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Updated ASCCP Management Guidelines1

The Updated Consensus Guidelines on the Management of Women with Abnormal Cervical Cancer Screening Tests and Cancer Precursors © 2013 aimed to update previously published guidelines, specifically in light of new screening changes that have indicated co-testing with cytology and HPV at 5 year intervals is preferred for women 30-65 years of age.

Management of Women with:

ASC-US

Atypical Squamous Cells of Undetermined Significance (ASC-US) on Cytology:

  • Reflex HPV testing is preferred.  For women with HPV-negative ASC-US (whether from reflex HPV testing or co-testing), repeat co-testing at 3 years is recommended.  For women with HPV-positive ASC-US (whether from reflex HPV testing or co-testing), colposcopy is recommended.
  • Repeat cytology at 1 year is acceptable.

Management of women with Atypical Squamous Cells of Undetermined Significance on Cytology

Cytology-negative but HPV Positive

Women ≥30, who are Cytology-negative but HPV Positive:

  • HPV genotyping is one option.  If HPV 16 or HPV 18 tests are positive, colposcopy is recommended.  If HPV 16 and HPV 18 tests are negative, repeat co-testing in 1 year is recommended.
  • Repeat co-testing at 1 year is also acceptable.  At the 1-year repeat co-test, if the HPV test is positive or cytology is ASC-US or worse, colposcopy is recommended.  If the 1-year repeat co-test result is HPV negative and cytology negative, repeat co-testing in 3 years is recommended.


The guidelines also note that women with HPV-16 are at particular risk for CIN 3+. Human papillomavirus-18 merits special consideration because of its association with cervical adenocarcinomas, which are less efficiently detected by cytology than squamous cancers.

Management of Women Aged 30-65 Who are Cytology Negative but HPV Positive

NILM

Cytology NILM but EC/TZ Absent/Insufficient

  • For women aged 21-29 years with negative cytology and absent or insufficient EC/TZ component, routine screening is recommended.
  • For women aged 30 years and older with cytology reported as negative and with absent or insufficient EC/TZ component and no or unknown HPV test result, HPV testing is preferred. 
    • If the HPV test is done and is negative, return to routine screening is recommended.  If the HPV test is positive, repeating both tests in 1 year is acceptable. 
    • Genotyping is also acceptable.  If HPV type 16 or type 18 is present, colposcopy is recommended.  If HPV type 16 and type 18 are absent, repeat co-testing in 12 months is recommended.
  • Repeat cytology in 3 years is acceptable if HPV testing is not performed. 

Cytology NILM but EC/TZ Absent/Insufficient

ASCCP Educational Tools

Download these ASCCP Algorithms:

Download the above ASCCP Updated Consensus Guidelines on the Management of Women with Abnormal Cervical Cancer Screening Tests and Cancer Precursors © 2013.

 

View All ASCCP Algorithms:

View all of the ASCCP Updated Consensus Guidelines on the Management of Women with Abnormal Cervical Cancer Screening Tests and Cancer Precursors © 2013.

 

 

Download the Mobile App:

Download the ASCCP Updated Consensus Guidelines on the Management of Women with Abnormal Cervical Cancer Screening Tests and Cancer Precursors © 2013 App from Google play or the iTunes App Store.  


  • Acronyms:

References:

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