Enduring Consensus Guidelines for Cervical Cancer Screening and Management: Introduction to the Scope and Process

Abstract

Objectives: The Enduring Consensus Cervical Cancer Screening and Management Guidelines (Enduring Guidelines) effort is a standing committee to continuously evaluate new technologies and approaches to cervical cancer screening, management, and surveillance.

Methods and results: The Enduring Guidelines process will selectively incorporate new technologies and approaches with adequate supportive data to more effectively improve cancer prevention for high-risk individuals and decrease unnecessary procedures in low-risk individuals. This manuscript describes the structure, process, and methods of the Enduring Guidelines effort. Using systematic literature reviews and primary data sources, risk of precancer will be estimated and recommendations will be made based on risk estimates in the context of established risk-based clinical action thresholds. The Enduring Guidelines process will consider health equity and health disparities by assuring inclusion of diverse populations in the evidence review and risk assessment and by developing recommendations that provide a choice of well-validated strategies that can be adapted to different settings.

Conclusions: The Enduring Guidelines process will allow updating existing cervical cancer screening and management guidelines rapidly when new technologies are approved or new scientific evidence becomes available.

FIGURE 1

Overview of cervical screening and management guidelines in the United States. The figure summarizes the continuum from cervical screening to management and treatment of cervical precancers for prevention of cervical cancer and related US guidelines. The Enduring Guidelines process primarily addresses management of abnormal screening results but may extend to specific questions related to screening and treatment. HPV, human papillomavirus; USPSTF US Preventive Services Task Force.

FIGURE 2

Roles and responsibilities in the Enduring Guidelines process. The development of recommendations in the Enduring Guidelines process involves several groups. The Technology and Risk Assessment Group conducts evidence evaluation through literature review and primary data analysis with risk assessment, as well as methods development when necessary. Working Groups include clinical, epidemiological, and statistical experts as well as patient representatives to evaluate evidence provided by the Technology and Risk Assessment Group and to develop draft recommendations. The Consensus Stakeholder Group includes voting members from all participating societies, agencies, and patient advocacy groups. The Stakeholder Group evaluates draft recommendations with supporting evidence and votes on final recommendations. The Steering Committee oversees the operations of the Enduring Guidelines process, communicates with stakeholders, and manages conflicts of interest, where necessary.

FIGURE 3

Enduring Guidelines process to develop new recommendations. The Enduring Guidelines process goes through several steps for development of new recommendations in 1 of 4 topic areas. Following evidence review and risk assessment, risk estimates are evaluated in the context of clinical action thresholds that form the bases of draft recommendations. Recommendations are discussed and revised as necessary before voting occurs. Ratified recommendations are published in peer-reviewed journals and integrated into clinical decision support tools.