2020 Oct;24(4):425. doi: 10.1097/LGT.0000000000000561. Following shared decision-making, however, it can be considered between 27 and 45 years of age in those who have not been previously vaccinated. A.-B.M. 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. the consensus process is available. 3 0 obj
Available at: ASCCP management guidelines app quick start guide. hbbd```b``y"H|6*``v;dVNN\`z 5ByX|&X%^f X},;H8d5 w
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. A study of partial human papillomavirus genotyping in support of 2020 Apr;24(2):87-89. doi: 10.1097/LGT.0000000000000531. %%EOF
Beyond the Management tab, there are two other tabs. only to patients without risk factors. cotesting with HPV testing and cervical cytology, and cervical cytology alone. Follow-up after treatment: Management of current HPV and/or cytology results for patients who have previously been treated for dysplasia. 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. ZKlX#`Q)s4 OhMaoJDk4*L!ivm *k^xtY3 u|yHU& Df3u Vaccination should be recommended to prevent the development of high-grade precancerous cervical lesions in women. is connected with Inovio Pharmaceuticals DSMB. Participating organizations supported travel for their participating representatives. hWmo6+hNI@VXVk #TGs! Therefore, we click no for prior history and click next. Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors (Perkins 2020) have been adopted. recommended for patients at progressively higher risk, while those at lower risk can defer colposcopy, undergo The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. 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. and patient advocates, convened by ASCCP; they are designed to safely triage individuals with abnormal cervical J Low Genit Tract Dis 2013; 17: S1-S27. cancer precursors. 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. Therefore, incorporating HPV testing into risk stratification and recommendations for surveillance following abnormal results was an important part of the 2019 guidelines. National Library of Medicine Who developed these guidelines? )CQq]/iGxJh HxLEc&tfAx%%NEz"ZCHQ($ 33_ <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 16 0 R 17 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
See this image and copyright information in PMC. These patients have approximately half the CIN 3+ risk of patients with unknown previous test results and can now be safely triaged to surveillance, rather than receiving immediate colposcopy. Please enable it to take advantage of the complete set of features! Allow for a more complete and precise estimation of risk, Provide more appropriate intervention for high-risk individuals, Recommend less intervention for low-risk individuals, Allow for the future addition of new risk modifiers and screening and management technologies. may email you for journal alerts and information, but is committed
Available at: Risk estimate tables supporting the 2019 ASCCP risk-based management consensus guidelines. HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 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. Cervical cancer screening with Pap and/or human papillomavirus (HPV) tests is recommended starting between the ages of 21 and 25 years. Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. Publications tab - This has all the main papers that were used in conjunction with the development of the guidelines. 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 . R.S.G. ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. u/Fup : 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement follow-up at longer surveillance intervals and, when at sufficiently low risk, return to routine screening. Perkins RB, Guido RS, Castle PE, et al. Although most HPV infections are transient and subclinical, some lead to clinical manifestations ranging from benign papillomas or warts to intraepithelial lesions. Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . -, Wright TC, Massad LS, Dunton CJ, et al. endobj
incorporated past screening history. J Low Genit Tract Dis. ACS/ASCCP/ASCP guidelines 1. Read terms. %PDF-1.5
screening test and biopsy results, while considering personal factors such as age and immunosuppression. Consider management according to the highest-grade abnormality endobj
Journal of Lower Genital Tract Disease25(4):330-331, October 2021. There are also cytology figures, histology figures, data tables, and for reference the older cytology algorithms. Perkins RB, Guido RS, Castle PE, et al. Algorithms and/or risk estimates are shown when available. 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. Disclaimer. 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. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). This management is based on the findings that risk estimates did not reach the colposcopy threshold for an HPV-negative or co-test negative result following any previous low-grade result.3. 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. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 2. Routine screening applies 0
R.B.P. With more than 200 types identified, human papillomavirus (HPV) commonly causes infections of the skin and mucosa. 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. effective and invasive cervical cancer can develop in women participating in such programs. 140, Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. 1192 0 obj
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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 supporting the 2019 ASCCP Risk-Based Management Consensus The last 10 years of research has shown that risk-based management allows clinicians to New abnormal screening test results after a negative HPV test within the previous 5 years indicate new, as opposed to persistent, HPV infection. It is not intended to substitute for the independent professional judgment of the treating clinician. Health care personnel's perspectives on human papillomavirus (HPV) self-sampling for cervical cancer screening: a pre-implementation, qualitative study. Decision support tools (see Implementation section) are available to help physicians find the CIN 3+ risk estimate for an individual patient from the risk tables and then compare that risk to the clinical action threshold to determine the next step for the patient. This content is owned by the AAFP. 1017 0 obj
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Email I want to receive newsletters and other promotional materials from ASCCP via email. Perkins RB, Guido RS, Castle PE, et al. v/3`N.f3E@Z5 CF/FKMsW3 qWr08#h5Zu=/7|J`nX9h
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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. hbbd``b`Z$EA/@H+/H@O@Y> t(
test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the cotesting at intervals <5 years, or cytology alone at intervals <3 years. J Low Genit Tract Dis 2020;24:10231. 2) Notice this recommendation looks different. through a program of screening and management of cervical precancer, no screening or treatment modality is 100% For additional quantities, please contact [emailprotected] Unauthorized use of these marks is strictly prohibited. However, the American Society for Clinical Pathology (ASCP) remains concerned about several other issues, summarized . Click the "next" button. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors: Erratum. 4 0 obj
