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2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors

Massad, L. Stewart MD; Einstein, Mark H. MD; Huh, Warner K. MD; Katki, Hormuzd A. PhD; Kinney, Walter K. MD; Schiffman, Mark MD; Solomon, Diane MD; Wentzensen, Nicolas MD; Lawson, Herschel W. MD; for the 2012 ASCCP Consensus Guidelines Conference

doi: 10.1097/AOG.0b013e3182883a34
Current Commentary

A group of 47 experts representing 23 professional societies, national and international health organizations, and federal agencies met in Bethesda, MD, September 14-15, 2012, to revise the 2006 American Society for Colposcopy and Cervical Pathology Consensus Guidelines. The group’s goal was to provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia (CIN) and adenocarcinoma in situ (AIS) following adoption of cervical cancer screening guidelines incorporating longer screening intervals and co-testing. In addition to literature review, data from almost 1.4 million women in the Kaiser Permanente Northern California Medical Care Plan provided evidence on risk after abnormal tests. Where data were available, guidelines prescribed similar management for women with similar risks for CIN 3, AIS, and cancer. Most prior guidelines were reaffirmed. Examples of updates include: Human papillomavirus–negative atypical squamous cells of undetermined significance results are followed with co-testing at 3 years before return to routine screening and are not sufficient for exiting women from screening at age 65 years; women aged 21–24 years need less invasive management, especially for minor abnormalities; postcolposcopy management strategies incorporate co-testing; endocervical sampling reported as CIN 1 should be managed as CIN 1; unsatisfactory cytology should be repeated in most circumstances, even when HPV results from co-testing are known, while most cases of negative cytology with absent or insufficient endocervical cells or transformation zone component can be managed without intensive follow-up.

Updated guidelines describe consensus management for abnormal cervical cancer screening tests and cancer precursors, accommodating new epidemiologic concepts and screening guidelines.

Washington University School of Medicine, St. Louis, Missouri; Albert Einstein College of Medicine, New York, New York; University of Alabama School of Medicine, Birmingham, Alabama; Division of Cancer Epidemiology and Genetics and Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland; The Permanente Medical Group, Sacramento, California; and Emory University School of Medicine, Atlanta, Georgia.

Corresponding author: L. Stewart Massad, MD, Division of Gynecologic Oncology, Washington University School of Medicine, 4911 Barnes-Jewish Hospital Plaza, St. Louis, MO 63110; e-mail: massadl@wudosis.wustl.edu.

These guidelines are being published simultaneously in Obstetrics & Gynecology and the Journal of Lower Genital Tract Disease. The complete algorithms are published in the Journal of Lower Genital Tract Disease and are also available on the web site of the American Society for Colposcopy and Cervical Pathology (http://www.asccp.org/).

The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health or U.S. federal government.

Financial Disclosure Dr. Massad has served as an expert witness. Dr. Huh has served as a consultant to Roche. Dr. Schiffman has researched reagents for Qiagen and Roche. The other authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists