2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors. These new screening recommendations differ in 4 important respects compared with the 2012 ACS recommendations: As of this time, the current cervical cancer screening guidelines of the US Preventative Services Task Force, ASCCP, and the American College of Obstetricians and Gynecologists (ACOG) have not been modified or updated to match the 2020 guideline update of the American Cancer Society. 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. Six clinical action thresholds, including surveillance (5-year, 3 year, or 1-year return visits), send to colposcopy, colposcopy, or treatment; and treatment preferred. Incorporating Stakeholder Feedback in Guidelines Development for the Management of Abnormal Cervical Cancer Screening Tests. Demarco M, Egemen D, Raine-Bennett TR, et al. Update your clinic or office protocols for cervical cancer screening and colposcopy to reflect the 2019 ASCCP Risk-Based Management Guidelines, In-service staff regarding the 2019 ASCCP Risk-Based Management Guidelines, Inform patients who are under surveillance following abnormal results that they will be managed based on updated guidelines, Watch for the publication of updated coding and billing policies from your payers (Medicaid, state family planning programs, Title X, commercial health plans), Perkins, Rebecca B.; Guido, Richard S.; Castle, Philip E.; et. By using clinical action thresholds, the guidelines allow for future modifications and changes in recommendations going forward as new data and technologies emerge. . For all cytology results of LSIL or worse (including ASC-H, AGC, AIS, and HSIL), referral to colposcopy is recommended regardless of HPV test result if done. Individuals with high-grade cervical disease without suspected invasive disease should have documented attempts to contact and procedures scheduled within 3 months. Keep in mind that using this methodology, disparate scenarios will end up in the same risk stratum. and” rather than “no” or “but”, Digital Family Planning: the Future is Now, Contraceptive efficacy: understanding how user and method characteristics play their part, Strategizing treatment for chronic heavy menstrual bleeding, Untangling the literature on obesity and contraception, Menstrual exacerbation of other medical conditions, From Princeton University: Thomas James Trussell (1949-2018), Selecting a Method When Guidance Isn’t Clear-cut, Healthcare in the Time of Digital Expansion, The Scoop on Two New FDA-Approved Contraceptive Methods, Pregnancy of unknown location—meeting the challenge, Big “yes” (with caveats) to CHCs during perimenopause, The role of IUDs (LNG IUDs, too!) Perkins and Guido and colleagues conclude. Shared decision-making should be used when considering expedited treatment, especially for patients with concerns about the potential impact of treatment on pregnancy outcomes.  @WKHealth, Copyright © 2021 by the American Association for the Advancement of Science (AAAS), University of Colorado Anschutz Medical Campus, American Association for the Advancement of Science, Barcelona Institute for Global Health (ISGlobal), Replacing guidelines for managing women with abnormal results on cervical cancer screening test from 2012. Individuals with high-grade cervical cancer screening tests should have documented attempts to contact and diagnostic evaluation scheduled within 3 months. The applicability of these risk estimates to other United States regions and populations was validated by comparison with data sets from CDC NBCCEDP programs, the New Mexico Pap Registry, and two clinical trials. 2020 Apr;24(2):167-177. EurekAlert! This patient information can be entered into the APP and the tool at the ASCCP website. Demarco M, Egemen D, Raine-Bennett TR, et al. J Low Genit Tract Dis 2020;24:102-31. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. This resulted in significant changes in the content of the recommendations which are now consistently based on estimated risk for combinations of current and past results. A “patient’s screening history” includes any abnormal screening result in the last five years and any treatment in the proceeding 25 years. al. Nayar R, Chhieng DC, Crothers B, et al. For people aged 25 to 65 years, the preferred screening recommendation is to get a primary human papillomavirus (HPV) test every 5 years. The standards are comprehensive and based on the most current data. recommendations going forward as new data and technologies emerge. The guideline is transitional, ie, options for screening with co-testing or cytology alone are provided but should be phased out once full access to primary HPV testing for cervical cancer screening is available without barriers. Watch the “QuickStart Guide” video on the ASCCP website at, Download the Perkins and Guido et al, and Egemen, et. Wolters Kluwer reported 2019 annual revenues of €4.6 billion. The ASCCP Risk-Based Management Consensus Guidelines reaffirm that colposcopy should be practiced according to the ASCCP Colposcopy Standards. Other similar changes exist in most other organizational guidelines. It is critical to ensure that the decision for expedited treatment is based on. Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. There is no reason to routinely screen pregnant females for cervical cancer, either prenatally or post-partum, simply because they are pregnant. At a minimum, a provider will need to know a patient’s age and current screening test result to make a clinical decision. Disclaimer: AAAS and EurekAlert! New 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors provide new recommendations ... 2020. Comment: Other than primary HPV screening and p16 immunohistochemistry (p16 IHC) staining of certain biopsies in the pathology lab, there are no new technologies included in the 2019 Guidelines when compared to the 2012 Guidelines. 3. Wentzensen N, Schiffman M, Silver MI, et al. J Low Genit Tract Dis 2017; 21:216–22. EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system. Screening Guidelines. 3. . With such a large database, it was possible to construct precise estimates for the risk of either acquiring or having CIN 3+ in the subsequent 5 years for a large number of clinical scenarios and combinations of past and current test results2. J Low Genit Tract Dis. Available: OnDemand for CME until December 31, 2020. All colposcopists should read through the standards to ensure their colposcopy methods are consistent with best practices. Additionally, glandular cancer pre-cursor lesions can be detected (cytologically, as atypical glandular cells [AGC] and histologically, as adenocarcinoma-in situ [AIS]) and treated before invasion occurs. 646-674-6348 New guidance for managing further testing in patients with minimal abnormalities detected during cervical cancer screenings will be shared at the American College of Obstetricians and Gynecologists (ACOG) 2020 Virtual Conference. 1 Three times before, in 2001, 2,3 2006, 4,5 and 2012, 6 the NCI and ASCCP had collaborated in a formal consensus guidelines process and also helped produce several other related guidances. Comment: The previous version of the ASCCP Consensus Management Guidelines4 offered the option of expedited treatment (also known as “see-and-treat” LEEP). The guidelines generally advise a reduction in the number of tests women get over their lifetime to better ensure that they receive the benefits of testing while minimizing the harms, and include a preference … Recommendations of routine screening, 1-year or 3-year surveillance, colposcopy, or treatment correspond to a risk stratum, a range of risk for CIN 3+. ASCCP is pleased to offer this app to streamline navigation of the ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors. Speaker Co-testing is preferable to using a Pap test alone for women ages 30– 1 ACS, ASCCP, & ASCP guidelines update In March In addition, the development process included stakeholder feedback from providers (survey and public comment period) and patients (survey) to ensure that the guidelines met the needs of those who would be using them7. More information on this technology can be found at http://www.asccp.org. Cheung, Li C.; Egemen, Didem; Chen, Xiaojian; et.al. If no history is available, “past history unknown” is considered as a separate risk factor and included with the risk estimates. 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]." On July 20, 2020, the American Cancer Society (ACS) published a new screening guideline entitled “Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society”. Scenarios were categorized in one of six risk strata or clinical action thresholds, which in turn contained a management recommendation for either surveillance, colposcopy, colposcopy or treatment, or expedited treatment. The revised guidelines with updated recommendations are now available in the Journal of Lower Genital Tract Disease (JLGTD), official journal of ASCCP. Personalized risk-based management is possible with knowledge of current results and past history. For more information visit http://www.asccp.org. Clinicians and staff doing follow-up should obtain the ASCCP APP (iPhone, iPad, Android) or try out the tool on the ASCCP.org website. The wide variety of demographics represented in these additional data sets reassures us that the risk-based recommendations apply broadly3. Release date. The company is headquartered in Alphen aan den Rijn, the Netherlands. War Against Planned Parenthood Hurts Women, Win-win for both treatment and prevention, Menopause, mood, mental acuity, and hormone therapy, Reproductive tract infections, sexually transmitted infections, or sexually transmitted diseases: “a rose by any other name…”, Be alert to VTE in hormonal