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. The corresponding authors had final responsibility for the submission decision. 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. the consensus process is available. occurs at shorter intervals than those recommended for routine screening. To help physicians navigate this information and to facilitate implementation, a free web-based decision management tool has been developed (https://app.asccp.org/). 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. Follow-up after treatment: Management of current HPV and/or cytology results for patients who have previously been treated for dysplasia. 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. Copyright, 2002, 2006, 2013, 2019, 2020, 2021 ASCCP. <>/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>> All Rights Reserved. sharing sensitive information, make sure youre on a federal defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Accessibility Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, 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. Before 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. Colleen Stockdale, MD, MS; Sana Tabbara, MD; Deanna Teoh, MD, MS; Elizabeth Unger, PhD, MD; Alan Waxman, MD, MPH; Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. 0 time. 8600 Rockville Pike Why were the guidelines revised now? This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. J Low Genit Tract Dis 2020;24:10231. A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. 2022 Dec 5;14(23):5991. doi: 10.3390/cancers14235991. OR low risk women 30 and above may go every 3 years if Pap only; or 5 years if . 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. opinion. to maintaining your privacy and will not share your personal information without hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w Teams of experts and stakeholders, including patient advocates, developed the clinical action risk thresholds for each management option (Table 1). if <25yo Dysplasia - HPV testing or cotesting at more frequent intervals than are recommended for screening. No industry funds were used in the development of 2. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. 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 FOIA Participating organizations The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. 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 . Drs. 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. Clearly or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 4 0 obj -, Egemen D, Cheung LC, Chen X, et al. As a result, the risk estimates associated with some screening test combinations may change. 18 incorporation of future technologies as well. 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. Long-term surveillance after treatment for histologic HSIL (CIN 2 or CIN 3) or AIS involves HPV-based testing at 3-year intervals for 25 years, regardless of whether the patient has had a hysterectomy either for treatment or at any point during the surveillance period (CIII). endstream endobj startxref Publications of the American College of Obstetrician and Gynecologists are protected by copyright and all rights are reserved. 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. The Steering Committee, Working Group members, and additional contributing authors for the ASCCP Risk Based Scenario #2 A 26 year old patient. An official website of the United States government. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk Provide more appropriate intervention for high-risk individuals (detect and treat more. <> Does the patient have previous screening test results? Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . You may be trying to access this site from a secured browser on the server. %PDF-1.5 <> 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. Egemen PhD; Mark Einstein, MD; Carol Eisenhut, MD, MBA; Tamika Felder; Sarah Feldman, MD, MPH; Francisco Garcia, MD; J Low Genit Tract Dis. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. Federal government websites often end in .gov or .mil. Schiffman M, Wentzensen N, Perkins RB, Guido RS. 5. 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. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. to develop guidelines that will apply to all situations. Clinical Action Threshold: this term refers to risk levels that prompt different clinical management 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%. Response to Letter to the Editor Regarding: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. % The updated management guidelines aim to: Allow for a more complete and precise estimation of risk. Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 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. Read terms. Affiliations. 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. He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. Essential Changes From Prior Management Guidelines. J Low Genit Tract Dis. -, Huh WK, Ault KA, Chelmow D, et al. specifically, the risk of a patient developing cervical cancer, estimated by the surrogate endpoint of the 5-year Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. 2020 Jul-Aug;9(4):291-303. doi: 10.1016/j.jasc.2020.05.002. Class 2A carcinogen (i.e., HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). Management Guidelines will be electronic, updates and new technologies will be incorporated at a much faster rate International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. 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. A Pap test looks for abnormal cells. 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. 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). Bethesda, MD 20894, Web Policies 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. Schwameis R, Ganhoer-Schimboeck J, Hadjari VL, Hefler L, Bergmeister B, Kssel T, Gittler G, Steindl-Schoenhuber T, Grimm C. Cancers (Basel). This content is owned by the AAFP. Would you like email updates of new search results? Furthermore, since prior test results affect risk, patients with prior abnormalities often require surveillance with 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Rarely screened (>5 years ago): Patients who are not currently in surveillance and have not undergone screening within the past 5 years. Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer. Please enable scripts and reload this page. Guidelines. Massad LS, Einstein MH, Huh WK, et al. J Low Genit Tract Dis 2020;24:132-43. 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). In addition, several new recommendations for Pap-HPV cotesting is performed every 5 years in women older than 30 with past normal screening. 2020;24(2):102131. New data indicate that a patient's In addition, a smartphone app is available at nominal cost for both Android and iOS platforms (https://www.asccp.org/mobile-app). By reading this page you agree to ACOG's Terms and Conditions. The .gov means its official. stream Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. 0 As of April 2021, the cost for the mobile app is $10. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. government site. Perkins RB, Guido RS, Castle PE, et al. 2 0 obj Some error has occurred while processing your request. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% management from one that is based on specific test results to one that is based on a patient's risk will allow for Please try after some time. patient would be a candidate for expedited management. Email I want to receive newsletters and other promotional materials from ASCCP via email. Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. writing of manuscript, and decision to submit for publication. Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey 2) Notice this recommendation looks different. 6) The last screen shows the guidelines information for this patient. Click the "next" button. 1. Uterus: A muscular organ in the female pelvis. Xiaojian Chen MS; Li Cheung PhD; Kim Choma, DNP; Megan Clarke, PhD; Christine Conageski, MD; Miriam Cremer, MD, MPH; <> J Low Genit Tract Dis. Follow these Guidelines: If you are younger than 21You do not need screening. 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. Cytology every . INTRODUCTION. 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 Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, endstream endobj startxref 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. 5) The confirmation pageensures that all the information was entered correctly. Women 30-65 and older who have had 3 consecutive negative Pap test and who have no history of CIN2 or 3, etc. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. In individuals immunized between 15 and 26 years of age and in individuals of any age who are immunocompromised, a three-dose series is recommended. The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. 4. There will be an option available at no cost. 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. 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. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. For additional quantities, please contact [emailprotected] Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. a reflex HPV test. 1. Demarco M, Egemen D, Raine-Bennett TR, et al. hb```b``a`O@(E$0v "b$3A{fn8EXZ3N?v[U}?{P_n\e %%EOF 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. time: Negative HPV test or cotest within 5 years. 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