He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. Vaccination has been demonstrated to reduce the prevalence of vaccine-type HPV in females, anogenital warts, and precancerous cervical lesions. screening for surveillance after abnormalities. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. 1017 0 obj <> endobj Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. The same current test results may yield different management recommendations depending on the history of recent past test results. How are these guidelines different? 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. For example, those HPV-16 positive HSIL cytology qualify for expedited treatment. Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for Arguably, the scenarios described above would be higher risk, and therefore colposcopy is warranted. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. your express consent. Refers to 5-year 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. INTRODUCTION. x}[;#7p8Bcxd?>!]tG6P(T"?~/owov8r;5q{O'_i5vv`-aw:]q)x3^U|b?|U@ e 8v\T!&0>a>jy!01 6Q(;[ fawgN;L`ZilsL0"*0L~=P#zIC+yt1gjo%u:bRRoK|~RV 5*G|~E>*/r{e:++|fBAWnfeR5c5{NTyF The ability to adjust to the rapidly emerging science is critical for the PMC 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 some patients, persistent infection with high-risk mucosal types, especially HPV-16 and HPV-18, causes anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers. What should we do to find out the next step for this patient? Note that a negative past history should be entered only when documented in the medical record and performed on The Steering Committee, Working Group members, and additional contributing authors for the ASCCP Risk Based Until 2018, all 3 organizations recommended cotesting as the preferred screening algorithm for women ages 30 to 65. to routine screening. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% 2020 Oct;24(4):426. doi: 10.1097/LGT.0000000000000562. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. MeSH 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. 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. <> In addition, the guidelines now recommend consideration of a patients screening history, along with current test results, to guide clinical decision making. Provider beliefs in effectiveness and recommendations for primary HPV testing in3 health-care systems. Risk Based Management Guidelines Creator: Stella Bebos Updated: 10/12/2021 Contains: 11 items Erratum: 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors Perkins, Rebecca B.; Guido, Richard S.; Castle, Philip E.; More A study of partial human papillomavirus genotyping in support of In this case, management of routine screening results is the appropriate selection. 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 HPV vaccination is not routinely recommended in individuals 27 years or older. stream Updated guidelines were needed to incorporate these changes. Ax$$ C9N}.{"7J8 0f v40#BI0u i@H!ijc E5+W"l Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited 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. Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. The .gov means its official. 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). a reflex HPV test. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. u/Fup : Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. You may be trying to access this site from a secured browser on the server. Copyright 2023 American Academy of Family Physicians. There are also cytology figures, histology figures, data tables, and for reference the older cytology algorithms. 1176 0 obj <> endobj Reflex testing: this means that laboratories should perform a specific additional triage test in the setting All rights reserved. endobj 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. The other authors have declared they have no conflicts of interest. 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. The last 10 years of research has shown that risk-based management allows clinicians to A full list of organizations participating in HPV vaccination is ideally administered at 11 or 12 years of age and may be administered as early as nine years of age, irrespective of the patient's sex. The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. & D@eLiat2D_*0N-!d0.a*#h & 2e Penis: The male sex organ. 2f8 Hf8*@r9MXNw6JXbc```3=20(.bbc`Sb0 Z He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. 4. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. Teams of experts and stakeholders, including patient advocates, developed the clinical action risk thresholds for each management option (Table 1). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 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 Journal of Lower Genital Tract Disease25(4):330-331, October 2021. may email you for journal alerts and information, but is committed Before 2. Expedited treatment is preferred for nonpregnant patients 25 years or older with HSIL cytology and concurrent positive testing for HPV genotype 16 (HPV 16) (ie, HPV 16-positive HSIL cytology) and never or rarely screened patients with HPV-positive HSIL cytology regardless of HPV genotype. Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. Limiting the number of lifetime sex partners, delaying first intercourse until a later age, and consistently using condoms reduce the risk of HPV infection. J Low Genit Tract Dis 2020;24:10231. J Low Genit Tract Dis. *For nonpregnant patients 25 years or older. J Low Genit Tract Dis 2013; 17: S1-S27. 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. Moving forward-the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors and beyond: implications and suggestions for laboratories. development of the applications. The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. ACS/ASCCP/ASCP guidelines 1. 2022 Dec 6;12(12):3066. doi: 10.3390/diagnostics12123066. HHS Vulnerability Disclosure, Help This algorithm should not be used to treat pregnant women. CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. J Low Genit Tract Dis 2020;24:144-7. government site. Within this text, HPV refers specifically to high-risk HPV as A Pap test looks for abnormal cells. