From the Guidelines
The 2019 ASCCP Risk-Based Management Consensus Guidelines recommend a risk-based approach to managing abnormal cervical cancer screening tests, prioritizing colposcopy and expedited treatment for high-risk patients, while allowing for deferred invasive diagnostic procedures for low-risk patients. The guidelines combine patient-level risk data with clinical action thresholds to generate personalized management recommendations, focusing on the risk of developing CIN 3 rather than specific test results 1. Key highlights of the guidelines include:
- Deferring colposcopy for patients at low risk
- Recommending follow-up in 1 year instead of colposcopy for patients with minimally abnormal test results who have had a negative screening HPV test or cotest within the past 5 years
- Referring to colposcopy if cytology test results are abnormal or the HPV test is positive at the 1-year follow-up visit
- Expediting treatment for high-risk patients, such as those with high-grade cytology results and positive HPV tests for HPV type 16 1. The guidelines aim to balance the benefits of detecting precancerous lesions with the potential harms of overtreatment, recognizing that most HPV infections and minor cellular abnormalities resolve spontaneously, particularly in younger women. By using a risk-based approach, the guidelines allow for more personalized care, potentially reducing unnecessary procedures for low-risk patients while ensuring appropriate intervention for those at higher risk 1.
From the Research
Overview of the 2019 ASCCP Risk-Based Management Consensus Guidelines
- The 2019 ASCCP Risk-Based Management Consensus Guidelines recommend clinical action based on the risk of cervical precancer and cancer 2.
- The guidelines employ HPV-based testing as the basis for risk estimation and allow for personalized risk-based management by incorporating knowledge of current results with prior results 3.
- The guidelines support the principles of "equal management for equal risk" and "balancing harms and benefits" adopted in the 2012 version of the guidelines 3.
Key Components of the Guidelines
- The guidelines present management of abnormal cervical screening results based on risk profiles for different clinical scenarios and combinations of past and current human papillomavirus and cytology test results 2.
- The guidelines recommend risk-based management derived from the Kaiser Permanente Northern California, which largely agreed with the management implied from the estimated risks of other data sources 2.
- The guidelines continue to support the use of HPV testing in cervical cancer screening, which plays an important role in identifying HSIL in patients with ASC-US, LSIL, and NILM 4.
Updates and Cost-Effectiveness
- The guidelines have been updated through 2023 to include endorsement of the 2021 Opportunistic Infections guidelines for HIV+ or immunosuppressed patients, clarification of use of human papillomavirus testing alone, and revision of unsatisfactory cytology management 5.
- A cost-effectiveness analysis of the 2019 guidelines found that they were less costly and more effective than the 2012 guidelines, with fewer colposcopies and cancer deaths 6.
- The 2019 guidelines were found to be more cost-effective at a willingness-to-pay threshold of $100,000 per life year gained, supporting the principle of "equal management of equal risks" 6.