What are the key points of the 2019 American Society for Colposcopy (ASCCP) and Cervical Pathology Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests and cancer precursors?

From the Guidelines

The 2019 ASCCP Risk-Based Management Consensus Guidelines prioritize a risk-based approach for managing abnormal cervical cancer screening tests, focusing on patient-level risk data and clinical action thresholds to guide personalized management recommendations. The guidelines, as outlined in the 2021 sexually transmitted infections treatment guidelines 1, aim to identify individuals at high risk who require colposcopy or expedited treatment and those at low risk who can safely defer invasive diagnostic procedures. 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, such as those with high-grade cytology results and HPV type 16 positivity
• The guidelines emphasize the use of electronic technology, such as smartphone applications or websites, to facilitate the use of the guidelines and incorporate future revisions. The guidelines can be accessed through the ASCCP website (https://www.asccp.org/Default.aspx) 1. The guidelines allow for more personalized management, potentially reducing unnecessary procedures while maintaining effective cancer prevention through appropriate surveillance and intervention based on individual risk assessment, as supported by the 2021 guidelines 1.

From the Research

Key Points of the 2019 ASCCP Risk-Based Management Consensus Guidelines

• The 2019 American Society for Colposcopy and Cervical Pathology (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 risk estimates to determine the recommended management, which is based on the immediate and 5-year risks of CIN 3+ 2, 3.
• The risk estimates are derived from a large cohort of patients who underwent triennial cervical screening by cotesting at Kaiser Permanente Northern California from 2003 to 2017 2, 3.
• The guidelines recommend clinical action based on the risk of CIN 3+, which is estimated using a combination of current and past human papillomavirus (HPV) and cytology test results 2, 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 4.
• The guidelines also take into account the decreasing CIN3+ risks as more patients who received HPV vaccination reach screening age 4.

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

Importance of HPV Testing

• HPV testing plays an important role in cervical cancer screening by identifying HSIL in patients with ASC-US, LSIL, and NILM 5.
• Co-testing (combination of cervical cytology and high-risk HPV testing) is an optimal method for identifying patients with higher risk for developing cervical abnormalities 5.