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 . test results in isolation, the new guidelines use current and past results to create individualized assessments of a J Low Genit Tract Dis 2020;24:144-7. This was a large consensus effort involving several clinical organizations, federal agencies, and patient representatives. acog pap guidelines algorithm 2021 pdf 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. As with many tests, there is the potential to do more harm than good if they are applied too frequently. cervical cancer screening tests and cancer precursors. The new guidelines rely on individualized assessment of risk for precancer (CIN3+), taking into account past history and current results. Copyright 2023 American Academy of Family Physicians. The PDFKEGs Acog PAP Guidelines Algorithm 2020 is an easy-to-use, interactive document that helps clinicians manage patients with suspected obstructive sleep apnea. Participating organizations It is also important to recognize that these guidelines should never substitute for clinical judgment. 0yr2"c` `<0 "!.XXL*H1Y0&P9H261o K6A$Q$iE30120e`+ Bq Available at: https://www.nsgc.org/page/abnormal-non-invasive-prenatal-testing-results. 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. The difference in the new ACS guidelines is that they elevate HPV testing alone over the other two tests. Also, you can rule out disease really well with HPV tests so they dont have to be repeated as frequently. On July 30, the American Cancer Society (ACS) published an updated guideline for cervical cancer screening. Find out more. Pap screening may end at age 65 if the Pap history is unremarkable and the patient is low risk. The guidelines recommendations differ in a few ways from ACSs prior recommendations and those of other groups. Risk estimates supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines. The new ACOG guidelines also say that women over 30 years old should have a Pap test every three years if they are healthy, have been having regular annual check-ups and do not have symptoms. Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP. to develop guidelines that will apply to all situations. We also have new evidence from large studies that really give us the assurance that we can update screening practices to provide better outcomes for women and for the health care system. Read the 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors, access the mobile app, and refer to the historical 2012 and 2006 guidelines. The American College of Obstetricians and Gynecologists (ACOG), is the nation's leading group of physicians providing health care for women. Article Level Metrics Sorry we can't load that information at this time. by Carmen Phillips, January 20, 2023, They also recommend that women over 30 whove had negative tests for HPV at least 3 times in a row can stop getting them altogether (but if youre over 30 and havent had a negative test for HPV yet, keep getting tested!). New data indicate that a patient's Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, et al. The standard approach is to do a Pap test, but there is also a new FDA-approved test, called dual stain. 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. Currently, there are two hrHPV tests approved by the FDA for primary screening in individuals aged 25 years and older. 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. Because the new Risk-Based 817: Options for Prevention and Management of Menstrual Bleeding in Adolescent Patients Undergoing Cancer Treatment (Obstet Gynecol 2021;137:e715), ACOG Committee Opinion No. writing of manuscript, and decision to submit for publication. Routine screening applies Acog PAP Guidelines Algorithm 2020 PDF Overview Cervical cytology screening is associated with a reduction in the incidence of and mortality from invasive squamous cancer. Reference:https://journals.lww.com/jlgtd/Fulltext/2020/04000/A_Study_of_Partial_Human_Papillomavirus_Genotyping.5.aspx. 5. Available at: Yeh PT, Kennedy CE, de Vuyst H, Narasimhan M. Self-sampling for human papillomavirus (HPV) testing: a systematic review and meta-analysis. The time: Negative HPV test or cotest within 5 years. The American Cancer Society (ACS) recommends that women ages 21 to 29 have a Pap test every 3 years. You have human immunodeficiency virus (HIV). risk of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or more severe diagnoses (CIN3+), regardless of 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. After a diagnosis of high-grade histology or cytology, patients may undergo hysterectomy for reasons related or unrelated to their cervical abnormalities.If hysterectomy is performed for treatment, patients should have 3 consecutive annual HPV-based tests before entering long-term surveillance. Note that a negative past history should be entered only when documented in the medical record and performed on The provider will then use a speculum (a device that holds open the walls of your vagina), which is inserted into your vagina. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. The 2018 USPSTF guideline included HPV testing alone, cotesting, and Pap testing as equal options. