Managing abnormal results on cervical cancer screening: ASCCP updated guidelines
Replacing guidelines for managing women with abnormal results on cervical cancer screening test from 2012, new recommendations from ASCCP emphasize more precise management based on estimates of the patient's risk - enabling more personalized recommendations for diagnosis, treatment, and follow-up. The revised guidelines with updated recommendations are now available in the Journal of Lower Genital Tract Disease (JLGTD), official journal of ASCCP. The journal is published in the Lippincott portfolio by Wolters Kluwer.
The 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors were published in JLGTD on April 2, 2020. The recommendations reflect advances in understanding of the multiple factors affecting a woman's risk of developing cervical cancer or precancer. Rebecca Perkins, MD, of Boston University School of Medicine and Richard Guido, MD, of University of Pittsburgh are lead authors of the revised Guideline documents.
Focus on 'More Complete and Precise' Management Based on Risk Estimates in Women with Cervical Screening Abnormalities
The three available strategies for cervical cancer screening are primary HPV screening, co-testing with HPV testing and cervical cytology (Papanicolaou test), and cervical cytology alone. The 2012 Guidelines were an important step forward, based on the principle of "equal management for equal risk."
Developed by a consensus of 19 professional societies, federal agencies, and patient advocacy groups, convened by ASCCP, the new update "further aligns management recommendations with current understanding of HPV natural history and cervical carcinogenesis [cancer development]." Objectives of the 2019 ASCCP Risk-Based Management Consensus Guidelines include:
Allowing for immediate and five-year personal risk estimation for the patient. Drs. Perkins and Guido and coauthors write, "New data indicate that a patient's risk of developing cervical precancer or cancer can be estimated using current screening test results and prior screening test and biopsy results," along with data on age and other personal factors. The revised recommendations incorporate recent evidence showing that patients with previous abnormal cervical screening results require more frequent screening.
Providing more appropriate intervention for high-risk individuals. The new 2019 risk-based guidelines call for more frequent follow-up, colposcopy/biopsy, and treatment for patients with higher individualized risk estimates of developing more advanced precancers or cervical cancer.
Recommending less intervention for low-risk individuals in order to decrease testing and treatment that won't prevent cancer and may cause reproductive harm. The new 2019 risk-based guidelines build on recent evidence showing that patients with lower-risk characteristic need less frequent-follow-up, and in some cases can take a 'wait-and-see' approach rather than undergoing immediate colposcopy/biopsy in some cases.
Allowing for the future addition of new screening and management technologies, and risk modifiers (such as HPV vaccination status). These changes reflect the rapidly evolving field of cervical cancer prevention and changes in population risk as more HPV-vaccinated women reaching screening age.
Recognizing that the new guidelines bring together an abundance of data, ASCCP has launched a brand new app, and soon a website, to streamline the navigation of the new 2019 risk-based guidelines. These computer resources greatly simplify what would otherwise be a very complex system. More information on this technology can be found at http://www.asccp.org.
"The revised Guidelines provide a framework for incorporating new data and technologies as ongoing incremental recommendation revisions, minimizing time to implement changes that are beneficial to patient care," Drs. Perkins and Guido and colleagues conclude. They plan future studies to assess the costs, benefits, and effectiveness of the updated recommendations, along with a guideline dissemination strategy "to create a new national standard-of-care for management of abnormal cervical cancer screening test results."
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