contraceptive users, LARC among teens increased 15-fold, but not enough, Free tools: Easy access to the US Medical Eligibility Criteria for Contraceptive Use, Alcohol consumption when pregnancy is unwanted or unintended, Latest Data on Contraceptive Use in the United States, LateBreaker sampler from Contraceptive Technology conference, Emergency Contraceptive Pill Efficacy and BMI/Body Weight, Handout on Unintended Pregnancy and Contraceptive Choice. In immunocompromised patients of any age, colposcopy referral is recommended for all results cytology results of HPV-positive ASC-US or higher. In April 2020, the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors were published. ASCCP c/o SHS Services, LLC 131 Rollins Ave, Suite 2 Rockville, MD 20852. Month: October 2020 New ASCCP consensus guidelines for managing abnormal cervical cancer screening test results Rebecca Perkins, MD, first co-author of the new guidelines and an associate professor of OBGYN at Boston University School of Medicine and Boston Medical Center New ASCCP consensus guidelines for managing abnormal cervical cancer screening test results feat. The fact that this Guideline integrates these other sources, and addresses so many common management dilemmas, is quite helpful. The new guidelines provide guidance on cotesting and recommend more conservative management for women years of age. Comment: Here are some ideas about implementing the 2019 Guidelines in your practice. 2019 ASCCP Risk-Based Management Consensus Guidelines: Methods for Risk Estimation, Recommended Management, and Validation Journal of Lower Genital Tract Disease. The American Cancer Society (ACS) has updated its guidelines for cervical cancer screening. This improvement results in management decisions that are more tailored to the individual, rather than relying on the “generic” algorithms that were used in the earlier consensus management guidelines. 3. Published in Journal of Lower Genital Tract Disease, new recommendations focus on more personalized risk assessment and management. New 13-Cycle Vaginal Contraceptive System, The Future of Family Planning in Post-COVID America, New ASCCP Guidelines: Implications for FP, On the alert: mood disorders during 2020 stressors, Challenges old and new during the pandemic, Reproductive health in the time of Covid-19, Missed Pills: The Problem That Hasn’t Gone Away, Find the “yes! While they are evolutionary, rather than revolutionary, the new guidelines were developed based on a greater amount of longitudinal data derived from a larger database than was previously available2,3 and validated against several other databases. The 2019 Guidelines go further by offering specific high-risk scenarios for which expedited treatment is actually preferred such as HSIL with positive HPV 16 and HSIL with any positive HPV in someone who has been under screened. Since publication of the American Society for Colposcopy and Cervical Pathology ASCCP consensus guidelines for management of abnormal cervical algoritthm 12 and histology, 34 new data have emerged. The premier reference in family planning for clinicians, “Patients’ serious mental illnesses (SMIs) have important implications for [their] family planning.” —Contraceptive Technology 21st edition (more…). is a service of the American Association for the Advancement of Science. Comment: For many clinicians, this will be the most profound change in how the guidelines are used…think of it as moving from using a map to using GPS when driving. For non-pregnant patients 25 years or older, expedited treatment, defined as treatment without preceding colposcopic biopsy demonstrating CIN 2+, is preferred when the immediate risk of CIN 3+ is ≥60%, and is acceptable for those with risks between 25% and 60%. are not responsible for the accuracy of news releases posted to EurekAlert! In April 2020, the 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors were published.1 This is the 4th edition of management Guidelines, updating the 2001, 2006 and 2012 versions. Quotations from the main 2019 ASCCP Risk-Based Management Consensus Guidelines article are indicated in green. For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. ", Click here to read "2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. The same current test results may yield different management recommendations depending on the history of recent past test results. We are not there yet. June 25, 2020 - 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. . Updated US consensus guidelines for management of cervical screening abnormalities are needed to accommodate the 3 available cervical screening strategies: primary human papillomavirus (HPV) screening, cotesting with HPV testing and cervical cytology, and cervical cytologyalone. The recognition that persistent HPV infection is necessary for developing precancer and cancer (defined as CIN 3+, which includes diagnoses of CIN 3, AIS, and cancer) underlies the 2019 guideline update. New guidance for managing further testing for patients with minimal abnormalities detected during cervical cancer screenings have been published in JAMA Insights. 