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. 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. They will then examine it under a microscope in order to detect any abnormal changes in your cervical cells that could be cancerous or pre-cancerous lesions (precancers). hb```@(qAqm_ ;+GF*MVu28XEK-P 1sW]tQyIGJVI^b*#m!3G3KR+p8c<1T:4m:!d!;U3\8VNY !U+4 Although HPV self-sampling has the potential to greatly improve access to cervical cancer screening, and there is an increasing body of evidence to support its efficacy and utility, it is still investigational in the United States 5 11 . a reflex HPV test. Data from clinical trial, cohort, and modeling studies demonstrate that among average-risk patients aged 2565 years, primary hrHPV testing and co-testing detect more cases of high-grade cervical intraepithelial neoplasia than cytology alone, but hrHPV-based tests are associated with an increased risk of colposcopies and false-positive results 1 6 7 . By reading this page you agree to ACOG's Terms and Conditions. Evaluation of a colposcopic biopsy: Management of biopsy results after colposcopy. evaluating histologic specimens obtained via colposcopic biopsy. If you dont know how often you should get screened for cervical cancer or if there are other factors like age or ethnicity that make it advisable for women who arent at risk to get additional testing (like HPV testing), make sure to consult with your doctor about whats right for YOU! The 2012 ASCCP guidelines were based on which test a patient got and what the results were. 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. In adolescents, CIN 2 can be managed with observation or with ablative or excisional therapy. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert HPV tests are a newer method of cervical cancer screening. Patients with symptoms such as abnormal uterine or vaginal bleeding or a visibly abnormal-appearing cervix require appropriate diagnostic testing as this may be a sign of cancer. Release of the 2020 American Cancer Society Cervical Cancer Screening Guidelines On July 30th, the American Cancer Society (ACS) released its updated guidelines for "Cervical Cancer Screening for . 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. Available at: Benard VB, Castle PE, Jenison SA, Hunt WC, Kim JJ, Cuzick J, et al. J Low Genit Tract Dis 2020;24:10231. cancer precursors. If you are 21 to 29 Have a Pap test alone every 3 years. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years - United States, 2019. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. Healthy People 2030. JAMA Oncol 2017;3:8337. Clinical Practice Listserv (Members Only), Colposcopy Education Completion Program (formerly CMP), new iOS& Android mobile apps and the Web application, https://journals.lww.com/jlgtd/Fulltext/2020/04000/2019_ASCCP_Risk_Based_Management_Consensus.2.aspx, https://www.sciencedirect.com/science/article/pii/S2213294520300818, https://journals.lww.com/jlgtd/Fulltext/2020/04000/A_Study_of_Partial_Human_Papillomavirus_Genotyping.5.aspx. 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. Reflex testing: this means that laboratories should perform a specific additional triage test in the setting The value of genotyping for surveillance in different clinical settings (post colposcopy and posttreatment) and the additional risk stratification of more detailed genotyping are being assessed and guidance will follow in subsequent updates of the Guidelines. See the full list of organizations (below) that participated in the consensus process. Egemen PhD; Mark Einstein, MD; Carol Eisenhut, MD, MBA; Tamika Felder; Sarah Feldman, MD, MPH; Francisco Garcia, MD; 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. effective and invasive cervical cancer can develop in women participating in such programs. PAP Education Program. Management of abnormal cervical cancer screening results should follow current ASCCP guidelines 3 4 . All these improvements have allowed us to make more accurate predictions of a persons chances of getting cervical precancer and cancer. HPV natural history and cervical carcinogenesis. 541: Professional Relationships With Industry (Obstet Gynecol 2012;120:12439), ACOG Committee Opinion No. Note that a negative past history should be entered only when documented in the medical record and performed on This content is owned by the AAFP. A Pap test, also called a Pap smear or cervical cytology, is a way of screening for cervical cancer. But there are current efforts to study the age limit more because its an area where we have less data. There will be an option available at no cost. Ask you to lie on your back on an examination table. 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). Available at: Melnikow J, Henderson JT, Burda BU, Senger CA, Durbin S, Weyrich MS. 