Available at: Agnor M, Prez AE, Peitzmeier SM, Borrero S. Racial/ethnic disparities in human papillomavirus vaccination initiation and completion among U.S. women in the post-Affordable Care Act era. Guidelines - ASCCP Perkins RB, Guido RS, Castle PE, et al. Erin Nelson, MD; Akiva Novetsky, MD, MS; Rebecca Perkins, MD; Jeffrey Quinlan, MD; Mona Saraiya, MD; Debbie Saslow, Inadequate cervical cancer screening remains a significant problem in the United States, with persistent health inequities across the entire spectrum of cervical cancer care 10 17 19 . Massad SL, Einstein MH, Huh WK, et al. ACS recommends cervical cancer screening with an HPV test alone every 5 years for everyone with a cervix from age 25 until age 65. the consensus process is available. You still need to have screening if you have been vaccinated against HPV. Updated Cervical Cancer Screening Guidelines | ACOG Studies have demonstrated that the KPNC population has lower rates of cervical cancer than the general US population. Reference:https://www.sciencedirect.com/science/article/pii/S2213294520300818. Bulk pricing was not found for item. Raising the screening start age to 25 years could increase the already high rate of underscreening among individuals aged 2529 years and exacerbate existing health inequities in cervical cancer screening, incidence, morbidity, and mortality 10 17 18 19 . Available at: https://www.nsgc.org/d/do/4584. 168, Cervical Cancer Screening and Prevention, as well as the 2012 ASCCP Available at: Updated Cervical Cancer Screening Guidelines, href="https://jamanetwork.com/journals/jama/fullarticle/2697704, https://academic.oup.com/ajcp/article/137/4/516/1760450, https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/10/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://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21628, : https://jamanetwork.com/journals/jama/fullarticle/2697702, https://jamanetwork.com/journals/jama/fullarticle/2697703, https://www.cdc.gov/cancer/hpv/statistics/cervical.htm, https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.30507, https://www.sciencedirect.com/science/article/abs/pii/S0027968420300432, https://gh.bmj.com/content/4/3/e001351.long, https://jamanetwork.com/journals/jamaoncology/fullarticle/2554749, https://www.cdc.gov/mmwr/volumes/70/wr/mm7012a2.htm, https://www.cdc.gov/mmwr/volumes/69/wr/mm6933a1.htm, https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08, https://www.tandfonline.com/doi/abs/10.1080/13557858.2018.1427703, https://www.liebertpub.com/doi/10.1089/jwh.2018.7380, https://www.cdc.gov/mmwr/volumes/70/wr/mm7002a1.htm, https://journals.sagepub.com/doi/10.1177/0033354920925094, https://journals.lww.com/greenjournal/Fulltext/2020/08000/Human_Papillomavirus_Vaccination__ACOG_Committee.48.aspx, Alliance for Innovation on Women's Health, Postpartum Contraceptive Access Initiative. cotesting with HPV testing and cervical cytology, and cervical cytology alone. It is also important to recognize that these guidelines should never substitute for clinical judgment. For additional quantities, please contact sales@acog.org or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 . ASCCP and the Society of Gynecologic Oncology endorse this Practice Advisory. 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. cervical cancer screening tests and cancer precursors. Data from Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. Does the patient have previous screening test results? This is an important change that is related to HPV vaccines. For example, primary HPV is a screening option for patients 25 years of age and older. Management Guidelines - ASCCP The ASCCP Risk-Based Management Consensus Guidelines represented a consensus of 19 professional organizations and patient advocates, convened by ASCCP; they are designed to safely triage individuals with abnormal cervical cancer screening results. JAMA 2018;320:70614. may email you for journal alerts and information, but is committed American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. 2012 updated consensus guidelines for the management of abnormal cervical Practice Advisory. Colposcopy Standards Recommendations - ASCCP This could prompt future changes to screening guidelines, such as raising the screening initiation age to 25 years, as is recommended in the recently updated ACS guidelines 5 . See the full list of organizations (below) that participated in the consensus process. National Society of Genetic Counselors (NSGC), November 2014. Primary hrHPV testing uses high-risk HPV testing alone (no cytology) with a test that is approved by the U.S. Food and Drug Administration (FDA) for stand-alone screening. writing of manuscript, and decision to submit for publication. 