1. Additionally, the guidelines and the evidence that support them are contained in 3 articles 1-3, each of which is dense with information, making it impossible to reference management advice in a single easy-to-read article or set of algorithms as in the past. Phone: 301-857-7877 2020 ACS: 2012 ACS: 2018 USPSTF: Age 21‒24: No screening: Pap test every 3 years: Pap test every 3 years: Age 25‒29: HPV test every 5 years (preferred) HPV/Pap cotest every 5 years (acceptable) Pap test every 3 years (acceptable) Pap test every 3 years: Pap test every 3 years: Age 30‒65: HPV test every 5 years (preferred) HPV/Pap cotest every 5 years (acceptable) This article, by Contraceptive Technology authors Michael Policar and Patty Cason, disentangles the eight most significant changes and offers perspectives on how they and be implemented into current clinical practice. EurekAlert! Below is a listing of the eight most significant modifications in the guidelines. Updated guidelines published in Alglrithm place greater emphasis on testing for high-risk human papillomavirus HPV. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services. 1 This is the 4th edition of management Guidelines, updating the 2001, 2006 and 2012 versions. All rights reserved. HIV-positive individuals should begin screening with cytology alone within 1 year of onset of sexual activity or, if currently sexually active, within the first year after HIV diagnosis, but no later than 21 years of age. Reviewed by: Rebecca Perkins, MD. 14 These updated guidelines clearly indicate that cervical cancer screening should begin at age 25 with the use of HPV primary screening as … July 30, 2020. Rules to Practice By: Safety First and Cleanliness is Close to. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 19,000 people worldwide. What is the quintessence of the recently published 2019 ASCCP Risk-Based Management Consensus Guidelines? Patients who are 30 years of age and older can be screened with cytology alone or co-testing. The guidelines articles, as published in the … 1. However, the downsides include the one-time cost of the mobile device APP ($9.99) and if you are using the website version, having limited access to management recommendations in the absence of a working computer connected to the internet. Connie.Hughes@wolterskluwer.com Hopefully in the future. New 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors provide new recommendations. What’s Vanity Fair Got Against the NuvaRing? The new guidelines are for people with a cervix with an average risk of cervical cancer. Perkins RB, Fuzzell LN, et.al. Quotations from the main 2019 ASCCP Risk-Based Management Consensus Guidelines article are indicated by indentation. in emergency contraception, Abortion in the U.S.: safe, declining, and under threat, Breast cancer still a small risk with some hormonal contraceptives, Viruses in semen potentially transmissible, Don’t Abstain from Your Role in Abstinence, Teens births declining but geographic ‘hotspots’ defy trend, Online Medical Abortion Service Effective and Safe, PMDD: Genetic clues may lead to improved treatment, Breast cancer risk when there is a family history, Body weight link to breast and endometrial cancers (and 11 others), Managing implant users’ bleeding and spotting, Zika virus fears prompt increased request for abortion in nations outlawing abortions, Opioid use epidemic among reproductive-age women. Wentzensen N, Massad LS, Mayeaux EJ, et al. ASCCP is a professional society for an interdisciplinary group of healthcare professionals including physicians, physician assistants, nurse practitioners, midwives and researchers, who are focused on improving lives through the prevention and treatment of anogenital and HPV-related diseases. Dr. Rebecca … . 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. The ASCCP just released their latest update in April 2020 and simultaneously released an updated guidelines app. “In light of the current unprecedented COVID-19 pandemic, and in settings where all non-essential medical office visits and elective procedures have been suspended, ASCCP recommends the following: These recommendations can be accessed at: https://www.asccp.org//covid-19-resources, The Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents (2018) recommends that females who are infected with HIV should have age-based cervical cancer screening, https://aidsinfo.nih.gov/guidelines/brief-html/4/adult-and-adolescent-opportunistic-infection/343/human-papillomavirus. The journal is published in the Lippincott portfolio by Wolters Kluwer. The guideline contains the following sections. The guidelines are found at: Guideline: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21628 When considering expedited treatment note that: The 2019 Guidelines may result in a greater number of “see-and-treat” LEEP procedures, with the benefit of fewer people being lost to follow-up before the LEEP can be performed, as well as requiring fewer in-person visits for the patient. Quotations from the main 2019 ASCCP Risk-Based Management Consensus Guidelines article are indicated by indentation. 