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 screening, prompted the American College of Obstetricians and Gynecologists (ACOG) to develop new guidelines for the management of abnormal cervical cytology and histology. Guidelines New Management Guidelines Are Here ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors have been published. The new Risk-Based Management Consensus Guidelines have several important differences from the 2012 Guidelines, The Pap test is a method for examining cells from the cervix. Wolters Kluwer Health 4. Bulk pricing was not found for item. Thats why ACS recommends starting screening at age 25. AGE TO BEGINSCREENINGRECOMMENDATION Under 21 years of ageScreening not recommended 21 - 29 years of age 30 - 65 years of age 65 years of age Status post hysterectomy for benign disease Liquid-based Pap test every 3 years2,3,4 Declines in prevalence of human papillomavirus vaccine-type infection among females after introduction of vaccineUnited States, 2003-2018. Screening for cervical cancer with high-risk human papillomavirus testing: updated evidence report and systematic review for the US Preventive Services Task Force. Identification of HPV 16 at the first visit including HPV testing elevated immediate risk of diagnosing CIN 3+ sufficiently to mandate colposcopic referral even when cytology was Negative for Intraepithelial Lesions or Malignancy and to support a preference for treatment of cytologic high-grade squamous intraepithelial lesion. And it detects a lot of minor changes that have a very low risk of turning into cancer. ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors have been published. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. 510: Ethical Ways for Physicians to Market a Practice (Obstet Gynecol 2011;118:11957), ACOG Committee Opinion No. | U.S. Preventive Services Task Force. Even if you are not due for cervical cancer screening, you should still see your ob-gyn regularly for birth control counseling, vaccinations, health screenings, prepregnancy care, and the latest information about your reproductive health. Place your feet in stirrups. For example, an immediate CIN3+ risk of 4% is the Clinical Action Threshold for colposcopy; risks below Am J Clin Pathol 2012;137:51642. Available at: https://www.asccp.org/Assets/b2263c88-ec67-4ab0-9f07-6f112e76f8d7/637269576182030000/2019-asccp-risk-based-management-consensus-3-5-pdf. The specific strategy selected is less important than consistent adherence to routine screening guidelines. National Society of Genetic Counselors (NSGC), November 2014. 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. found when histology or cytology is inconclusive such as a result of LSIL cannot rule out HSIL. Counseling for diet, exercise, smoking , birth control, STD prevention, Immunization etc. A Pap test, often called a Pap smear, looks for abnormal cells that can lead to cancer in the cervix. Available at: U.S. Department of Health and Human Services. The Pap test looks for changes in the cells of your cervix that may be caused by hpv (human papillomavirus), an extremely common virus that affects both men and women. Atypical glandular cells (AGC) in adolescents are rare. Although cervical cancer screening options have expanded, cervical cytology, primary hrHPV testing, and co-testing are all effective in detecting cervical precancerous lesions and cancer. Screening recommended every 3 years for women 21-29. You may be trying to access this site from a secured browser on the server. 809. The corresponding authors had final responsibility for the submission decision. high-risk HPV types only. Michael Gold, MD; Robert Goulart, MD; Richard Guido, MD; Paul Han, MD; Sally Hersh, DNP; Aimee Holland, DNP; Eric New for these guidelines, a positive screening HPV test should trigger both a reflex genotyping 104 0 obj <> endobj Do the new guidelines still use algorithms? American College of Obstetricians and Gynecologists 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. 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. This information is not intended for use without professional advice. The Pap test can find early signs of cervical cancer. USPSTF Recommendations for Routine Cervical Cancer Screening. JAMA 2018;320:67486. Sometimes, two cell samples are taken. Demarco M, Egemen D, Raine-Bennett TR, et al. 702: Female Athlete Triad (Obstet Gynecol 2017;129:e1607). www.acog.org. The algorithm contains tabs with videos and links to additional resources designed to make it easier to guide your next visit. Women 30-65 and older who have had 3 consecutive negative Pap test and who have no history of CIN2 or 3, etc. Within this text, HPV refers specifically to high-risk HPV as Publications of the American College of Obstetrician and Gynecologists are protected by copyright and all rights are reserved. 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 . A Practice Advisory constitutes ACOG clinical guidance and is issued only on-line for Fellows but may also be used by patients and the media. 162: Prenatal Diagnostic Testing for Genetic Disorders (Obstet Gynecol 2016;127:e10822), ACOG Practice Bulletin No. Read common questions on the coronavirus and ACOGs evidence-based answers. National Society of Genetic Counselors (NSGC), November 2014. 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. 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 . How are these guidelines different? 