The overarching theme of the recommendations reflects a 'risk-based' strategy, rather than rigid focus on a particular result. 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. and N.W.) determine a patient's care. long-term utility of the guidelines. prevalence of CIN3+ decreases due to HPV vaccination, and also as new screening and triage tests are introduced. A Practice Advisory is issued when information on an emergent clinical issue (e.g. test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the In general, a two-dose series is recommended if administered before 15 years of age; however, individuals who are immunocompromised require three doses. Some error has occurred while processing your request. Beyond the Management tab, there are two other tabs. Vaccination is the primary method of prevention. HPV testing and positive HPV results discussed throughout this document, refer to 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement ASCCP endorses the United States Preventative Services Task Force (USPSTF) cervical cancer screening guidelines. Management Consensus Guidelines Committee includes: defined risk thresholds to guide management are designed to continue functioning appropriately when population-level 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). Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. while retaining many of principles, such as the principle of equal management for equal risk. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. 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. Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. Colleen Stockdale, MD, MS; Sana Tabbara, MD; Deanna Teoh, MD, MS; Elizabeth Unger, PhD, MD; Alan Waxman, MD, MPH; The app is only to be used by medical professionals and email addresses will be retained under the terms of the privacy policy. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. Conflict of interest: The following listed authors have no conflicts of interest to disclose: Drs. Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. 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. Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. 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%. Read all of the Articles Read the Main Guideline Article Management Guidelines Wolters Kluwer Health Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. 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. Risk estimates supporting the 2019 ASCCP risk-based management consensus guidelines. 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 The 2012 consensus guidelines were the first to be based on the principle of equal management for equal risk, The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Read the new ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and 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 However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. 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. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. and transmitted securely. 5 - 8 New algorithms focus on special populations (i.e., adolescents and . 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. & D@eLiat2D_*0N-!d0.a*#h & 2e 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. ZKlX#`Q)s4 OhMaoJDk4*L!ivm *k^xtY3 u|yHU& Df3u 1017 0 obj <> endobj hWmo6+hNI@VXVk #TGs! 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors J Low Genit Tract Dis . Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. In addition, a smartphone app is available at nominal cost for both Android and iOS platforms (https://www.asccp.org/mobile-app). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. No industry funds were used in the development of these guidelines. If you are 21 to 29 Have a Pap test alone every 3 years. your express consent. 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. Algorithms and/or risk estimates are shown when available. Surveillance: this term refers to repeat testing (HPV primary screening, cotesting, or cytology alone), that 1 0 obj Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. Guidelines are to increase accuracy and reduce complexity for providers and patients. Class 2A carcinogen (i.e., HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines. Please enable scripts and reload this page. cervical cancer screening have come out since 2012, such as primary HPV as a screening option for patients 25 years Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. strategies. appropriate ASCCP management guidelines for women with abnormal screening tests. 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. <> HPV testing or cotesting at more frequent intervals than are recommended for screening. recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently 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. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; Perkins, Chelmow, Garcia, Kim, Nayar, Saraiya, and Sawaya. Funding for these activities is for the research related costs of the trials. All rights reserved. Who developed these guidelines? 2) Enter the patient's age and the clinical situation. of age and older. 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. 4 0 obj Definitions tab - Definitions of terms in the app, a summary of the changes in the current guidelines from prior guidelines, and frequently asked questions. endobj 2022 Dec 6;12(12):3066. doi: 10.3390/diagnostics12123066. Algorithms and/or risk estimates are shown when available. 