ASCCP guidelines prioritize risk for management of abnormal screenings

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Rebecca B. Perkins, MD, MSC, associate professor in the Department of Obstetrics and Gynecology at the Boston University School of Medicine, walked audience members through the 2019 ASCCP Guidelines for management of abnormal results on cervical cancer screenings.She served as a co-chair for the 2019 Risk-Based Management Consensus Guidelines project under ASCCP, which is a professional society of an interdisciplinary group of healthcare professionals that includes physicians, physician assistants, nurse practitioners, midwives and researchers, who are focused on improving lives through the prevention and treatment of anogenital and HPV-related diseases.

These revised guidelines provide a framework for incorporating new data and technologies as ongoing incremental recommendation revisions, minimizing time to implement changes that are beneficial to patient care, Perkins and colleagues have said. Central to understanding abnormal test results is understanding human papillomavirus (HPV) and its genotypes.

According to a joint statement on HPV elimination from 22 organizations (including the ACOG, American Academy of Pediatrics, the American Cancer Society, American Urological Society, and the Society of Family Planning), HPV is a type of virus that can cause abnormal tissue growth and other changes to cells and causes significant morbidity and mortality in adults. HPV infection is associated with anogenital cancer (including cervical, vaginal, vulvar, penile, and anal), oropharyngeal cancer, recurrent respiratory papillomatosis, and genital warts.

Of the more than 150 HPV genotypes, only a small fraction cause cancer, but the malignancies these viruses cause often don’t develop for years or even decades after the initial infection.

Perkins said that the new guidelines evaluate risk and use evidence to triage patients. “Past history influences current risk,” she said. “We actually have different management for patients who have not been screened.”

For example, it stands to reason that women who have not been able to participate in screening are at higher risk. Since the pandemic also affected patients’ willingness to be screened, there now is a significant backlog of patients who need to be screened. “We actually have a nice evidence-based way of bringing them in,” she said of the new guidelines.

“It’s important that we’re bringing patients back in and doing it in an evidence-based way.”

“We are now preferring HPV testing in follow up,” Perkins said. “Cytology alone is a snapshot. It really doesn’t tell you if there is an HPV infection that may put the patient at risk later.”

Two of the most significant changes is that patients who are at high risk will go straight to treatment. Patients who are lower risk than practitioners thought are managed completely differently where they can be allowed to skip colposcopy for a year.

For more information on the guidelines, visit www.asccp.org/management-guidelines. ASCCP also developed apps for iOS and Android, along with a Web application.