ASCCP released new guidance (April 2020) to inform assessment and treatment of abnormal cervical cancer screening results. The overarching theme reflects a ‘risk-based’ strategy, rather than rigid focus on a particular result. Risk tables have been generated to assist the clinician and guide practice (Egemen et al. Journal of Lower Genital Tract Disease, 2020). This is a consensus document with input from ACOG, ACS, SGO and multiple other professional organizations, including those affiliated with laboratory medicine. (In October 2020, ACOG released a practice advisory supporting the new ASCCP guidance and withdrew its previous practice bulletin on cervical cancer screening management. )
The executive summary states
New data indicate that a patient’s risk of developing cervical precancer or cancer can be estimated using current screening test results and previous screening test and biopsy results, while considering personal factors such as age and immunosuppression
For a given current results and history combination, the immediate CIN 3+ risk is examined
If this risk is 4% or greater, immediate management via colposcopy or treatment is indicated
If the immediate risk is less than 4%, the 5-year CIN 3+ risk is examined to determine whether patients should return in 1, 3, or 5 years
Routine screening applies only to asymptomatic individuals who do not require surveillance for prior abnormal screening results
Human papilloma virus assays that are Food and Drug Administration (FDA)-approved for screening should be used for management according to their regulatory approval in the United States
Note: All HPV testing in this document refers to testing for high-risk HPV types only
For all management indications, HPV mRNA and HPV DNA tests without FDA approval for primary screening alone should only be used as a cotest with cytology, unless sufficient, exceptionally rigorous data are available to support primary HPV testing in management
ACOG Practice Advisory: Updated Guidelines for Management of Cervical Cancer Screening Abnormalities
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