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. The corresponding authors had final responsibility for the submission decision. Allow for a more complete and precise estimation of risk, Provide more appropriate intervention for high-risk individuals, Recommend less intervention for low-risk individuals, Allow for the future addition of new risk modifiers and screening and management technologies. cervical cancer screening tests and cancer precursors. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to More frequent surveillance, colposcopy, and treatment are that incorporation of the risk-based approach can provide more appropriate and personalized management for an 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. evaluating histologic specimens obtained via colposcopic biopsy. If everything is correct, click next and move on to the recommendations page. Perkins RB, Guido RS, Castle PE, et al. This content is owned by the AAFP. endobj development of the applications. Beyond the Management tab, there are two other tabs. However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. Additional testing from the same laboratory specimen is recommended because the findings may inform colposcopy practice. 2. By using this site, you agree to the Privacy Policy and acknowledge the use of cookies to store information, which may be essential to making our site work properly or enhancing user experience. 6) The last screen shows the guidelines information for this patient. FOIA <> Available at: ASCCP. 1017 0 obj <> endobj 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. *For nonpregnant patients 25 years or older. Xiong S, Lazovich A, Hassan F, Ambo N, Ghebre R, Kulasingam S, Mason SM, Pratt RJ. As a result, the risk estimates associated with some screening test combinations may change. Massad LS, Einstein MH, Huh WK, et al. 1. Follow these Guidelines: If you are younger than 21You do not need screening. Consider management according to the highest-grade abnormality https://cervixca.nlm.nih.gov/RiskTables/ official website and that any information you provide is encrypted USPSTF guidelines 13. Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. The defined risk thresholds to guide management are designed to continue functioning appropriately when population-level 8600 Rockville Pike This site needs JavaScript to work properly. 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. hbbd``b`qkA,` $E@!$tDS Eb``D'u` # 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Perkins RB, Guido RS, Castle PE, et al. A.-B.M. Federal government websites often end in .gov or .mil. 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 https:// ensures that you are connecting to the cancer precursors. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Unable to load your collection due to an error, Unable to load your delegates due to an error, Collaborators, 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. Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. W.K.H. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, 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. Introduction of risk- based guidelines in 2012 was a conceptual stream 1192 0 obj <>stream PMC doi: 10.1093/jncics/pkac086. Available at. This information is not intended for use without professional advice. 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. Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test. Refers to immediate CIN 3+ risk. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). of age and older. is connected with Inovio Pharmaceuticals DSMB. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; Disclaimer. Your browser does not support the video tag. In addition, a smartphone app is available at nominal cost for both Android and iOS platforms (https://www.asccp.org/mobile-app). 1075 0 obj <>stream ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. <> to routine screening. No industry funds were used in the development of 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 By using the app, you agree to the Terms of Use and Privacy Policy. Screening recommended every 3 years for women 21-29. %PDF-1.6 % time: Negative HPV test or cotest within 5 years. In immunocompetent individuals immunized before 15 years of age, a two-dose series is indicated. Excisional treatment: this term includes procedures that remove the transformation zone and produce a Please try again soon. Available at: Risk estimate tables supporting the 2019 ASCCP risk-based management consensus guidelines. MT]y_o. No industry funds were used in the Teams of experts and stakeholders, including patient advocates, developed the clinical action risk thresholds for each management option (Table 1). Note that a negative past history should be entered only when documented in the medical record and performed on 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. OR low risk women 30 and above may go every 3 years if Pap only; or 5 years if . Management of results during post colposcopy surveillance (within past 7 years): Management of current HPV and/or cytology results for patients who previously were triaged to 1-year, 3-year or 5-year follow-up after colposcopy. endstream endobj startxref *For nonpregnant patients 25 years or older. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. your express consent. A Practice Advisory is issued when information on an emergent clinical issue (e.g. Women 30-65 and older who have had 3 consecutive negative Pap test and who have no history of CIN2 or 3, etc. J Low Genit Tract Dis 2020;24:10231. <>>> 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. New data indicate that a patient's Author disclosure: No relevant financial affiliations. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Implement Sci Commun. All rights reserved. Expression of E4 Protein and HPV Major Capsid Protein (L1) as A Novel Combination in Squamous Intraepithelial Lesions. revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental Histopathological follow-ups within six months were also reviewed for correlation. Clipboard, Search History, and several other advanced features are temporarily unavailable. Funding for these activities is for the research related costs of the trials. 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. 1) In this case, we would enter the data as we did before and continue clicking button until we get to the recommendations page. Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. Reflex testing: this means that laboratories should perform a specific additional triage test in the setting Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. "m&"h-B5c;[. Risk estimation will use technology, such as a smartphone application or website. 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). determine a patient's care. An HPV test looks for infection with the types of HPV that are linked to cervical cancer. Do not perform annual cervical cytology (Pap test) or annual HPV screening in immunocompetent women with a history of negative screening. It is also important to recognize that these guidelines should never substitute for clinical judgment. Age/population. 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. %PDF-1.5 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. Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. Again, notice the references are listed with hyperlinks and you do have a back and start over button. 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. variables to consider, the 2019 guidelines further align management recommendations with current understanding of Egemen D, Cheung LC, Chen X, et al. New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. Please enable it to take advantage of the complete set of features! 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). J Low Genit Tract Dis 2020;24:132-43. endstream endobj startxref Expedited treatment was an option for patients with high-grade squamous intraepithelial lesion (HSIL) cytology in the 2012 guidelines; this guidance is now better defined. All participating consensus organizations, including the Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. Risk estimates are organized into tables of risk by current test result and history. The goals of the ASCCP Risk-Based Management Consensus risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of 1 0 obj 5. