The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Usually, the sample taken for the Pap test also can be used for the HPV test. %%EOF 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 American College of Obstetricians and Gynecologists Hysterectomy-corrected cervical cancer mortality rates reveal a larger racial disparity in the United States. primary funders, had equal and balanced roles in the consensus process including data analysis and interpretation, Because management in some instances differs for adolescent patients, ACOG also created guidelines specific to this population. Follow-up should be individualized, but cytology or colposcopy at intervals of four to six months is reasonable. defined risk thresholds to guide management are designed to continue functioning appropriately when population-level Wolters Kluwer Health Pausing Therapy for Early-Stage Breast Cancer to Get Pregnant, Lung-Sparing Surgery Effective for Some with Lung Cancer, U.S. Department of Health and Human Services, Pap test every 3 years, HPV test every 5 years, or HPV/Pap cotest every, No screening if a series of prior tests were normal, No screening if a series of prior tests were normal and not at high risk for cervical cancer. Therefore, as an alternative to immediate colposcopy, adolescents with ASC-US and a positive high-risk HPV test result may be monitored with cytologic screening at six and 12 months or a single high-risk HPV test at 12 months. test (to determine the presence/absence of HPV 16/18), and also a reflex cytology test to determine whether the 146: Management of Late-term and Postterm Pregnancies (Obstet Gynecol 2014;124:3906), ACOG Practice Bulletin No. It is not a substitute for a treating clinicians independent professional judgment. Please contact [emailprotected] with any questions. Theres alsothe possibility of added anxiety and other emotions from incorrect, or false-positive, test results. [https://journals.lww.com/jlgtd/Fulltext/2020/04000/2019_ASCCP_Risk_Based_Management_Consensus.2.aspx]. A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide. 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. Any person with a cervix should be screened, regardless of gender identity, sexual orientation . The dual stain test uses two biomarkers that can give a more accurate sign that precancer is present. One is to start screening at a slightly older age, and the other is to preferentially recommend a type of screening test called an HPV test. endstream endobj startxref Cryotherapy, laser therapy, and LEEP are equally effective treatments; excision has been recommended for biopsy-confirmed CIN 3. Healthy People 2030. There is more interest now in looking at people who had an abnormal screening test result at an older age to see if they require more years of screening or more frequent screening. Although HPV vaccination rates continue to improve, nationwide HPV vaccination coverage remains below target levels, and there are racial, ethnic, socioeconomic, and geographic disparities in vaccination rates 13 14 15 16 . Terms and Conditions of Use, Get the latest on COVID-19, pregnancy, and breastfeeding, ACOG Booklets: Download Health Guides on Key Topics, Your Pregnancy and Childbirth: A Guide to Pregnancy From the Nation's Ob-Gyns. ET). Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited or call toll-free from U.S.: (800) 762-2264 or (240) 547-2156 individual patient based on their current results and past history. To ensure the risk estimates generated from KPNC data are generalizable (portable), we also estimated risks using data from the Centers for Disease Control and Prevention (CDC), the New Mexico Pap Study, and two clinical trials. a reflex HPV test. by Edward Winstead, March 9, 2023, 169: Multifetal Gestations: Twin, Triplet, and Higher-Order Multifetal Pregnancies (Obstet Gynecol 2016;128:e13146), ACOG Practice Bulletin No. Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. variables to consider, the 2019 guidelines further align management recommendations with current understanding of J Low Genit Tract Dis 2020;24:10231. incorporated past screening history. Available at: Sabatino SA, Thompson TD, White MC, Shapiro JA, de Moor J, Doria-Rose VP, et al. Am J Obstet Gynecol 2017; DOI: 10.1016/j.ajog.2017.10.019. Data from Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. only to patients without risk factors. ASCCP supports the American Cancer Society (ACS) cervical cancer screening guidelines. Copyright 2023 American Academy of Family Physicians. cervical cancer screening have come out since 2012, such as primary HPV as a screening option for patients 25 years The 2019 ASCCP Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, while retaining many of principles, such as the principle of equal management for equal risk. Read common questions on the coronavirus and ACOGs evidence-based answers. Published by Wolters Kluwer Health, Inc. All rights reserved. (Monday through Friday, 8:30 a.m. to 5 p.m. Am J Obstet Gynecol 2017; DOI: 10.1016/j.ajog.2017.07.039. The algorithm contains tabs with videos and links to additional resources designed to make it easier to guide your next visit. 