409 12th Street SW, Washington, DC 20024-2188, Privacy Statement 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Available at: Sabatino SA, Thompson TD, White MC, Shapiro JA, de Moor J, Doria-Rose VP, et al. Society for Maternal-Fetal Medicine (SMFM). Please try after some time. PFSI009: This information was designed as an educational aid to patients and sets forth current information and opinions related to womens health. Confirm your email to receive complimentary access to the ASCCP Management Guidelines web application. ASCCP (formerly known as The American Society of Colposcopy and Cervical Pathology) recently published updated guidelines for the care of patients with abnormal cervical screening test results. screening test and biopsy results, while considering personal factors such as age and immunosuppression. 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. 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. 209: Obstetric Analgesia and Anesthesia (Obstet Gynecol 2019;133:e20825). So, the vaccines have led to a drop in HPV infections and cervical precancer in this age group. Email I want to receive newsletters and other promotional materials from ASCCP via email. It is not intended to substitute for the independent professional judgment of the treating clinician. 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. Theres alsothe possibility of added anxiety and other emotions from incorrect, or false-positive, test results. See Downloadable PDFs below for details. management from one that is based on specific test results to one that is based on a patient's risk will allow for 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. Available at: Johnson NL, Head KJ, Scott SF, Zimet GD. Any updates to this document can be found on www.acog.orgor by calling the ACOG Resource Center. risk of developing cervical precancer or cancer can be estimated using her current screening test results and prior There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. For more information on the USPSTF grades, see https://www.uspreventiveservicestaskforce.org/Page/Name/grade-definitions Primary hrHPV testing is FDA approved for use starting at age 25 years, and ACOG, ASCCP, and SGO advise that primary hrHPV testing every 5 years can be considered as an alternative to cytology-only screening in average-risk patients aged 2529 years. Adult and adolescent women with HSIL should have colposcopy with endocervical assessment. Adolescents with HSIL cytology and a postcolposcopy diagnosis of CIN 1 or less with adequate colposcopy and negative results on endocervical assessment may be monitored with colposcopy and cytology at four to six months. This evaluation may include cervical cytology, colposcopy, diagnostic imaging, and cervical, endocervical, or endometrial biopsy. Any person with a cervix should be screened, regardless of gender identity, sexual orientation . Given these concerns, ACOG, ASCCP, and SGO continue to recommend cervical cancer screening initiation at age 21 years. HPV-based testing: this term is used in this document to describe the use of either cotesting or primary HPV 724: Consumer Testing for Disease Risk (Obstet Gynecol 2017;130:2703) has been withdrawn and replaced by ACOG Committee Opinion No. HPV: this term refers to Human Papillomavirus. It also allows your doctor to determine if treatment or further testing should be needed. >21 years: shared decision between provider and patient, no recommendations either way for bimanual or pelvic exam (ACOG) In future some visits will be just talking and listening!! 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. HPV vaccines are very good at preventing HPV infections, particularly infection with HPV types 16 and 18, the types that cause most cervical cancers. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred. Although the guidelines are based on evidence whenever possible, for certain clinical situations, there is limited 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. It is also important to recognize that these guidelines should never substitute for clinical judgment. The goals of the ASCCP Risk-Based Management Consensus Guidelines are to increase accuracy and reduce complexity for providers and patients while maintaining a high degree of safety for patients. 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. The American Cancer Societys new guideline has two major differences from previous guidelines. Colposcopic examination confirming CIN1 or less within 1 year. The recommended age limit for cervical cancer screening has been consistent across different guidelines over the years. Management Consensus Guidelines Committee includes: If you experience severe bleeding after sexual intercourse or other strenuous activity, you may need a hysterectomy in addition to surgery for your cervical abnormality. high quality evidence, and in these situations the guidelines have, by necessity, been based on consensus expert However, if youre younger than 21 or older than 65, you should consult your healthcare provider about how often to get screened for cervical cancer. If you are 30 to 65You can choose one of three options: Have a Pap test and an HPV test (co-testing) every 5 years. Two HPV tests have been approved by the Food and Drug Administration (FDA) for use as a primary HPV test, meaning it is not part of an HPV/Pap cotest.