From the Guidelines
The 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors prioritize a patient's risk of developing cervical precancer or cancer, guiding management decisions based on individual risk assessment. The guidelines combine patient-level risk data with clinical action thresholds to generate personalized management recommendations, allowing for the identification of persons at high risk who require colposcopy or expedited treatment and those at low risk who might safely defer invasive diagnostic procedures 1. Key points of the guidelines include:
- Colposcopy can be deferred for patients at low risk, with follow-up in 1 year instead of colposcopy recommended for patients with minimally abnormal test results preceded by a negative screening HPV test or cotest within the past 5 years
- Referral to colposcopy is recommended if cytology test results are abnormal or the HPV test is positive at the 1-year follow-up visit
- Treatment can be expedited for high-risk patients, with loop electrosurgical excision procedure (LEEP) recommended for patients with high-grade cytology results and HPV positivity for HPV type 16
- The guidelines emphasize the importance of complete documentation of colposcopy findings and endocervical sampling for certain situations, and recommend excisional treatments rather than ablative methods when high-grade disease is identified 1. The guidelines aim to personalize care based on individual risk assessment, reducing unnecessary procedures for low-risk patients while ensuring adequate intervention for those at higher risk, ultimately improving morbidity, mortality, and quality of life outcomes for patients with abnormal cervical cancer screening tests and cancer precursors 1.
From the Research
Key Points of 2019 ASCCP Risk-Based Management Consensus Guidelines
- The 2019 ASCCP Risk-Based Management Consensus Guidelines recommend one of six clinical actions based on the risk of cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, or cancer (CIN 3+) for different combinations of current and recent past screening results 2.
- The guidelines use 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 present recommendations for the management of abnormal screening test and histology results, with key risk estimates supporting the guidelines available online 2.
- The risk-based management is derived from a large cohort of patients undergoing triennial cervical screening by cotesting at the Kaiser Permanente Northern California from 2003 to 2017 4.
- The guidelines continue to support the principles of "equal management for equal risk" and "balancing harms and benefits" adopted in the 2012 version of the guidelines 3.
Clinical Actions Recommended by the Guidelines
- Treatment
- Optional treatment or colposcopy/biopsy
- Colposcopy/biopsy
- 1-year surveillance
- 3-year surveillance
- 5-year return to regular screening 2
Risk Estimation and Management
- The guidelines estimate immediate and 5-year risks of CIN 3+ for combinations of current test results paired with history of screening test and colposcopy/biopsy results 2.
- Risk tables are presented for different clinical scenarios, with examples of important results highlighted 2.
- The guidelines validate the recommended management by comparing with the estimated risks in several external data sources 4.