2013 Apr;121(4):829-46. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. Consequently, the clinical endpoint that screening and evaluation seeks to identify is CIN 2/3+ (which includes CIN 2, CIN 2/3, CIN3, AIS, and cancer). Guideline recommendations were based on risk estimates calculated with data from a large, prospective, longitudinal cohort of > 1.5 million patients at Kaiser Permanente Northern California (KPNC). 2. The National Cancer Institute (NCI) and ASCCP agreed formally in 2017 through a Memorandum of Understanding to embark on a new set of guidelines. As before, the goal of screening and management is to discover pre-malignant cervical lesions and to treat them before invasion occurs. We have none of these in place yet. It can be accessed at https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21628. In order to have a screening program (any screening – but this applies to anal CA), we need to: 1) Know the best way to screen and have clinicians training in screening 2) have data showing that screening impacts disease 3)  know what to do with screening results 4) have the manpower/capacity to manage abnormal results (clinicians trained in high resolution anoscopy (HRA) 5) have sufficient data suggesting that use of HRA and treatments impacts disease. For patients with an unknown history, the minimum information required to make clinical decisions is patient age and current test result. The use of the mobile device APP or website APP allows you to efficiently incorporate a considerable amount of clinical and demographic information when determining next steps in management and actualize personalized risk assessment. September 23, 2020 • 3:00 - 4:00 PM (Eastern) In April 2019, the new ASCCP Risk Based Management Consensus Guidelines were published. With this approach, if the cytology result is HSIL and the colposcopy reveals a lesion that has a high likelihood of requiring treatment, an excisional LEEP (CPT code 57460) or a LEEP conization (CPT code 57461) is done for the purpose of diagnosis and treatment in a single step, avoiding the need for 2 visits (one for colposcopy and biopsies and a second for the LEEP procedure itself). When successive rounds of cervical screening are done with HPV-based testing (either HPV alone or HPV plus cytology co-testing), it is easier to determine whether persistent HPV infection is present. Perkins RB, Guido RS, Castle PE, et al. Re-screening after her delivery should occur only when 3 years have passed since her last cytology test or 5 years from her last hrHPV-alone or co-test. J Low Genit Tract Dis 2020;24:132-43. Numbers matter, so make them simple for patients, The Recession’s Effect on Unintended Pregnancies, Lessons Learned from the Contraceptive CHOICE Project: The Hull LARC Initiative, Applying the “New” Cervical Cytology Guidelines in Your Practice, Acute Excessive Uterine Bleeding: New Management Strategies, Contraceptivetechnology.com New and Improved, Highlights of 2019 ASCCP Risk-Based Management Guidelines, Implications for Family Planning Service Providers, Written by: Michael Policar, MD, and Patty Cason, RN, MS, FNP-BC The ASCCP Risk-Based Management Consensus Guidelines represented a consensus of 19 professional organizations and patient advocates. 2020;24(2):102–131. J Lower Gen Tract Dis 2020;24:102–131. offers eligible public information officers paid access to a reliable news release distribution service. ASCCP is committed to our mission and recently launched the ASCCP Risk-Based Management Consensus Guidelines for the management of women with abnormal cervical cancer screening,” said Dr. Einstein. Comment: It has been known for decades that the most important risk factor for CIN 2/3+ is a persistent high-risk HPV infection. Maybe, if you are inspired, consider getting trained in HRA, it’s an important and valuable skill. Below is a listing of the eight most significant modifications in the guidelines. Release date. View Cart. Individuals with suspected invasive disease should have contact attempted within 2 weeks and evaluation within 2 of that contact (4 weeks from the initial report or referral). Recommendations of colposcopy, treatment, or surveillance will be based on a patient’s risk of CIN 3+ determined by a combination of current results and past history (including unknown history). 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