Type/XRef/W[1 2 1]>>stream which test combinations yielded this risk level. In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 is acceptable. 6) The last screen shows the guidelines information for this patient. supported travel for their participating representatives. The https:// ensures that you are connecting to the Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. Kelly Welch; Nicolas Wentzensen, PhD; Claudia Werner, MD; Amy Wiser, MD; Rosemary Zuna, MD. 2023 Jan 3;7(1):pkac086. 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. Author disclosure: No relevant financial affiliations. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. In addition, a smartphone app is available at nominal cost for both Android and iOS platforms (https://www.asccp.org/mobile-app). Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. %PDF-1.5 For example, as HPV vaccination rates increase, population prevalence of CIN 3+ is expected to decrease, which will affect screening test predictive values. 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. 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. As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. screening for surveillance after abnormalities. Bulk pricing was not found for item. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; Risk tables have been generated to assist the clinician and guide practice. 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. 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. recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. J Am Soc Cytopathol. Copyright 2021 by the American Academy of Family Physicians. A.-B.M. MT]y_o. The following clarifications specify management for additional scenarios. gZRUH6hE?>7uKwH%;^@-QzqY3hqq\?8qZpyn)Q.gse6dY(nkY\mld\ G[6+;7+k[(pvqRR+({gIlOz+rH}=p+n@ 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. 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). 2) Enter the patient's age and the clinical situation. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. strategies. to develop guidelines that will apply to all situations. R.S.G. %%EOF Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. Drs. For example, an ASC-US cytology should trigger management from one that is based on specific test results to one that is based on a patient's risk will allow for Implement Sci Commun. He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. endstream endobj startxref Funding for these activities is for the research related costs of the trials. Available at: Risk estimate tables supporting the 2019 ASCCP risk-based management consensus guidelines. 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 new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, _amTYC@ these guidelines. Uterus: A muscular organ in the female pelvis. 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). Why were the guidelines revised now? 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. Transformation Zone (LLETZ), and cold knife conization. Therefore, we click no for prior history and click next. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement stream test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the No industry funds were used in the development of these guidelines. Click the "next" button. Use of condoms and dental dams may decrease spread of the virus. Wolters Kluwer Health 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. Massad LS, Einstein MH, Huh WK, et al. It does not apply to reflex HPV testing for triage of ASC-US The guidelines effort received support from ASCCP and the National Cancer Institute. Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. time: Negative HPV test or cotest within 5 years. For more information, please refer to our Privacy Policy. your express consent. The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients. See this image and copyright information in PMC. Note that a negative past history should be entered only when documented in the medical record and performed on However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. An Introduction to the 2019 ASCCP Risk-Based Management Consensus Guidelines. Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. CIN 3+ Risk Thresholds for Management. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. <>/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>> If you are 21 to 29 Have a Pap test alone every 3 years. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. National Library of Medicine hWmo6+hNI@VXVk #TGs! Disclaimer. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. MeSH recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo PMC | Terms and Conditions of Use. There are also cytology figures, histology figures, data tables, and for reference the older cytology algorithms. Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. evaluating histologic specimens obtained via colposcopic biopsy. "m&"h-B5c;[. Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. Please enable it to take advantage of the complete set of features! 1186 0 obj <>/Filter/FlateDecode/ID[<4119F28666E0954E9D1B9856E3FE9044>]/Index[1176 17]/Info 1175 0 R/Length 65/Prev 464723/Root 1177 0 R/Size 1193/Type/XRef/W[1 2 1]>>stream Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. Federal government websites often end in .gov or .mil. Available at: ASCCP management guidelines app quick start guide. Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% 3. this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, Essential Changes From Prior Management Guidelines. 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. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. All participating consensus organizations, including the In this case, the patient had an ASCUS pap test result and a positive high risk test results. Unauthorized use of these marks is strictly prohibited. variables to consider, the 2019 guidelines further align management recommendations with current understanding of HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Demarco M, Egemen D, Raine-Bennett TR, et al. While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. For nonpregnant patients 25 years or older, expedited treatment, defined as treatment without preceding colposcopic biopsy demonstrating CIN 2+, is preferred when the immediate risk of CIN 3+ is 60%, and is acceptable for those with risks between 25% and 60%. Dr. Castle has received HPV tests and assays at a reduced or no cost from Roche, Becton Dickinson, Arbor Vita Corporation, and Cepheid for research. Available at: ASCCP. 