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . For more information, please refer to our Privacy Policy. Updated guidelines were needed to incorporate these changes. This algorithm should not be used to treat pregnant women. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. J Low Genit Tract Dis 2020;24:10231. individual patient based on their current results and past history. a reflex HPV test. 1 0 obj Conflict of interest: The following listed authors have no conflicts of interest to disclose: Drs. breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently Cotesting: this term refers to screening or surveillance performed with both cytology and HPV testing. 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. c5K44s American Society for Colposcopy and Cervical Pathology. In this case, the patient had an ASCUS pap test result and a positive high risk test results. 2012 ASCCP Consensus Guidelines Conference. Obstet Gynecol 2013;121:82946. 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 Bethesda, MD 20894, Web Policies Transformation Zone (LLETZ), and cold knife conization. The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients. According to a 2018 Cochrane review, vaccinating women, with or without HPV exposure, between 15 and 26 years of age decreases the risk of cervical intraepithelial neoplasia 2 and 3, with a number needed to treat of 39. -, Egemen D, Cheung LC, Chen X, et al. However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . <> Schiffman, Wentzensen: The National Cancer Institute (incl. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. %PDF-1.5 Available at: ASCCP management guidelines app quick start guide. Ax$$ C9N}.{"7J8 0f v40#BI0u i@H!ijc E5+W"l Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). 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. The Steering Committee, Working Group members, and additional contributing authors for the ASCCP Risk Based specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the 4 0 obj Read all of the Articles Read the Main Guideline Article Management Guidelines The 2012 consensus guidelines were the first to be based on the principle of equal management for equal risk, A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. J Am Soc Cytopathol. 2022 Dec 6;12(12):3066. doi: 10.3390/diagnostics12123066. Please enable scripts and reload this page. 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. Algorithms and/or risk estimates are shown when available. endobj long-term utility of the guidelines. <>>> hb```b``a`O@(E$0v "b$3A{fn8EXZ3N?v[U}?{P_n\e if <25yo Dysplasia - Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented Massad SL, Einstein MH, Huh WK, et al. We don't have any prior history in this particular case. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. management from one that is based on specific test results to one that is based on a patient's risk will allow for 2020 Oct;24(4):426. doi: 10.1097/LGT.0000000000000562. MeSH This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. 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. Barbara Crothers, DO; Teresa Darragh, MD; Maria Demarco, PhD; Eileen Duffey-Lind, MSN; Ysabel Duron, BA; Didem To help physicians navigate this information and to facilitate implementation, a free web-based decision management tool has been developed (https://app.asccp.org/). This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. 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. The app is only to be used by medical professionals and email addresses will be retained under the terms of the privacy policy. 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. Careers. How are these guidelines different? 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 The new management guidelines are lengthy and include six supporting papers (see Resources section). 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. 2. 2023 Jan 3;7(1):pkac086. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Risk factors for HPV infection include early sexual contact, having multiple sex partners, a history of other sexually transmitted infections, HIV infection, an immunocompromised state, and not using barrier protection during sex.3,13,14, Persistent oral and genital HPV infections are associated with alcohol use and smoking.15,16 There is some evidence that human leukocyte antigen type may impact an individual's ability to clear HPV viruses.17 Although several factors have been associated with an increased risk of progression to cervical disease (e.g., age, body mass index, income, oral contraceptive use, race/ethnicity, smoking), persistent high-risk HPV infection is the most significant risk factor for progression.18,19, Infection with a low-risk HPV type does not preclude infection with a concomitant high-risk type. The web-based tool is free to use. 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> The management guidelines were revised now due to the availability of sufficient data from the United States showing If you are 21 to 29 Have a Pap test alone every 3 years. Cytology every . 3 0 obj www.acog.org, American College of Obstetricians and Gynecologists Risk tables have been generated to assist the clinician and guide practice. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. HPV is spread by direct skin-to-skin contact and has tropisms for cutaneous or mucosal epithelial cells.1 A small subset of HPV types can cause cutaneous warts.2 The approximately 40 types that infect mucosal surfaces are typically spread through sexual contact, including vaginal, anal, or oral sex, and can be divided into low-risk and high-risk types based on their associated cancer risk. Participating organizations The recommendation is more than a cytology or HPV follow up. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. may email you for journal alerts and information, but is committed The new iOS & Android mobile apps and the Web application , to streamline navigation of the guidelines, have launched. is an ASCCP consultant of Inovio Pharmaceuticals DSMB. 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. Rather than consider 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. 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. incorporation of future technologies as well. An Introduction to the 2019 ASCCP Risk-Based Management Consensus Guidelines. while retaining many of principles, such as the principle of equal management for equal risk. hb```^6.EAd`0pHH)zeoP4T``rI< lJBUc.0S0w"I)Wz~(qLl~@`;c 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. 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. cancer screening results. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. Clearly %%EOF 5 - 8 New algorithms focus on special populations (i.e., adolescents and . Cytology every three years (liquid or conventional) Recommend against annual Pap smear. 3. For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. Evaluating the Feasibility of Machine-Learning-Based Predictive Models for Precancerous Cervical Lesions in Patients Referred for Colposcopy. Essential Changes From Prior Management Guidelines. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping As of April 2021, the cost for the mobile app is $10. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. 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. Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based opinion. HPV testing or cotesting at more frequent intervals than are recommended for screening. endobj Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible 0 endobj Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. /+=jYOu3jz;?oVX'm6HtW|`k* hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w 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. 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.
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