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 to managing abnormal cervical cancer screening tests, focusing on a patient's risk of developing cervical cancer rather than specific test results alone. The guidelines recommend management decisions based on the patient's current risk of high-grade cervical disease (CIN 3+), which is determined by combining current test results with past screening history 1. Key points include:

• Colposcopy can be deferred for patients at low risk
• If a patient has a minimally abnormal test result that was preceded by a negative screening HPV test or cotest within the past 5 years, follow-up in 1 year instead of colposcopy is recommended
• 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 HSIL cytology and an HPV test positive for HPV type 16 1. The guidelines emphasize the use of risk thresholds to guide clinical actions, allowing for more personalized management decisions and reducing unnecessary procedures 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 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 present six clinical actions: treatment, optional treatment or colposcopy/biopsy, colposcopy/biopsy, 1-year surveillance, 3-year surveillance, and 5-year return to regular screening 2.
• Risk estimates are based on data from 1.5 million individuals aged 25 to 65 years who underwent human papillomavirus (HPV) and cytology cotesting scheduled every 3 years at Kaiser Permanente Northern California (KPNC) from 2003 to 2017 2, 3.
• The risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative 2.
• Comprehensive risk estimates are freely available online at https://CervixCa.nlm.nih.gov/RiskTables 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 4.
• 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.
• HPV genotyping can be used as a risk-based triage approach for women with atypical squamous cells-undetermined significance (ASC-US) and low-grade squamous intraepithelial lesions (LSIL) cytology 5.

Clinical Actions and Risk Estimation

• The guidelines recommend clinical actions based on the estimated risk of CIN 3+ 2, 3.
• Risk tables are presented for different clinical scenarios, including combinations of current test results paired with history of screening test and colposcopy/biopsy results 2.
• The immediate and 5-year risks of CIN 3+ are used to decide clinical management 2.
• The guidelines provide a framework for risk-based management, allowing for personalized management recommendations based on individual risk estimates 4.

Implications for Laboratories and Pathologists

• The guidelines have implications for laboratories, pathologists, and cytotechnologists, including the need to adjust laboratory practices to accommodate the new risk-based management approach 4.
• Pathology organizations were closely involved in the development of the guidelines, and the guidelines support the principles of "equal management for equal risk" and "balancing harms and benefits" 4.