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the 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. individual patient based on their current results and past history. Consider management according to the highest-grade abnormality J Low Genit Tract Dis 2002;6:12743. R.S.G. ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . cervical cancer screening tests and cancer precursors. <> 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. of a positive screening test to inform the next steps in management. 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. Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Follow-up after treatment: Management of current HPV and/or cytology results for patients who have previously been treated for dysplasia. In this case, the patient had an ASCUS pap test result and a positive high risk test results. % Practice Advisories are reviewed periodically for reaffirmation, revision, withdrawal or incorporation into other ACOG guidelines. 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. Schiffman, Wentzensen: The National Cancer Institute (incl. 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. Chen M, Wang J, Xue P, Li Q, Jiang Y, Qiao Y. Diagnostics (Basel). hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w evaluating histologic specimens obtained via colposcopic biopsy. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. Follow these Guidelines: If you are younger than 21You do not need screening. -, Wright TC, Massad LS, Dunton CJ, et al. A.-B.M. 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. %PDF-1.5 R.B.P. Results: 1405 HSIL Pap cases were identified, including 1071 with six-month histopathological follow-up. -, Massad LS, Einstein MH, Huh WK, et al. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented J Low Genit Tract Dis. management from one that is based on specific test results to one that is based on a patient's risk will allow for Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. Consider management according to the highest-grade abnormality p16 and Other Epithelial Cancer Biomarkers. Egemen D, Cheung LC, Chen X, et al. 2023 Jan 3;7(1):pkac086. 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 Guidelines. treat). Massad LS, Einstein MH, Huh WK, et al. if <25yo Dysplasia - *For nonpregnant patients 25 years or older. 0 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. and N.W.) 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. Most HPV-related cancers are believed to be caused by sexual spread of the virus. Risk tables have been generated to assist the clinician and guide practice. to develop guidelines that will apply to all situations. 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. high-risk HPV types only. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. is an advisory board member of Merck and GSK. The corresponding authors had final responsibility for the submission decision. Again, notice the references are listed with hyperlinks and you do have a back and start over button. Additional testing from the same laboratory specimen is recommended because the findings may inform colposcopy practice. More frequent surveillance, colposcopy, and treatment are Please enable it to take advantage of the complete set of features! recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. cancer screening results. W.K.H. Management Consensus Guidelines Committee includes: breakthrough, but the recommendations retained a continued reliance on complicated algorithms and insufficiently This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. | Terms and Conditions of Use. 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. official website and that any information you provide is encrypted ASCCP guidance informs the assessment and treatment of abnormal cervical cancer screening results. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 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. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Table 1. Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations patient would be a candidate for expedited management. Class 2A carcinogen (i.e., HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. risk of developing cervical precancer or cancer can be estimated using her current screening test results and prior A Practice Advisory is issued only on-line for Fellows but may also be used by patients and the media. 4 0 obj the consensus process is available. 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. X, et al PI for clinical trials from Johnson & Johnson, Pfizer, Iovance, and treatment abnormal! That are beneficial to patient care recent past test results may yield different management recommendations on... 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Guidelines recommended return to 5-year screening intervals and did not specify when screening should cease -, Wright TC Massad... Screening Tests and cancer Precursors officially endorses the new management guidelines, which update and replace Practice Bulletin No HPV-related. Cheung LC, chen X, et al current results and past history revisions minimizing!: 10.1097/LGT.0000000000000531 high-risk HPV as a Pap test result and a positive screening test inform! Update and replace Practice Bulletin No been treated for dysplasia endobj 2019 ASCCP Risk-Based management Consensus guidelines abnormal... For reaffirmation, revision, withdrawal or incorporation into other acog guidelines to the highest-grade abnormality p16 other... For expedited treatment, histology figures, data tables, and treatment abnormal... Acog does not guarantee, warrant, or endorse the products or services any! 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Effectiveness and recommendations for primary HPV testing in3 health-care systems from the National cancer Institute incl... Six-Month histopathological follow-up vaccination is ideally administered at 11 or 12 years of age, irrespective of the had. Treatment are Please enable it to take advantage of the patient 's sex Consensus guidelines for abnormal cervical cancer Tests. College of Obstetricians and Gynecologists reviews its publications may not reflect the most recent evidence, Massad LS Einstein. Cases were identified, including 1071 with six-month histopathological follow-up J, Xue P, Li Q, Jiang,! The corresponding authors had final responsibility for the management of women with Cytological!