2019 ASCCP Risk-Based Management Consensus Guidelines Committee [published erratum appears in J Low Genit Tract Dis 2020;24:427]. Participating organizations For example, primary HPV is a screening option for patients 25 years of age and older. The American College of Obstetricians and Gynecologists (ACOG) joins ASCCP and the Society of Gynecologic Oncology (SGO) in endorsing the U.S. Preventive Services Task Force (USPSTF) cervical cancer screening recommendations 1 , which replace ACOG Practice Bulletin No. J Low Genit Tract Dis 2020;24:144-7. Consider management according to the highest-grade abnormality J Womens Health (Larchmt) 2019;28:2449. Please try again soon. Consider management according to the highest-grade abnormality Please check for updates at www.acog.org to ensure accuracy. The new recommendations are more precise and tailored to many factors that determine a persons risk of cervical cancer and precancer, such as their age and past test results. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. For any result of ASC-US or higher on repeat cytology or if HPV positive, referral to colposcopy is recommended. Screening with an HPV test alone was not recommended by ACS in 2012 because that approach wasnt yet approved by FDA. Place your feet in stirrups. Colposcopic examination is considered an STD evaluation, and parental consent is preferred but should not be required; in the absence of parental consent, consent should be obtained from the minor and noted in the medical record. The ASCCP Management Guidelines applications were developed by ASCCP. The standard approach is to do a Pap test, but there is also a new FDA-approved test, called dual stain. All Rights Reserved. Barbara Crothers, DO; Teresa Darragh, MD; Maria Demarco, PhD; Eileen Duffey-Lind, MSN; Ysabel Duron, BA; Didem 501: MaternalFetal Intervention and Fetal Care Centers (Obstet Gynecol 2011;118:40510), ACOG Committee Opinion No. National Society of Genetic Counselors (NSGC), November 2014. Note that a negative past history should be entered only when documented in the medical record and performed on Details of the statistical methods are described in the publication Li C., et al. This is an important change that is related to HPV vaccines. specifically, the risk of a patient developing cervical cancer, estimated by the surrogate endpoint of the 5-year Available at: Yeh PT, Kennedy CE, de Vuyst H, Narasimhan M. Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis. Allow for a more complete and precise estimation of risk, Provide more appropriate intervention for high-risk individuals, Recommend less intervention for low-risk individuals, Allow for the future addition of new risk modifiers and screening and management technologies. Available at: MacLaughlin KL, Jacobson RM, Radecki Breitkopf C, Wilson PM, Jacobson DJ, Fan C, et al. If youve had a series of normal screening test results over a long period of time, then you can stop screening at age 65. Cervical cancer screening may include Pap tests, testing for a virus called human papillomavirus (HPV), or both. ScreeningCervical cancer screening and abnormal result management recommendations for immunocompromised individuals without HIV use the guidelines developed for people living with HIV144: Cytology only screening should begin within 1 year of first insertional sexual activity Continue cytology only annually for 3 years Continue every 3 years (cytology only) until the age of 30 years Cytology alone or cotesting every 3 years after the age of 30 years for the patient's lifetime.Management of Abnormal ResultsIn immunocompromised patients of any age, colposcopy referral is recommended for all results of HPV-positive ASC-US or higher. However, the risk of invasive cancer in adolescents is almost zero, and the likelihood of HPV clearance is high; most infections in adolescents resolve within two years. If you are 65 or olderYou do not need screening if you have no history of cervical changes and either three negative Pap test results in a row, two negative HPV tests in a row, or two negative co-test results in a row within the past 10 years. In addition, changing the paradigm of If you have had a hysterectomy in which your cervix was removed and: You have a history of cervical cancer or moderate to severe cervical changesContinue to have screening for 20 years after your surgery. Grade A denotes that The USPSTF recommends the service. Colposcopic examination confirming CIN1 or less within 1 year. 