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. 2020 Apr;24(2):132-143.
doi: 10.1097/LGT.0000000000000529.

Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines

Didem Egemen  1 , Li C Cheung  1 , Xiaojian Chen  1 , Maria Demarco  1 , Rebecca B Perkins  2 , Walter Kinney  3 , Nancy Poitras  4 , Brian Befano  5 , Alexander Locke  4 , Richard S Guido  6 , Amy L Wiser  7 , Julia C Gage  1 , Hormuzd A Katki  1 , Nicolas Wentzensen  1 , Philip E Castle  8 , Mark Schiffman  1 , Thomas S Lorey  3
Affiliations

Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines

Didem Egemen et al. J Low Genit Tract Dis. 2020 Apr.

Abstract

The 2019 American Society for Colposcopy and Cervical Pathology Risk-Based Management Consensus Guidelines for the management of cervical cancer screening abnormalities recommend 1 of 6 clinical actions (treatment, optional treatment or colposcopy/biopsy, colposcopy/biopsy, 1-year surveillance, 3-year surveillance, 5-year return to regular screening) based on the risk of cervical intraepithelial neoplasia grade 3, adenocarcinoma in situ, or cancer (CIN 3+) for the many different combinations of current and recent past screening results. This article supports the main guidelines presentation by presenting and explaining the risk estimates that supported the guidelines.

Methods: From 2003 to 2017 at Kaiser Permanente Northern California (KPNC), 1.5 million individuals aged 25 to 65 years were screened with human papillomavirus (HPV) and cytology cotesting scheduled every 3 years. We estimated immediate and 5-year risks of CIN 3+ for combinations of current test results paired with history of screening test and colposcopy/biopsy results.

Results: Risk tables are presented for different clinical scenarios. Examples of important results are highlighted; for example, the risk posed by most current abnormalities is greatly reduced if the prior screening round was HPV-negative. The immediate and 5-year risks of CIN 3+ used to decide clinical management are shown.

Conclusions: The new risk-based guidelines present recommendations for the management of abnormal screening test and histology results; the key risk estimates supporting guidelines are presented in this article. Comprehensive risk estimates are freely available online at https://CervixCa.nlm.nih.gov/RiskTables.

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Conflict of interest statement

The National Cancer Institute (including M.S. and N.W.) has received cervical screening results at reduced or no cost from commercial research partners (Qiagen, Roche, BD, MobileODT, Arbor Vita) for independent evaluations of screening methods and strategies. P.E.C. has received HPV tests and assays at a reduced or no cost from Roche, Becton Dickinson, Arbor Vita Corporation, and Cepheid for research. R.S.G. reports that he was an ASCCP consultant for the guideline and a DSMB consultant for Ikonosys. The other authors have declared they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Frequency of women at their first cotest visit based on age groups: First visit age group 30- to 34-year frequency reflects initiation of cotesting at 30 years and older starting in 2003. The 25- to 29-year age group frequency reflects KPNC initiation of cotesting starting at age 25 in 2013.
FIGURE 2
FIGURE 2
Determining suggested management based on calculated risk.
See this image and copyright information in PMC

References

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    1. Massad LS, Einstein MH, Huh WK, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013;17:S1–27. - PubMed
    1. Cheung LC, Egemen D, Chen X, et al. 2019 ASCCP risk-based management consensus guidelines: methods for risk estimation, recommended management, and validation. J Low Genit Tract Dis 2020;24:90–101. - PMC - PubMed
    1. Castle PE, Kinney WK, Cheung LC, et al. Why does cervical cancer occur in a state-of-the-art screening program? Gynecol Oncol 2017;146:546–53. - PMC - PubMed
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