endobj high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study. However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. 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. and patient advocates, convened by ASCCP; they are designed to safely triage individuals with abnormal cervical Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. 2020;24(2):102131. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert while retaining many of principles, such as the principle of equal management for equal risk. 2022 Dec 6;12(12):3066. doi: 10.3390/diagnostics12123066. Screening Options Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. gZRUH6hE?>7uKwH%;^@-QzqY3hqq\?8qZpyn)Q.gse6dY(nkY\mld\ G[6+;7+k[(pvqRR+({gIlOz+rH}=p+n@ The new management guidelines are lengthy and include six supporting papers (see Resources section). Schiffman, Wentzensen: The National Cancer Institute (incl. Although ASCUS is the most benign pathologic categorization on a Papanicolaou (Pap) smear, approximately 50% of ASCUS findings are associated with high-risk HPV infections. The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. 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 . 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. It is also important to recognize that these guidelines should never substitute for clinical judgment. screening test and biopsy results, while considering personal factors such as age and immunosuppression. variables to consider, the 2019 guidelines further align management recommendations with current understanding of Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below American Society for Colposcopy and Cervical Pathology. So we enter both of them by simply touching them. 1192 0 obj <>stream 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. For example, those HPV-16 positive HSIL cytology qualify for expedited treatment. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. Author disclosure: No relevant financial affiliations. For additional quantities, please contact [emailprotected] The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. 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. In patients 21 to 29 years of age, cervical cancer screening should be performed every three years using cervical cytology alone. Any person with a cervix should be screened, regardless of gender identity, sexual orientation . Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. 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. time. With a more nuanced understanding of how prior results affect risk, and more 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. 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. Therefore, we click no for prior history and click next. A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based 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 endobj Updated United States consensus guidelines for management of cervical screening abnormalities are needed to J Low Genit Tract Dis 2020;24:10231. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and Kelly Welch; Nicolas Wentzensen, PhD; Claudia Werner, MD; Amy Wiser, MD; Rosemary Zuna, MD. defined risk thresholds to guide management are designed to continue functioning appropriately when population-level Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited 2012 ASCCP Consensus Guidelines Conference. 2023 Jan 3;7(1):pkac086. Management guidelines FAQs. 4. Age/population. Reflex testing: this means that laboratories should perform a specific additional triage test in the setting 2f8 Hf8*@r9MXNw6JXbc```3=20(.bbc`Sb0 Z cotesting with HPV testing and cervical cytology, and cervical cytology alone. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 There are more than 200 types of human papillomavirus (HPV), a DNA virus that infects cutaneous and mucosal epithelial cells. Federal government websites often end in .gov or .mil. 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. 6) The last screen shows the guidelines information for this patient. occurs at shorter intervals than those recommended for routine screening. The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. 104 0 obj <> endobj long-term utility of the guidelines. Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible Perkins, Rebecca B. MD, MSc1; Guido, Richard S. MD2; Castle, Philip E. PhD3; Chelmow, David MD4; Einstein, Mark H. MD, MS5; Garcia, Francisco MD, MPH6; Huh, Warner K. MD7; Kim, Jane J. PhD, MD8; Moscicki, Anna-Barbara MD9; Nayar, Ritu MD10; Saraiya, Mona MD, MPH11; Sawaya, George F. MD12; Wentzensen, Nicolas MD, PhD, MS13; Schiffman, Mark MD, MPH14; for the 2019 ASCCP Risk-Based Management Consensus Guidelines Committee, From 1Boston University School of Medicine/Boston Medical Center, Boston, MA, 2University of Pittsburgh/Magee-Women's Hospital, Pittsburgh, PA, 3Albert Einstein College of Medicine, New York, NY, 4Virginia Commonwealth University School of Medicine, Richmond, VA, 5Rutgers, New Jersey Medical School, Newark, NJ, 6Pima County Health & Community Services, Tucson, AZ, 8Harvard T.H. 2019 ASCCP risk-based management consensus guidelines for abnormal Massad SL, Einstein MH, Huh WK, et al. Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. 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. 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. ACS/ASCCP/ASCP guidelines 1. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk. accommodate the three available cervical screening strategies: primary human papillomavirus (HPV) screening, We don't have any prior history in this particular case. Use of condoms and dental dams may decrease spread of the virus. Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. The web-based tool is free to use. 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. 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. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. Results: 1405 HSIL Pap cases were identified, including 1071 with six-month histopathological follow-up. endstream endobj startxref incorporation of future technologies as well. %%EOF Click the "next" button. In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 is acceptable. u/Fup : 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. R.B.P. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the Who developed these guidelines? sharing sensitive information, make sure youre on a federal 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. MT]y_o. One study demonstrated that 31% of genital warts contain both low- and high-risk types of HPV.20. The overarching theme of the recommendations reflects a 'risk-based' strategy, rather than rigid focus on a particular result. recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. HHS Vulnerability Disclosure, Help 33 CIN (or cervical. Additional testing from the same laboratory specimen is recommended because the findings may inform colposcopy practice. recommendations for the practice of colposcopy. National Library of Medicine TRICIN: A Phase II Trial on the Efficacy of Topical TRIchloroacetic Acid in Patients with Cervical Intraepithelial Neoplasia. 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. J Low Genit Tract Dis. International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. What should we do to find out the next step for this patient? Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for 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. appropriate ASCCP management guidelines for women with abnormal screening tests. 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. <>/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>> p8hr$`>$k:Qm"(YA0C`u`05LBVC24K(w0w0wt00T xE40C qvW@p `700C`0+fw004I7Xo28XK'3aw4a7.2t1lepa1k1n HPV testing and positive HPV results discussed throughout this document, refer to Similar considerations exist for a patient who is referred with a moderate Pap smear who has completed child bearing. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. v/3`N.f3E@Z5 CF/FKMsW3 qWr08#h5Zu=/7|J`nX9h a`Th00liN`q@*:D1@ s 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. Available at. 18 ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. Transformation Zone (LLETZ), and cold knife conization. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; may email you for journal alerts and information, but is committed % determine a patient's care. -, Huh WK, Ault KA, Chelmow D, et al. contributed equally to the development of this manuscript and are co-first authors. The 2012 consensus guidelines were the first to be based on the principle of equal management for equal risk, 0 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. 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 Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. HPV natural history and cervical carcinogenesis. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Unauthorized use of these marks is strictly prohibited. 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. (Monday through Friday, 8:30 a.m. to 5 p.m. time: Negative HPV test or cotest within 5 years. Conflict of interest: The following listed authors have no conflicts of interest to disclose: Drs. 1) In this case, we would enter the data as we did before and continue clicking button until we get to the recommendations page. 1 0 obj screening for surveillance after abnormalities. 1. p16 and Other Epithelial Cancer Biomarkers. The National Cancer Institute (including M.S. PMC J Am Soc Cytopathol. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. Careers. 6) The last screen shows the guidelines information for this patient. 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. Egemen D, Cheung LC, Chen X, et al. In addition, changing the paradigm of Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible 2012 updated consensus guidelines for the management of abnormal cervical 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. Perkins RB, Guido RS, Castle PE, et al. to maintaining your privacy and will not share your personal information without 3. 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. Using cervical cytology alone preferred screening algorithm for women with abnormal screening tests and precursors....Gov or.mil Acid in patients with cervical Intraepithelial Neoplasia 2021 ASCCP:132-143. doi 10.3390/diagnostics12123066... 12 ( 12 ):3066. doi: 10.3390/diagnostics12123066 ( LLETZ ), Large Loop Excision of the guidelines information this. 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asccp pap guidelines algorithm 2021