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. 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 J Low Genit Tract Dis. One study demonstrated that 31% of genital warts contain both low- and high-risk types of HPV.20. 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. Refers to 5-year CIN 3+ risk. J Low Genit Tract Dis 2020;24:13243. In cases where a colposcopy was previously recommended but not completed, if on repeat testing the patient has a persistent HPV-positive result and/or persistent cytologic abnormality (atypical squamous cells of uncertain significance, ASC-US, or higher), colposcopy is recommended. How are these guidelines different? Egemen D, Cheung LC, Chen X, Demarco M, Perkins RB, Kinney W, Poitras N, Befano B, Locke A, Guido RS, Wiser AL, Gage JC, Katki HA, Wentzensen N, Castle PE, Schiffman M, Lorey TS. Dr. Einstein 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. P.E.C. Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. %PDF-1.6 % 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV If for any reason you entered something incorrectly, press the back button to go back and reenter data. % J Low Genit Tract Dis. Children and young adults age 13 through 26 who have not been vaccinated, or who haven't completed the vaccine series, should get the vaccine as soon as possible. J Low Genit Tract Dis. better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return Screening recommended every 3 years for women 21-29. Your browser does not support the video tag. 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 . FOIA Guidelines cannot cover all clinical situations and clinical judgment is advised, especially in those circumstances which are not covered by the 2019 guidelines.Perkins RB, Guido RS, Castle PE, et al. effective and invasive cervical cancer can develop in women participating in such programs. It is also important to recognize that these guidelines should never substitute for clinical judgment. opinion. Available at. Kruse GR, Lykken JM, Kim EJ, Haas JS, Higashi RT, Atlas SJ, McCarthy AM, Tiro JA, Silver MI, Skinner CS, Kamineni A. JNCI Cancer Spectr. management from one that is based on specific test results to one that is based on a patient's risk will allow for ScreeningCervical cancer screening and abnormal result management recommendations for immunocompromised individuals without HIV use the guidelines developed for people living with HIV144: Cytology only screening should begin within 1 year of first insertional sexual activity Continue cytology only annually for 3 years Continue every 3 years (cytology only) until the age of 30 years Cytology alone or cotesting every 3 years after the age of 30 years for the patient's lifetime.Management of Abnormal ResultsIn immunocompromised patients of any age, colposcopy referral is recommended for all results of HPV-positive ASC-US or higher. A study of partial human papillomavirus genotyping in support of Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. International Agency for Research on Cancer - Screening Group, Wright TC, Cox JT, Massad LS, et al. Copyright 2021 by the American Academy of Family Physicians. The .gov means its official. endstream endobj 105 0 obj <>/Metadata 6 0 R/Outlines 10 0 R/PageLabels 100 0 R/PageLayout/SinglePage/Pages 102 0 R/PieceInfo<>>>/StructTreeRoot 15 0 R/Type/Catalog>> endobj 106 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 90/StructParents 0/Type/Page/VP[<>]/D[<>]/R(1:1)/Subtype/RL/X[<. Cotesting: this term refers to screening or surveillance performed with both cytology and HPV testing. This site needs JavaScript to work properly. The https:// ensures that you are connecting to the Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. Clipboard, Search History, and several other advanced features are temporarily unavailable. The Steering Committee, Working Group members, and additional contributing authors for the ASCCP Risk Based the 2019 ASCCP risk-based management consensus guidelines. A Pap test looks for abnormal cells. 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. Expedited treatment: this term means treatment without confirmatory colposcopic biopsy (e.g., see and The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. See this image and copyright information in PMC. Use of condoms and dental dams may decrease spread of the virus. Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based endstream endobj startxref is an advisory board member of Merck and GSK. Risk tables have been generated to assist the clinician and guide practice. Disclaimer. Federal government websites often end in .gov or .mil. cancer screening tests and cancer precursors. a reflex HPV test. Updated United States consensus guidelines for management of cervical screening abnormalities are needed to cotesting with HPV testing and cervical cytology, and cervical cytology alone. 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 . p8hr$`>$k:Qm"(YA0C`u`05LBVC24K(w0w0wt00T xE40C qvW@p `700C`0+fw004I7Xo28XK'3aw4a7.2t1lepa1k1n Epub 2020 May 23. TRICIN: A Phase II Trial on the Efficacy of Topical TRIchloroacetic Acid in Patients with Cervical Intraepithelial Neoplasia.

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