702: Female Athlete Triad (Obstet Gynecol 2017;129:e160-7) REVISED This allows him or her to get a closer look at your cervix as well as collect samples from different parts of it using swabs called cytobrushes (or Pap brushes). For a patient at the doctors office, an HPV test and a Pap test are done the same wayby collecting a sample of cervical cells with a scraper or brush. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. Available at: American College of Obstetricians and Gynecologists. Limited access to primary hrHPV testing is of particular concern in rural and under-resourced communities and among communities of color, which have disproportionately high rates of cervical cancer incidence, morbidity, and mortality 8 9 10 . Get new journal Tables of Contents sent right to your email inbox, https://www.acog.org/clinical/clinical-guidance/acog-endorsed, https://www.asccp.org/Assets/b2263c88-ec67-4ab0-9f07-6f112e76f8d7/637269576182030000/2019-asccp-risk-based-management-consensus-3-5-pdf, https://onlinelibrary.wiley.com/doi/full/10.1002/jum.14677, https://www.perinatalquality.org/Vendors/NSGC/NIPT/, https://www.nsgc.org/page/abnormal-non-invasive-prenatal-testing-results, https://www.acog.org/clinical/journals-and-publications/clinical-updates, ACOG Practice Bulletin No. the 2019 ASCCP risk-based management consensus guidelines. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); PdfKeg covers information on books available in Pdf format. Currently, there are 3 options available for cervical cancer screening: the Pap-only test, the Pap-HPV cotest, and the high-risk HPV-only test. Risk-based management allows clinicians to better identify which patients will likely go on to develop pre-cancer and which patients can return to surveillance. | Terms and Conditions of Use. Conventional cytology is reported to be 30 to 87 . One is we have amazing results from the HPV vaccine, so that continually changes the picture for screening. 117 0 obj <>/Filter/FlateDecode/ID[<2A3A72E8287AD77BE571CDCCA6D1568C><7C4167790C383844A9780EF022A9F20A>]/Index[104 29]/Info 103 0 R/Length 73/Prev 24323/Root 105 0 R/Size 133/Type/XRef/W[1 2 1]>>stream These recommendations also do not apply to individuals with in utero exposure to diethylstilbestrol or those who have a compromised immune system (eg, individuals with human immunodeficiency virus). Rather than consider Healthy People 2030. Surgical excision or destruction of cervical tissue in nulliparous adolescents may harm fertility and cervical competency. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. For example, HPV primary testing or There is high certainty that the net benefit is substantial. A Grade D definition means that, The USPSTF recommends against the service. Cryotherapy, laser therapy, and LEEP are equally effective treatments; excision has been recommended for biopsy-confirmed CIN 3. 162: Prenatal Diagnostic Testing for Genetic Disorders (Obstet Gynecol 2016;127:e10822), ACOG Practice Bulletin No. The ability to adjust to the rapidly emerging science is critical for the long-term utility of the guidelines. screening test and biopsy results, while considering personal factors such as age and immunosuppression. The ASCCP Risk-Based Management Consensus Guidelines represent a consensus of nearly 20 professional organizations Available at: https://www.asccp.org/Assets/b2263c88-ec67-4ab0-9f07-6f112e76f8d7/637269576182030000/2019-asccp-risk-based-management-consensus-3-5-pdf. This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. 178: Shoulder Dystocia (Obstet Gynecol 2017;129:e12333), ACOG Practice Bulletin No. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. ACOG Publications: February 2021 : Obstetrics & Gynecology - LWW Details of the statistical methods are described in the publication Li C., et al. They have been very active in disseminating these guidelines, via a detailed publication Moving forward the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors and beyond: implications and suggestions for laboratories and a number of presentations at national meetings and via webinars, etc in any effort to educate and encourage appropriate ordering, testing and reporting of cytology and histology that are consistent with use of validated/approved tests for screening, standardized reporting recommendations and the ASCCP management guidelines. 