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. The latter 2 options detect high-risk HPV genotypes. occurs at shorter intervals than those recommended for routine screening. The cervix is part of the female reproductive system that connects the uterus to the vagina. 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. Available at: https://onlinelibrary.wiley.com/doi/full/10.1002/jum.14677. For example, HPV primary testing or On July 30, the American Cancer Society (ACS) published an updated guideline for cervical cancer screening. Trends over time in Pap and Pap-HPV cotesting for cervical cancer screening. 5. Women who are 30 or older will have their first screening at 35 and then follow-up screenings every three years thereafter. to routine screening. HPV tests are a newer method of cervical cancer screening. With an enduring consensus committee, the principle of equal management for equal risk, and the Clinical Action Thresholds of the 2019 guidelines, new technologies and approaches can be incorporated into the new guidelines framework as they become available. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. An expert on cervical cancer screening, Nicolas Wentzensen, M.D., Ph.D., of NCIs Division of Cancer Epidemiology and Genetics, explains the changes. Pap tests have lower sensitivity compared with HPV tests, so they may miss some precancers and have to be repeated frequently. Transformation Zone (LLETZ), and cold knife conization. Retrieved April 12, 2021. No, the recommendations for this age group are the same as before. The selected Green Journal articles are free through the end of the calendar year. ACOG Publications February 2021 Obstetrics & Gynecology: February 2021 - Volume 137 - Issue 2 - p 383-384 doi: 10.1097/AOG.0000000000004242 Buy 2020 by the American College of Obstetricians and Gynecologists. In addition, if youre age 30 or older and have never had an abnormal Pap smear result before, talk with your healthcare provider about when it is appropriate to begin screening for cervical cancer by having a baseline test called a liquid-based cytology (LBC). cancer precursors. Widelyusedguidelines on screening women for cervical cancer have several important changes, including a recommendation to start screening at a slightly older age and use of an HPV test as the primary screening test. The introduction of vaccines targeting the most common cancer-causing HPV genotypes has advanced the primary prevention of cervical cancer. %%EOF The management guidelines were revised to reflect the availability of sufficient data from the United States showing that the risk-based approach can provide more appropriate and personalized management for an individual patient based on their current results and past history. %PDF-1.6 % The adoption of the USPSTF guidelines expands the recommended options for cervical cancer screening in average-risk individuals aged 30 years and older to include screening every 5 years with primary high-risk human papillomavirus (hrHPV) testing. of age and older. by Carmen Phillips, January 20, 2023, Adequate negative prior screening test results are defined as three consecutive negative cytology results, two consecutive negative cotesting results, or two consecutive negative hrHPV test results within 10 years before stopping screening, with the most recent test occurring within the recommended screening interval for the test used (1, 5). Public Health Rep 2020;135:48391. 702: Female Athlete Triad (Obstet Gynecol 2017;129:e160-7) REVISED The Steering Committee, Working Group members, and additional contributing authors for the ASCCP Risk Based Acog PAP Guidelines Algorithm 2020 PDF Overview A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. We also have seen great development of new technologies like HPV testing and improvement in some of the secondary tests that are used for following up after screening. 145: Antepartum Fetal Surveillance (Obstet Gynecol 2014;124:18292), ACOG Practice Bulletin No. The updated management guidelines aim to: Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited to develop guidelines that will apply to all situations. J Low Genit Tract Dis 2020;24:10231. A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. These recommendations were published in the April 2006 issue of Obstetrics & Gynecology. Save my name, email, and website in this browser for the next time I comment. Women with risk factors for cervical cancer should be screened more frequently than every three years under these guidelines as well; if you are over 30 and also have had an abnormal pap test result in the past 5 years or HPV infection, you should also get screened more frequently (every 3-5 years). You may still need to have screening if you have had a hysterectomy and your cervix was not removed. This algorithm is not intended for women with a personal history of cervical cancer1. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented. As a result, guidelines can become out of date rapidlyyears before the scheduled next cycle. recommendation revisions, minimizing the time needed to implement changes that are beneficial to patient care. Risk estimates were calculated using electronic health record data from patients in the Kaiser Permanente of Northern California cohort. The 2012 Guidelines relied on algorithms to map management for individual patients based on current test results. The ability to adjust to the rapidly emerging science is critical for the opinion. See the full list of organizations (below) that participated in the consensus process. September 2021 Number 1 Osteoporosis Prevention, Screening, and Diagnosis September 2021 Jump To . 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. U.S. Preventive Services Task Force. 500: Professional Responsibilities in ObstetricGynecologic Medical Education and Training (Obstet Gynecol 2011;118:4004), ACOG Committee Opinion No. The abnormal changes are called dysplasia; over time, these changes may progress to cervical cancer if left untreated. J Natl Med Assoc 2020;112:22932. cancer screening tests and cancer precursors. Cervical cancer screening recommendations have changed since the 2012 guidelines. Repeat Pap test in six and 12 months or high-risk HPV test alone in 12 months, Colposcopy, endocervical assessment, possible endometrial evaluation, Pap test at six and 12 months or high-risk HPV test at 12 months; colposcopy for any abnormality, Close follow-up at four- to six-month intervals (cytology or colposcopy)*. For more information, please refer to our Privacy Policy. Available at: Buskwofie A, David-West G, Clare CA. Huang, MD; Warner Huh, MD; Michelle Khan, MD, MPH; Jane Kim, PhD; Rachel Kupets, MD; Margaret Long, MD; Thomas Lorey Updated guidelines were needed to incorporate these changes. The specific strategy selected is less important than consistent adherence to routine screening guidelines. defined by IARC, including the 12 types that are considered Class 1 carcinogens, plus type 68 which is considered a Thank you to theASCCP Risk-Based Management Consensus GuidelinesParticipating Organizations: ASCCP,American Academy of Family Physicians (AAFP),American Cancer Society(ACS),American College of Nurse-Midwives (ACNM),American College of Obstetricians and Gynecologists (ACOG),American Society for Clinical Pathology (ASCP),American Sexual Health Association (ASHA), American Society of Cytopathology (ASC), Centers for Disease Control & Prevention (CDC), Cervivor, College of American Pathologists (CAP), Latino Cancer Institute, National Cancer Institute(NCI), Nurses for Sexual and Reproductive Health (NSRH), Nurse Practitioners in Women's Health (NPWH),Papanicolaou Society of Cytopathology, Society of Gynecologic Oncology (SGO), Team Maureen,Women Veterans Health Strategic Healthcare Group, ASCCP, 23219 Stringtown Rd, #210, Clarksburg, MD 20871. HPV 16+ NILM has a risk greater than 4% and needs colposcopy, HPV 16+ HSIL has risk >60% and needs expedited treatment). As a private, voluntary, nonprofit membership organization of more than 58,000 members, ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women's health care. Patients monitored without therapy should be reliable for follow-up and should understand the risks. There are a few risks that come with cervical cancer screening tests. Who developed these guidelines? 1. Aggressive management of benign lesions in adolescents should be avoided because most cervical intraepithelial neoplasia (CIN) grades 1 and 2 lesions regress spontaneously. 168, October 2016) development of the applications. These adolescents should be monitored with cytologic testing at six and 12 months or high-risk HPV testing at 12 months. Guidelines from USPSTF, ACOG, and ACS recommend that cervical cancer screening begin at age 21 years (124-126). 0yr2"c` `<0 "!.XXL*H1Y0&P9H261o K6A$Q$iE30120e`+ Bq Article Level Metrics Sorry we can't load that information at this time. Egemen D, Cheung LC, Chen X, et al. Atypical squamous cells of undetermined significance (ASC-US) may indicate HPV infection. Thats why ACS recommends starting screening at age 25.