New ASCCP consensus guidelines for managing abnormal cervical cancer screening test results

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The guidelines, developed by a consensus of 19 national organizations convened by ASCCP, are an update to 2012 consensus guidelines. New guidelines emphasize reducing invasive procedures while maintaining high standards of cancer prevention.

New guidance for managing further testing in patients with minimal abnormalities detected during cervical cancer screenings will be shared at the American College of Obstetricians and Gynecologists (ACOG) 2020 Virtual Conference.

“Although the older guidelines represented a conceptual breakthrough in risk-based management, those recommendations retained a continued reliance on complicated algorithms and insufficiently incorporated past screening history,” said Rebecca Perkins, MD, first co-author of the new guidelines. “Since their issuance, we have developed a more nuanced understanding of how prior results affect risk, and more variables to consider, such as the natural progression of human papillomavirus (HPV) and cervical carcinogenesis.”

Screening outcomes among 1.5 million people revealed that 90% of test results were normal and only 0.75% were severely abnormal.

“Colposcopy is still recommended if the estimated risk of currently having a precancer or cancer is from 4% to 24% or if testing results are positive for the HPV types 16 or 18, which are most highly associated with cervical cancer,” said Dr. Perkins, an associate professor of ob/gyn at Boston University School of Medicine and Boston Medical Center.

If the risk of currently having a precancer is from 25% to 59%, the patient may choose either a colposcopy with biopsy or proceed directly to treatment. But if the risk is 60% or higher, it is preferred that patients undergo treatment without requiring a biopsy first, according to Dr. Perkins.

Rebecca Perkins, MD, first co-author of the new guidelines and an associate professor of ob/gyn at Boston University School of Medicine and Boston Medical Center.

“This was an option in the prior guidelines, but has been more clearly defined in the new guidelines,” she said.

In addition, patients with minor abnormalities, such as Pap test results that indicate low-grade or atypical squamous cells of undetermined significance (ACS-US) or HPV infections, “can defer colposcopy, if these results were preceded by negative screening with either HPV testing or co-testing within the past 5 years or if preceded by a colposcopy at which precancer was not found in the past year,” Dr. Perkins told Contemporary OB/GYN. “Previously, colposcopy was always recommended for these outcomes, but new data indicate that follow-up in 1 year is safe for many patients.”

Adhering to the new guidelines will result in fewer patients being referred to colposcopy, “and those who are referred are at higher risk for precancer,” Dr. Perkins said. “The new guidelines are also designed to minimize unnecessary biopsies where precancer is not found, reduce patient harm and allow resources to be concentrated on high-risk patients.”

Hence, colposcopists should have a high level of suspicion and biopsy all abnormal-appearing areas, typically two to four biopsies per colposcopy.

“They should also expect that a higher proportion of their colposcopy patients will have precancer requiring treatment,” Dr. Perkins said.

The guidelines’ framework is based on a patient's risk of precancer rather than a specific combination of test results.

“This will allow more personalized recommendations for patients, and more streamlined incorporation of new screening and diagnostic technologies into clinical practice,” Dr. Perkins said. “Management of abnormal test results will shift from paper algorithms to electronic decision aids, which will further facilitate patient care predicated on the best available data.”

The ACOG 2020 Virtual Conference will be held on October 30 and 31 from noon to 4 pm ET. Register here.

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Dr. Perkins reports no relevant financial disclosures.