The New ASCCP Management Consensus Guidelines for Abnormal Cervical Cancer Screening Results: What are the Key Changes?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Describe the new ASCCP ‘risk based’ strategy to determine whether a woman needs further treatment following an abnormal cervical cancer screening result 2. Discuss the major changes in the new ASCCP consensus management guidelines following an abnormal cervical cancer screening test report
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
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Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
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
Key Changes to Watch for in the New Guidelines
Recommendations (colposcopy and treatment vs surveillance) are based on risk for CIN 3+
Risk determined by prior history as well as screen results
Risk tables also address ‘unknown history’ scenario
Deferral of colposcopy: Low risk for CIN 3+ (risk defined by tables)
Repeat HPV testing or cotesting at 1 year
At the 1-year follow-up test, referral to colposcopy if still abnormal
Expansion of expedited treatment category (biopsy not needed prior to therapy), for example, in nonpregnant patients ≥25 years, expedited treatment is
Preferred: CIN 3+ risk is ≥60%
Preferred: HPV 16–positive HSIL cytology and never or rarely screened patients with HPV-positive HSIL regardless of HPV genotype
Acceptable: CIN 3+ risk is between 25% and 60%
Shared decision making is important in the context of “impact on pregnancy outcomes”
Preferred over ablation for HSIL (CIN 2 or CIN 3) in the US
Recommended for AIS
Observation is preferred vs treatment
Treatment acceptable with persistent CIN 1 results >2 years
Lower Anogenital Squamous Terminology (LAST)/World Health Organization (WHO) recommendations for reporting histologic HSIL
Include HSIL (CIN 2) and HSIL (CIN 3) (i.e., include CIN 2 and 3 qualifiers)
Should be performed on all positive HPV tests, regardless of genotype
If HPV 16 and 18 testing is positive but additional laboratory testing of the same sample is not feasible, proceed directly to colposcopy
Surveillance recommendations following histologic HSIL, CIN 2, CIN 3, or AIS
Continue surveillance with HPV testing or cotesting at 3-year intervals for at least 25 years (recommended)
>25 years is acceptable “for as long as the patient’s life expectancy and ability to be screened are not significantly compromised by serious health issues”
The ASCCP consensus document states the following in reference to HPV tests
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
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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