The new management guidelines are lengthy and include six supporting papers (see Resources section). better identify which patients will likely go on to develop pre-cancer and which patients may be indicated to return A Pap test looks for abnormal cells. endstream endobj startxref By reading this page you agree to ACOG's Terms and Conditions. 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 American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . 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. 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. The guidelines effort received support from ASCCP and the National Cancer Institute. 21 to 29 years of age *. _amTYC@ HPV infection is the most common sexually transmitted infection in the United States. The corresponding authors had final responsibility for the submission decision. New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus 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. Perkins RB, Guido RS, Castle PE, et al. A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. Any person with a cervix should be screened, regardless of gender identity, sexual orientation . If everything is correct, click next and move on to the recommendations page. <> development of the applications. So we enter both of them by simply touching them. The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, Furthermore, since prior test results affect risk, patients with prior abnormalities often require surveillance with -, Egemen D, Cheung LC, Chen X, et al. 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 . Risk tables have been generated to assist the clinician and guide practice. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. A Practice Advisory is issued when information on an emergent clinical issue (e.g. 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. In patients 21 to 29 years of age, cervical cancer screening should be performed every three years using cervical cytology alone. Perkins RB, Guido RS, Castle PE, et al. 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. test results in isolation, the new guidelines use current and past results to create individualized assessments of a The web-based tool is free to use. For example, HPV primary testing or Clipboard, Search History, and several other advanced features are temporarily unavailable. Squamous Intraepithelial Lesion (SIL): A term used to describe abnormal cervical cells detected by the Pap test. 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> Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. p16 and Other Epithelial Cancer Biomarkers. Li Z, Griffith CC, Yan S, Chen C, Ding X, Liang X, Yang H, Zhao C. Prior high-risk HPV testing and Pap test results for 427 invasive cervical . long-term utility of the guidelines. 2020 Apr;24(2):102-131. doi: 10.1097/LGT.0000000000000525. New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. 2012 ASCCP Consensus Guidelines Conference. 104 0 obj <> endobj 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. Guidelines. ASCCP recently released its Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors 1 . 2012 Jul;16(3):175-204. doi: 10.1097/LGT.0b013e31824ca9d5. undergo colposcopy. 2 0 obj 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, 3. 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 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. 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. 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. 2 0 obj In such cases, using the 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors2 is acceptable. M.H.E. Przybylski M, Pruski D, Millert-Kaliska S, Krzyaniak M, de Mezer M, Frydrychowicz M, Jach R, urawski J. Biomedicines. In addition, changing the paradigm of <>>> The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. Reprinted with permission from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. The ASCCP Cervical Cancer Screening Task Force Endorsement and Opinion on the American Cancer Society Updated Cervical Cancer Screening Guidelines. clinical study, scientific report, draft regulation) is released that requires an immediate or rapid response, particularly if it is anticipated that it will generate a multitude of inquiries. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; 3. Obstet Gynecol 2013;121:82946. The overarching theme of the recommendations reflects a 'risk-based' strategy, rather than rigid focus on a particular result. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. hb```o,g(v``X b n(f`$PpRME`%uA*?20FA@Z7a'(2 ^$ primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, Penis: The male sex organ. ACS/ASCCP/ASCP guidelines 1. cancer precursors. if 25yo Guideline IId. doi: 10.1093/jncics/pkac086. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% 2020 Oct;24(4):427. doi: 10.1097/LGT.0000000000000563. 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. 2012 updated consensus guidelines for the management of abnormal cervical Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for 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. Available at: Risk estimate tables supporting the 2019 ASCCP risk-based management consensus guidelines. 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. 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. Careers. Genital warts occur in 1% of sexually active adults.3 The prevalence of HPV infection peaks in the early 20s in women and in the mid-20s to early 30s in men, based on data from population registries and the National Health and Nutrition Examination Survey.9,10 A second peak occurs in postmenopausal women and older men and may be associated with a combination of new and persistent infection.1012 The average number of annual HPV-related carcinomas in the United States is summarized in eTable A. Copyright, 2002, 2006, 2013, 2019, 2020 ASCCP. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 1008 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> %PDF-1.5 The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients. To assist the clinician and guide practice 2006, 2013, 2019, ASCCP. 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