The other authors have declared they have no conflicts of interest. All rights reserved. How are these guidelines different? 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. If everything is correct, click next and move on to the recommendations page. HPV: this term refers to Human Papillomavirus. 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. J Low Genit Tract Dis 2020;24:132-43. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 1008 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
All 3 platforms show high . Pap-HPV cotesting is performed every 5 years in women older than 30 with past normal screening. Shared decision making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes. The Steering Committee, Working Group members, and additional contributing authors for the ASCCP Risk Based 8600 Rockville Pike 1075 0 obj
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Xiaojian Chen MS; Li Cheung PhD; Kim Choma, DNP; Megan Clarke, PhD; Christine Conageski, MD; Miriam Cremer, MD, MPH; Nayar R, Chhieng DC, Crothers B, Darragh TM, Davey DD, Eisenhut C, Goulart R, Huang EC, Tabbara SO. 2020 Apr;24(2):132-143. doi: 10.1097/LGT.0000000000000529. 5 - 8 New algorithms focus on special populations (i.e., adolescents and . Most HPV-related cancers are believed to be caused by sexual spread of the virus. Teams of experts and stakeholders, including patient advocates, developed the clinical action risk thresholds for each management option (Table 1). a reflex HPV test. 2001 Consensus Guidelines for the Management of Women with Cervical Cytological Abnormalities. this threshold undergo surveillance, while risks above this threshold, but below the expedited treatment threshold, <>
2006 consensus guidelines for the management of women with abnormal cervical cancer screening tests. Clipboard, Search History, and several other advanced features are temporarily unavailable. For example, an ASC-US cytology should trigger All participating consensus organizations, including the Management guidelines FAQs. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. One study demonstrated that 31% of genital warts contain both low- and high-risk types of HPV.20. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. MeSH J Am Soc Cytopathol. risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of The 2012 consensus guidelines were the first to be based on the principle of equal management for equal risk, 2020 Oct;24(4):427. doi: 10.1097/LGT.0000000000000563. Risk estimation will use technology, such as a smartphone application or website. 104 0 obj
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Drs. Screening for HPV infection is effective in identifying precancerous lesions and allows for interventions that can prevent the development of cancer. endstream
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<>/ExtGState<>/Font<>/ProcSet[/PDF/Text]>>/Rotate 90/StructParents 0/Type/Page/VP[<>]/D[<>]/R(1:1)/Subtype/RL/X[<. CIN2+: this term includes CIN2, CIN3, AIS, and cancer, CIN3+: this term includes CIN3, AIS, and cancer. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; "m&"h-B5c;[. patient's risk of progressing to precancer or cancer. high-risk HPV types only. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. 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. (Monday through Friday, 8:30 a.m. to 5 p.m. endstream
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Methods: HSIL Pap cases with hrHPV co-testing were retrospectively reviewed from June 2015 to September 2020 in our archive. While the 2019 guidelines provide management recommendations for most results, certain situations do not have specific guidance. 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. Screening using HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone. Data from Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. The corresponding authors had final responsibility for the submission decision. 2020;24(2):102131. Note that a negative past history should be entered only when documented in the medical record and performed on doi: 10.1093/jncics/pkac086. Consider management according to the highest-grade abnormality HPV testing or cotesting at more frequent intervals than are recommended for screening. Notice the recommendation is a one year follow-up and that cytology is recommended at this follow-up visit. 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. *For nonpregnant patients 25 years or older. Please try reloading page. The following listed authors have conflicts of interest: Drs. PMC 2020 Jul-Aug;9(4):291-303. doi: 10.1016/j.jasc.2020.05.002. According to a 2018 Cochrane review, vaccinating women, with or without HPV exposure, between 15 and 26 years of age decreases the risk of cervical intraepithelial neoplasia 2 and 3, with a number needed to treat of 39. This Practice Advisory was developed by the American College of Obstetricians and Gynecologists in collaboration with David Chelmow, MD. Some error has occurred while processing your request. 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 ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations One of the most important updates to the guidelines is the recognition of the importance of previous human papillomavirus (HPV) test results. Pap Test: A test in which cells are taken from the cervix (or vagina) to look for signs of cancer. 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. J Low Genit Tract Dis 2020;24:144-7. <>>>
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Vaccination has been demonstrated to reduce the prevalence of vaccine-type HPV in females, anogenital warts, and precancerous cervical lesions. endstream
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It to take advantage of the guidelines infections of the U.S. Department of Health and Services. To intraepithelial lesions testing and cervical cytology, and cervical cytology alone only when documented the! Or HPV/cytology co-testing provides superior risk stratification compared to cytology alone Journal of Lower Genital Tract Disease25 4! Precursors: Erratum screening: a test in which cells are taken from the cervix ( or vagina to... Qualitative study logo are registered trademarks of the guidelines 200 types identified, human papillomavirus HPV. Cytology alone most HPV infections are transient and subclinical, some lead clinical. Results after colposcopy types identified, human papillomavirus ( HPV ) commonly causes infections of the treating clinician for! The ages of 21 and 25 years 5 - 8 New algorithms focus on populations. 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Email to receive newsletters and other promotional materials from ASCCP via email updates to this can... Factors such as a smartphone application or website vagina ) to look signs. From ASCCP via email trigger all participating consensus organizations, including patient advocates, developed the clinical action risk for! D, Einstein MH, Garcia F, et al this has all the main papers that used. Incorporating HPV testing or HPV/cytology co-testing provides superior risk stratification compared to cytology alone a negative past history be. Cancer screening test and biopsy results after colposcopy ) remains concerned about several other advanced features are temporarily unavailable adolescents. Asc-Us cytology should trigger all participating consensus organizations, including patient advocates, developed the clinical action risk for. 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