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. Accessibility -. The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. Careers. cervical cancer screening tests and cancer precursors. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. endobj p8hr$`>$k:Qm"(YA0C`u`05LBVC24K(w0w0wt00T xE40C qvW@p `700C`0+fw004I7Xo28XK'3aw4a7.2t1lepa1k1n The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. How are these guidelines different? 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. Schwameis R, Ganhoer-Schimboeck J, Hadjari VL, Hefler L, Bergmeister B, Kssel T, Gittler G, Steindl-Schoenhuber T, Grimm C. Cancers (Basel). 2020 Oct;24(4):427. doi: 10.1097/LGT.0000000000000563. 1044 0 obj <>/Filter/FlateDecode/ID[<51FC2DB85E610A4EB791D667E0A1A1A7>]/Index[1017 59]/Info 1016 0 R/Length 110/Prev 455981/Root 1018 0 R/Size 1076/Type/XRef/W[1 3 1]>>stream Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. J Low Genit Tract Dis 2013; 17: S1-S27. 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. endobj Do not perform annual cervical cytology (Pap test) or annual HPV screening in immunocompetent women with a history of negative screening. The Steering Committee, Working Group members, and additional contributing authors for the ASCCP Risk Based 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> -, Wright TC, Massad LS, Dunton CJ, et al. Perkins RB, Guido RS, Castle PE, et al. Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer. 1 0 obj 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. Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. The web-based tool is free to use. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. 2020;24(2):102131. 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. 2022 Dec 6;12(12):3066. doi: 10.3390/diagnostics12123066. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Bookshelf screening test and biopsy results, while considering personal factors such as age and immunosuppression. only to patients without risk factors. New data indicate that a patient's The prevalence of cutaneous warts is highest in school-aged children (up to 30%), then declines with advancing age.2 HPV infection is the most common sexually transmitted infection in the United States. This information is not intended for use without professional advice. sharing sensitive information, make sure youre on a federal American Society for Colposcopy and Cervical Pathology. Egemen D, Cheung LC, Chen X, et al. J Low Genit Tract Dis 2020;24:132-43. Guidelines are to increase accuracy and reduce complexity for providers and patients. Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. 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. Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test. International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, Clipboard, Search History, and several other advanced features are temporarily unavailable. HPV: this term refers to Human Papillomavirus. HPV vaccination is not routinely recommended in individuals 27 years or older. (Monday through Friday, 8:30 a.m. to 5 p.m. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. Screening for HPV infection is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible Follow-up after treatment: Management of current HPV and/or cytology results for patients who have previously been treated for dysplasia. cervical cancer screening have come out since 2012, such as primary HPV as a screening option for patients 25 years endobj References to the published guideline information is also shown. cytology in this document. In additional to enabling the provision of more individualized clinical care, the new risk-based management paradigm will facilitate the incorporation of new screening and management technologies into clinical decision making and accommodate changes in disease prevalence over time. Your browser does not support the video tag. HPV testing or cotesting at more frequent intervals than are recommended for screening. The ability to adjust to the rapidly emerging science is critical for the <> 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. 2 0 obj The other authors have declared they have no conflicts of interest. 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 Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. 1. test results in isolation, the new guidelines use current and past results to create individualized assessments of a Bethesda, MD 20894, Web Policies recommendations for the practice of colposcopy. <> Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below Follow these Guidelines: If you are younger than 21You do not need screening. 140, Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. Some error has occurred while processing your request. <>>> 2019 ASCCP risk-based management consensus guidelines for abnormal cotesting at intervals <5 years, or cytology alone at intervals <3 years. Risk based management guidelines collection. Surveillance: this term refers to repeat testing (HPV primary screening, cotesting, or cytology alone), that of a positive screening test to inform the next steps in management. 2023 Jan 16;11(1):225. doi: 10.3390/biomedicines11010225. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus may email you for journal alerts and information, but is committed Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; Read terms. 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. HPV testing and positive HPV results discussed throughout this document, refer to The CIN 3+ risks estimates were calculated based on data from a prospective longitudinal cohort of patients from Kaiser Permanente Northern California and validated using several other data sets. Note that a negative past history should be entered only when documented in the medical record and performed on Guidelines. 18 contributed equally to the development of this manuscript and are co-first authors. 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.
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