Before 5) The confirmation pageensures that all the information was entered correctly. Colposcopic examination confirming CIN1 or less within 1 year. J Am Soc Cytopathol. Disclaimer. J Low Genit Tract Dis 2020;24:10231. determine a patient's care. 1. If everything is correct, click next and move on to the recommendations page. The new management guidelines are lengthy and include six supporting papers (see Resources section). patient's risk of progressing to precancer or cancer. %PDF-1.5 Xiaojian Chen MS; Li Cheung PhD; Kim Choma, DNP; Megan Clarke, PhD; Christine Conageski, MD; Miriam Cremer, MD, MPH; Guidelines are to increase accuracy and reduce complexity for providers and patients. Smoking and alcohol cessation should be recommended to reduce the risk of HPV persistence and the development of HPV-related malignancies. J Low Genit Tract Dis 2020;24:144-7. high-risk HPV types only. www.acog.org, American College of Obstetricians and Gynecologists through a program of screening and management of cervical precancer, no screening or treatment modality is 100% 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. Refers to immediate CIN 3+ risk. hb```^6.EAd`0pHH)zeoP4T``rI< lJBUc.0S0w"I)Wz~(qLl~@`;c By using the app, you agree to the Terms of Use and Privacy Policy. Deborah Arrindell; Pelin Batur, MD; Alicia Carter, MD; Patty Cason, MS, FNP; Philip Castle, PhD; David Chelmow, MD; Please try reloading page. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk. Funding for these activities is for the research related costs of the trials. and transmitted securely. 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. The 2012 guidelines recommended return to 5-year screening intervals and did not specify when screening should cease. An Introduction to the 2019 ASCCP Risk-Based Management Consensus Guidelines. Guidelines. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. Algorithms and/or risk estimates are shown when available. Box 1. It is also important to recognize that these guidelines should never substitute for clinical judgment. Vaccination has been demonstrated to reduce the prevalence of vaccine-type HPV in females, anogenital warts, and precancerous cervical lesions. Surveillance: this term refers to repeat testing (HPV primary screening, cotesting, or cytology alone), that Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. Screening recommended every 3 years for women 21-29. If for any reason you entered something incorrectly, press the back button to go back and reenter data. 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 Most HPV-related cancers are believed to be caused by sexual spread of the virus. For all cytology results of LSIL or worse (including ASC-H, AGC, AIS, and HSIL), referral to colposcopy is recommended regardless of HPV test result if done.Perkins RB, Guido RS, Castle PE, et al. development of the applications. only to patients without risk factors. The 2012 consensus guidelines were the first to be based on the principle of equal management for equal risk, Read terms. | Terms and Conditions of Use. See this image and copyright information in PMC. OR low risk women 30 and above may go every 3 years if Pap only; or 5 years if . 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 https://cervixca.nlm.nih.gov/RiskTables/ supported travel for their participating representatives. Data is temporarily unavailable. 140, Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. 4 0 obj Ax$$ C9N}.{"7J8 0f v40#BI0u i@H!ijc E5+W"l Therefore, we click no for prior history and click next. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. cancer screening results. 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. Pap-HPV cotesting is performed every 5 years in women older than 30 with past normal screening. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; stream 3. Follow-up after treatment: Management of current HPV and/or cytology results for patients who have previously been treated for dysplasia. HHS Vulnerability Disclosure, Help Immediate, unlimited access to all AFP content, Immediate, unlimited access to this issue's content, Immediate, unlimited access to just this article. Clipboard, Search History, and several other advanced features are temporarily unavailable. Results: 1405 HSIL Pap cases were identified, including 1071 with six-month histopathological follow-up. New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. 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. 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. % Bethesda, MD 20894, Web Policies 5. 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. endobj endobj The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. Human Papillomavirus (HPV) Vaccine Guidelines The American Cancer Society recommends HPV vaccination for boys and girls between ages 9 and 12. Scenario #2 A 26 year old patient. Use of condoms and dental dams may decrease spread of the virus. /+=jYOu3jz;?oVX'm6HtW|`k* 2f8 Hf8*@r9MXNw6JXbc```3=20(.bbc`Sb0 Z Updated guidelines published in October 2007 place greater emphasis on testing for high-risk human papillomavirus (HPV). Please contact [emailprotected] with any questions. Disclosure of Financial Support: The guidelines effort received support from the National Cancer Institute and ASCCP. official website and that any information you provide is encrypted Class 2A carcinogen (i.e., HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68). Accessibility J Low Genit Tract Dis 2020;24:13243. A Practice Advisory is issued when information on an emergent clinical issue (e.g. 