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 intraepithelial neoplasia grade 3 or worse (CIN 3+), rather than specific test results alone. The guidelines use current and past screening results to calculate a patient's risk, then recommend management based on risk thresholds 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 that were preceded by a negative screening HPV test or cotest within the past 5 years 1
- Referral to colposcopy is recommended if cytology test results are abnormal or the HPV test is positive at the 1-year follow-up visit 1
- Treatment can be expedited for high-risk patients, with loop electrosurgical excision procedure (LEEP) recommended for patients with high-grade cytology results and an HPV test positive for HPV type 16 1
- The guidelines emphasize the use of electronic technology, such as smartphone applications or websites, to facilitate the use of the guidelines and provide continually updated information 1
- Management of abnormal results follows risk-based thresholds rather than specific result categories, allowing for more personalized management and consideration of factors like age, HPV vaccination status, and screening history 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 human papillomavirus (HPV) and cytology cotesting results, as well as history of screening test and colposcopy/biopsy results 2, 3.
- 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" and will be able to adjust for decreasing CIN3+ risks as more patients who received HPV vaccination reach screening age 4.
Risk Estimation and Management
- 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 risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative 2.
- HPV genotyping can identify multiple risk bands for high-grade cervical disease, supporting a 1-year follow-up period to preclude immediate colposcopy for women with low-risk HPV genotypes 5.
- Co-testing with cytology and high-risk HPV testing can identify patients with higher risk for developing cervical abnormalities 6.
Implications for Laboratories and Pathologists
- The guidelines will require adjustments to laboratory practices, including modifications to screening and reporting recommendations 4.
- Pathology organizations were closely involved in the development of the guidelines, and pathologists will play a key role in implementing the new risk-based management approach 4.