169: Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies (Obstet Gynecol 2016;128:e13146), ACOG Practice Bulletin No. New information about the natural history of cervical dysplasia and the role of human papillomavirus (HPV) in cervical cancer, as well as the development of new technologies for cervical cancer. 816: Consumer Testing for Disease Risk (Obstet Gynecol 2021;137:e16). The American Cancer Society (ACS) recommends that women ages 21 to 29 have a Pap test every 3 years. Colposcopy standards: this term refers to the ASCCP Colposcopy Standards that provide evidence-based A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. cancer screening results. J Low Genit Tract Dis 2013; 17: S1-S27. 107: Induction of Labor, Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214, Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222, The Case for Standardizing Cesarean Delivery Technique: Seeing the Forest for the Trees, Privacy Policy (Updated December 15, 2022), by The American College of Obstetricians and Gynecologists. Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era. These recommendations do not apply to individuals who are at high risk of the disease, such as those who have previously received a diagnosis of a high-grade precancerous cervical lesion. 606: Options for Prevention and Management of Heavy Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment (Obstet Gynecol 2014;124:397402) has been withdrawn and replaced by ACOG Committee Opinion No. Choice of therapy is determined by the geometry of the lesion and the clinical recommendations of the physician. Other HPV tests are approved as part of an HPV/Pap cotest. Human papillomavirus vaccination is another important prevention strategy against cervical cancer, and obstetriciangynecologists and other health care professionals should continue to strongly recommend HPV vaccination to eligible patients and stress the benefits and safety of the HPV vaccine 20 . If, in the past, you had an abnormal result or anything suspicious on a screening test, or had treatment for cervical cancer or precancer, then you should continue to be screened. Declines in prevalence of human papillomavirus vaccine-type infection among females after introduction of vaccineUnited States, 2003-2018. Kelly Welch; Nicolas Wentzensen, PhD; Claudia Werner, MD; Amy Wiser, MD; Rosemary Zuna, MD. Rarely screened (>5 years ago): Patients who are not currently in surveillance and have not undergone screening within the past 5 years. Several organizations have screening algorithms that recommend when to use these tests, but the 3 that shape today's standard of care in cervical . Specifics are laid out in a series of scientific articles published in the Journal of Lower Genital Tract Diseases. All three screening strategies are effective, and each provides a reasonable balance of benefits (disease detection) and potential harms (more frequent follow-up testing, invasive diagnostic procedures, and unnecessary treatment in patients with false-positive results) 1 . Available at: MacLaughlin KL, Jacobson RM, Radecki Breitkopf C, Wilson PM, Jacobson DJ, Fan C, et al. time. The ACOG recommends that women 30 or older get screened every 3 years with a Pap test, while women 21-29 should be screened every 5 years. 4. The algorithm contains tabs with videos and links to additional resources designed to make it easier to guide your next visit. That may raise the risk of serious complications in a future pregnancy, including pregnancy loss and preterm birth. See the full list of organizations (below) that participated in the consensus process. The American College of Obstetricians and Gynecologists (ACOG) has issued new cervical cancer screening guidelines that recommend women begin screening for cervical cancer at 21 years of age. Pap screening may end at age 65 if the Pap history is unremarkable and the patient is low risk. Until primary hrHPV testing is widely available and accessible, cytology-based screening methods should remain options in cervical cancer screening guidelines. Obstetrics Gynecology Science NLM title. 