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%. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. 2023 Jan 16;11(1):225. doi: 10.3390/biomedicines11010225. 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. 2. J Low Genit Tract Dis. 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). defined risk thresholds to guide management are designed to continue functioning appropriately when population-level 1017 0 obj <> endobj Clinical judgment should always be used when applying a guideline to an individual patient because it is impossible Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Table 1. Updated guidelines were needed to incorporate these changes. Colposcopy is also recommended if a patient has 2 consecutive HPV positive results and an exact risk estimate is not available. J Low Genit Tract Dis 2020;24:132-43. 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. -, Massad LS, Einstein MH, Huh WK, et al. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. The https:// ensures that you are connecting to the 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. 2020 Oct;24(4):427. doi: 10.1097/LGT.0000000000000563. 6) The last screen shows the guidelines information for this patient. Risk estimation will use technology, such as a smartphone application or website. 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. Excisional treatment: this term includes procedures that remove the transformation zone and produce a 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. 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). 21 to 29 years of age *. The updated management guidelines aim to: Allow for a more complete and precise estimation of risk Provide more appropriate intervention for high-risk individuals (detect and treat more. the 2019 ASCCP risk-based management consensus guidelines. -. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 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. that incorporation of the risk-based approach can provide more appropriate and personalized management for an With more than 200 types identified, human papillomavirus (HPV) commonly causes infections of the skin and mucosa. and patient advocates, convened by ASCCP; they are designed to safely triage individuals with abnormal cervical Perkins RB, Guido RS, Castle PE, et al. stream The CIN 3+ risks estimates were calculated based on data from a prospective longitudinal cohort of patients from Kaiser Permanente Northern California and validated using several other data sets. In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 is acceptable. Follow these Guidelines: If you are younger than 21You do not need screening. -, Huh WK, Ault KA, Chelmow D, et al. which test combinations yielded this risk level. 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. 3. The goals of the ASCCP Risk-Based Management Consensus management from one that is based on specific test results to one that is based on a patient's risk will allow for Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert occurs at shorter intervals than those recommended for routine screening. government site. The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited With a more nuanced understanding of how prior results affect risk, and more 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. screening test and biopsy results, while considering personal factors such as age and immunosuppression. Copyright 2021 by the American Academy of Family Physicians. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; PMC Perkins RB, Guido RS, Castle PE, et al. a reflex HPV test. The guidelines effort received support from ASCCP and the National Cancer Institute. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited The site is secure. The same current test results may yield different management recommendations depending on the history of recent past test results. Conflict of interest: The following listed authors have no conflicts of interest to disclose: Drs. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. Schiffman, Wentzensen: The National Cancer Institute (incl. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental HPV vaccination is not routinely recommended in individuals 27 years or older. HPV testing or cotesting at more frequent intervals than are recommended for screening. 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. Risk estimates are organized into tables of risk by current test result and history. Available at: ASCCP management guidelines app quick start guide. 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: Erratum. 4. Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV sharing sensitive information, make sure youre on a federal Essential Changes From Prior Management Guidelines. cotesting at intervals <5 years, or cytology alone at intervals <3 years. The other authors have declared they have no conflicts of interest. 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. 132 0 obj <>stream 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. 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