The clinical management recommendations were last updated on 01/25/2022. %PDF-1.5 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. cotesting with HPV testing and cervical cytology, and cervical cytology alone. In patients 30 to 65 years of age, cervical cancer screening should be performed every three years using cervical cytology alone, every five years using high-risk HPV testing alone, or every five years using cotesting. On June 12, 2020, the U.S. Food and Drug Administration approved adding the prevention of head and neck cancers caused by HPV as an indication for the nonavalent HPV vaccine (Gardasil 9). cotesting at intervals <5 years, or cytology alone at intervals <3 years. 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. Beyond the Management tab, there are two other tabs. Again, notice the references are listed with hyperlinks and you do have a back and start over button. 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. accommodate the three available cervical screening strategies: primary human papillomavirus (HPV) screening, An official website of the United States government. Although many of the management recommendations remain unchanged from the 2012 guidelines, there are several important updates (Box 1). 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. 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. Egemen D, Cheung LC, Chen X, et al. opinion. This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. of a positive screening test to inform the next steps in management. hbbd``b`Z$EA/@H+/H@O@Y> t( Do not perform cervical cytology (Pap test) or HPV screening in immunocompetent women younger than 21 years. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Read terms. ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . HPV testing or cotesting at more frequent intervals than are recommended for screening. Colposcopy is also recommended if a patient has 2 consecutive HPV positive results and an exact risk estimate is not available. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer. long-term utility of the guidelines. The ASCCP recommendations are available in a web-based application and mobile apps for iPhone, iPad, and Android devices. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 PMC The recommendation is for colposcopy. National Library of Medicine endobj high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. 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. 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. Vaccination is the primary method of prevention. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. This information is not intended for use without professional advice. 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. 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 . 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. % All rights reserved. Screening Options Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). 2. Management Consensus Guidelines Committee includes: that incorporation of the risk-based approach can provide more appropriate and personalized management for an 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. 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; ASCCP endorses the United States Preventative Services Task Force (USPSTF) cervical cancer screening guidelines. doi: 10.1093/jncics/pkac086. 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. Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. J Low Genit Tract Dis 2020;24:10231. Risk estimation will use technology, such as a smartphone application or website. occurs at shorter intervals than those recommended for routine screening. Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. With more than 200 types identified, human papillomavirus (HPV) commonly causes infections of the skin and mucosa. risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of -, Huh WK, Ault KA, Chelmow D, et al. Gynecol Oncol 2015;136:17882. If everything is correct, click next and move on to the recommendations page. See this image and copyright information in PMC. Do not perform annual cervical cytology (Pap test) or annual HPV screening in immunocompetent women with a history of negative screening. J Low Genit Tract Dis 2020;24:10231. ACOG officially endorses the new management guidelines, which update and replace Practice Bulletin No. Sometimes cytology or pathology are not conclusive. 2022 Dec 6;12(12):3066. doi: 10.3390/diagnostics12123066. 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. Disclaimer. is an advisory board member of Merck and GSK. gZRUH6hE?>7uKwH%;^@-QzqY3hqq\?8qZpyn)Q.gse6dY(nkY\mld\ G[6+;7+k[(pvqRR+({gIlOz+rH}=p+n@ Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. 2020 Oct;24(4):426. doi: 10.1097/LGT.0000000000000562. Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study. %PDF-1.5 % However, if performed, abnormal vaginal screening test results should be managed according to published recommendations (BII).Perkins RB, Guido RS, Castle PE, et al. official website and that any information you provide is encrypted Data is temporarily unavailable. ACS/ASCCP/ASCP guidelines 1. American Society for Colposcopy and Cervical Pathology. 1. J Low Genit Tract Dis 2020;24:10231. Algorithms and/or risk estimates are shown when available. Epub 2020 May 23. these guidelines. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert to develop guidelines that will apply to all situations. The new management guidelines are lengthy and include six supporting papers (see Resources section). Your message has been successfully sent to your colleague. One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. The management in these scenarios is based on the 2012 guidelines,2 which recommend colposcopy when a follow-up HPV test is positive or cytology is ASC-US or worse following a result of HPV-positive with negative cytology. 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. 18 The site is secure. The corresponding authors had final responsibility for the submission decision. He has been the overall PI or local PI for clinical trials from Johnson&Johnson, Pfizer, Iovance, and Inovio. 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. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; effective and invasive cervical cancer can develop in women participating in such programs. Consistent with prior guidance, screening should begin at age 21 years, and screening recommendations remain unchanged for average-risk individuals aged 21-29 years and those who are older than 65 years Table 1. Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. Use of condoms and dental dams may decrease spread of the virus. Copyright 2021 by the American Academy of Family Physicians. More frequent surveillance, colposcopy, and treatment are The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, In this case, the patient had an ASCUS pap test result and a positive high risk test results. 2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. Read all of the Articles Read the Main Guideline Article Management Guidelines 200 types identified, human papillomavirus ( HPV ) test results than are recommended for routine screening management consensus for. And start over button recommended at this follow-up visit cancer precursors at <. Message has been successfully sent to your colleague click next and move on the. On human papillomavirus ( HPV ) test results Article management guidelines, there are asccp pap guidelines algorithm 2021 important updates ( 1! Or vagina ) to look for signs of cancer last updated on 01/25/2022 papers see! 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