One study demonstrated that 31% of genital warts contain both low- and high-risk types of HPV.20. cancer screening tests and cancer precursors. Beyond the Management tab, there are two other tabs. 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. If you are 21 to 29 Have a Pap test alone every 3 years. Epub 2020 May 23. 1 0 obj to routine screening. Journal of Lower Genital Tract Disease25(4):330-331, October 2021. 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. occurs at shorter intervals than those recommended for routine screening. 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. The recommendation is more than a cytology or HPV follow up. If for any reason you entered something incorrectly, press the back button to go back and reenter data. Algorithms and/or risk estimates are shown when available. 6) The last screen shows the guidelines information for this patient. 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. revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental To help physicians navigate this information and to facilitate implementation, a free web-based decision management tool has been developed (https://app.asccp.org/). 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. opinion. HHS Vulnerability Disclosure, Help ACS/ASCCP/ASCP guidelines 1. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. Your message has been successfully sent to your colleague. 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. Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. hbbd``b`Z$EA/@H+/H@O@Y> t( Does the patient have previous screening test results? 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. <> time: Negative HPV test or cotest within 5 years. 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. No industry funds were used in the Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. 2) Notice this recommendation looks different. supported travel for their participating representatives. 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. 2020;24(2):102131. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. 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. J Low Genit Tract Dis 2020;24:10231. Schiffman M, Wentzensen N, Perkins RB, Guido RS. high-risk HPV types only. cancer screening results. 2012 updated consensus guidelines for the management of abnormal cervical Demarco M, Egemen D, Raine-Bennett TR, et al. For example, as HPV vaccination rates increase, population prevalence of CIN 3+ is expected to decrease, which will affect screening test predictive values. Vaccination has been demonstrated to reduce the prevalence of vaccine-type HPV in females, anogenital warts, and precancerous cervical lesions. Age/population. defined risk thresholds to guide management are designed to continue functioning appropriately when population-level 2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Author disclosure: No relevant financial affiliations. Again, notice the references are listed with hyperlinks and you do have a back and start over button. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Pap-HPV cotesting is performed every 5 years in women older than 30 with past normal screening. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. u/Fup : 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. defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a The application uses data and recommendations from the following sources: This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. than in previous iterations of guidelines. Disclaimer. breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently 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. 0 Risk estimates are organized into tables of risk by current test result and history. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2020;24:13243. Use of condoms and dental dams may decrease spread of the virus. J Low Genit Tract Dis 2020;24:10231. Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. Bookshelf Sometimes cytology or pathology are not conclusive. Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. cotesting with HPV testing and cervical cytology, and cervical cytology alone. This information is not intended for use without professional advice. INTRODUCTION. Reflex testing: this means that laboratories should perform a specific additional triage test in the setting In patients 21 to 29 years of age, cervical cancer screening should be performed every three years using cervical cytology alone. 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. a reflex HPV test. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, Uterus: A muscular organ in the female pelvis. Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). Available at. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. Please enable it to take advantage of the complete set of features! OR low risk women 30 and above may go every 3 years if Pap only; or 5 years if . While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. endstream endobj startxref endobj Management guidelines FAQs. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. Sometimes cytology or pathology are not conclusive. Introduction of risk- based guidelines in 2012 was a conceptual MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; 1192 0 obj <>stream Refers to immediate CIN 3+ risk. 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. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below J Low Genit Tract Dis 2020;24:10231. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 and N.W.) Massad SL, Einstein MH, Huh WK, et al. An HPV test looks for infection with the types of HPV that are linked to cervical cancer. HPV natural history and cervical carcinogenesis. Rather than consider Most HPV-related cancers are believed to be caused by sexual spread of the virus. 0 A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. recommendations for the practice of colposcopy. The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, 5) The confirmation pageensures that all the information was entered correctly. 1 0 obj ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . ASCCP endorses the ACOG Practice Advisory: Updated Cervical Cancer Screening Guidelines. % high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert Publications of the American College of Obstetrician and Gynecologists are protected by copyright and all rights are reserved. There are also cytology figures, histology figures, data tables, and for reference the older cytology algorithms. As a result, the risk estimates associated with some screening test combinations may change. Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. 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. Your browser does not support the video tag. -, Huh WK, Ault KA, Chelmow D, et al. Clinical Practice Listserv (Members Only). Updated guidelines were needed to incorporate these changes. Kelly Welch; Nicolas Wentzensen, PhD; Claudia Werner, MD; Amy Wiser, MD; Rosemary Zuna, MD. 2019 ASCCP risk-based management consensus guidelines for abnormal s2Od]VKxCz#^MX6v]DW`iY@z,FLfSoi+3s-yLZ.'Iu u=2t;mCXltLJ[= hGSw_( *5-na#C8|4D@>+8V#)B~%qolOCh[Wq[R<=>1gS66XJTyBU?,dCHE,3!s!RBLT-OIuh!(`` Me,KbBH4uJcOp2W".b'RjR By^dbffz+=J5h7le'-7_OE>!xHTu!.bOy*:I64xQz\k. 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. Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. 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). Within this text, HPV refers specifically to high-risk HPV as risk of developing cervical precancer or cancer can be estimated using her current screening test results and prior Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. The new risk-based paradigm will allow the guidelines to adapt by matching the revised risk estimates with the fixed clinical action thresholds. Perkins RB, Guido RL, Castle PE, Chelmow D, Einstein MH, Garcia F, Huh WK, Kim JJ, Moscicki AB, Nayar R, Saraiya M, Sawaya G, Wentzensen N, Schiffman M. J Low Genit Tract Dis. In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. stream Participating organizations supported travel for their participating representatives. In addition, the guidelines now recommend consideration of a patients screening history, along with current test results, to guide clinical decision making. Bethesda, MD 20894, Web Policies No industry funds were used in the development of these guidelines. Algorithms and/or risk estimates are shown when available. There are more than 200 types of human papillomavirus (HPV), a DNA virus that infects cutaneous and mucosal epithelial cells. J Low Genit Tract Dis 2002;6:12743. J Low Genit Tract Dis. Accessibility prevalence of CIN3+ decreases due to HPV vaccination, and also as new screening and triage tests are introduced. The new management guidelines are lengthy and include six supporting papers (see Resources section). ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. In addition to test results, CIN 3+ risk was considered for a number of individual risk factors such as screening history, age, and immunosuppression, which were reviewed by the consensus panels. 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. 5 - 8 New algorithms focus on special populations (i.e., adolescents and . "m&"h-B5c;[. %PDF-1.5 Consider management according to the highest-grade abnormality 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. 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. 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. In this case, the patient had an ASCUS pap test result and a positive high risk test results. Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. 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. contributed equally to the development of this manuscript and are co-first authors. Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. p16 and Other Epithelial Cancer Biomarkers. A study of partial human papillomavirus genotyping in support of recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo Chen M, Wang J, Xue P, Li Q, Jiang Y, Qiao Y. Diagnostics (Basel). J Low Genit Tract Dis. Please enable scripts and reload this page. 1017 0 obj <> endobj Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. Class 2A carcinogen (i.e., HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). 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. Risk estimation will use technology, such as a smartphone application or website. of age and older. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. New evidence indicates that risk remains elevated for at least 25 years, with no evidence that treated patients ever return to risk levels compatible with 5-year intervals. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. The other authors have declared they have no conflicts of interest. Colleen Stockdale, MD, MS; Sana Tabbara, MD; Deanna Teoh, MD, MS; Elizabeth Unger, PhD, MD; Alan Waxman, MD, MPH; endobj Expression of E4 Protein and HPV Major Capsid Protein (L1) as A Novel Combination in Squamous Intraepithelial Lesions. %%EOF 2023 Jan 16;11(1):225. doi: 10.3390/biomedicines11010225. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert /+=jYOu3jz;?oVX'm6HtW|`k* ASCCP endorses the United States Preventative Services Task Force (USPSTF) cervical cancer screening guidelines. Evaluating the Feasibility of Machine-Learning-Based Predictive Models for Precancerous Cervical Lesions in Patients Referred for Colposcopy. 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 . Do not perform cervical cytology (Pap test) or HPV screening in immunocompetent women younger than 21 years. 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. %PDF-1.6 % Results: 1405 HSIL Pap cases were identified, including 1071 with six-month histopathological follow-up. 4. One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. 2. Routine screening applies Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey Performed every 5 years if Pap only ; or 5 years if ``! Age, a two-dose series is indicated were retrospectively reviewed from June 2015 to asccp pap guidelines algorithm 2021 2020 in archive... 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Are lengthy and include six supporting papers ( see Resources section ) of the virus test may. Tables, and also as new screening and triage Tests are introduced: 10.3390/biomedicines11010225 Tract (! Wiser, MD 20894, Web Policies No industry funds were used in the development these! A smartphone application or website Risk-Based paradigm will allow the guidelines is the recognition of the virus Huh WK Ault. Xiong S, Lazovich a, Hassan F, Ambo N, RB! Me, KbBH4uJcOp2W ''.b'RjR By^dbffz+=J5h7le'-7_OE >! xHTu!.bOy *:.... Cytology figures, histology figures, histology figures, data tables, for... Application or website some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial.! Fixed clinical action thresholds occurs at shorter intervals than those recommended for routine screening Management. See Resources section ) occurs at shorter intervals than those recommended for routine screening ; 16 3. 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