5. Guidelines cannot cover all clinical situations and clinical judgment is advised, especially in those circumstances which are not covered by the 2019 guidelines.Perkins RB, Guido RS, Castle PE, et al. The new guidelines rely on individualized assessment of risk for precancer (CIN3+), taking into account past history and current results. cotesting at intervals <5 years, or cytology alone at intervals <3 years. MMWR Morb Mortal Wkly Rep 2021;70:2935. The PDFKEGs Acog PAP Guidelines Algorithm 2020 is an easy-to-use, interactive document that helps clinicians manage patients with suspected obstructive sleep apnea. Finally, both clinicians and patients need to recognize that while most cases of cervical cancer can be prevented Trends over time in Pap and Pap-HPV cotesting for cervical cancer screening. If youve had a series of normal screening test results over a long period of time, then you can stop screening at age 65. Wolters Kluwer Health The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited HPV: this term refers to Human Papillomavirus. Atypical squamous cells of undetermined significance (ASC-US) may indicate HPV infection. Article Level Metrics Sorry we can't load that information at this time. incorporation of future technologies as well. 107: Induction of Labor (Obstet Gynecol 2009;114:38697), ACOG Practice Bulletin No. MD; Jennifer Loukissas, MPP; Anna-Barbara Moscicki, MD; Jeanne Murphy, PhD; Amber Naresh, MD, MPH; Ritu Nayar, MD; Persistent disparities in cervical cancer screening uptake: knowledge and sociodemographic determinants of Papanicolaou and human papillomavirus testing among women in the United States. The College's publications may not be reproduced in any form or by any means without written permission from the copyright owner. The results of the second test will help decide if you need a colposcopya procedure to look at the cervix with a magnifying lens and take samples from spots on the cervix that look abnormal. PhD; George Sawaya, MD; Mark Schiffman, MD; Kathryn Sharpless, MD, PhD; Katie Smith, MD, MS; Elizabeth Stier, MD; Zhao C, Li Z, Nayar R, et al. Available at: Buskwofie A, David-West G, Clare CA. to routine screening. These recommendations differ slightly from those given by ACS in 2012 and by the US Preventive Services Task Force (USPSTF) in 2018. or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 It is not a substitute for a treating clinicians independent professional judgment. Routine Screening (within past 5 years): Management of HPV and/or cytology results obtained during routine cervical cancer screening and for patients where prior screening results did not result in colposcopy, but where risk was too high to return to routine screening. For an HPV/Pap cotest, an HPV test and a Pap test are done together. An HPV test looks for the human papillomavirus, a virus that can cause cervical cancer. Available at: Kim JJ, Burger EA, Regan C, Sy S. Screening for cervical cancer in primary care: a decision analysis for the US Preventive Services Task Force. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. The following ACOG documents have been withdrawn: ACOG Committee Opinion No. ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors have been published. If something abnormal or suspicious was found, also called a positive test result, you will typically get a second test. Society for Maternal-Fetal Medicine (SMFM). ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Evaluation and Management Changes for 2021 | ACOG Lower Anogenital Squamous Terminology (LAST): this term refers to two-tiered pathology criteria for Am J Obstet Gynecol 2017; DOI: 10.1016/j.ajog.2017.07.039. 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. In both tests, cells are taken from the cervix and sent to a lab for testing: An HPV test looks for infection with the types of HPV that are linked to cervical cancer. specimen for histologic analysis, such as Loop Electrosurgical Excision Procedure (LEEP), Large Loop Excision of the patient's risk of progressing to precancer or cancer. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. As a result, guidelines can become out of date rapidlyyears before the scheduled next cycle. If youve had an abnormal Pap smear in the past three years, talk with your doctor about when you should be rescreenedit may be earlier than whats recommended above. This series is coordinated by Michael J. Arnold, MD, contributing editor. Also, in young women, most HPV infections go away on their own. 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement Available at: Benard VB, Castle PE, Jenison SA, Hunt WC, Kim JJ, Cuzick J, et al. (Endorsed March 2018). The purpose of this test is to screen for cervical cancer, precancers, and other abnormalities that can occur in womens vaginas. Patients monitored without therapy should be reliable for follow-up and should understand the risks.