@article{7a90ac13549d4c498b7de3ef8665175a,
title = "Risk Estimates Supporting the 2019 ASCCP Risk-Based Management Consensus Guidelines",
abstract = "Objective 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 presentation1 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.",
keywords = "HPV, cervical screening, management guidelines, risk-based",
author = "Didem Egemen and Cheung, {Li C.} and Xiaojian Chen and Maria Demarco and Perkins, {Rebecca B.} and Walter Kinney and Nancy Poitras and Brian Befano and Alexander Locke and Guido, {Richard S.} and Wiser, {Amy L.} and Gage, {Julia C.} and Katki, {Hormuzd A.} and Nicolas Wentzensen and Castle, {Philip E.} and Mark Schiffman and Lorey, {Thomas S.}",
note = "Funding Information: Objective: 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 presentation1 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 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; 2Department of Obstetrics and Gynecology, Boston University School of Medicine/Boston Medical Center, Boston, MA; 3Division of Gynecologic Oncology, Kaiser Permanente Medical Care Program, Oakland, CA (contributed before retirement); 4Regional Laboratory, Kaiser Permanente Northern California, Berkeley, CA; 5Information Management Services Inc, Information Management, Calverton, NY; 6Department of Obstetrics, Gynecology and Reproductive Sciences, UPMC Magee-Women's Hospital, Pittsburgh, PA; 7Department of Family Medicine, Oregon Health and Science University, Portland, OR; and 8Albert Einstein College of Medicine, Bronx, NY Reprint requests to: Didem Egemen, PhD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rm 7E610 Rockville, MD 20892. E-mail: didem.egemen@nih.gov. 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. This study was partly supported by the Intramural Research Program of the US National Institutes of Health (NIH)/National Cancer Institute (NCI). NCI-Kaiser Permanente Northern California (KPNC) Persistence and Progression (PaP) study have been reapproved yearly by both KPNC and NCI Institutional Review Board review committees. Copyright {\textcopyright} 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASCCP. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. DOI: 10.1097/LGT.0000000000000529 estimates supporting guidelines are presented in this article. Comprehensive risk estimates are freely available online at https://CervixCa.nlm.nih.gov/RiskTables. Publisher Copyright: {\textcopyright} Lippincott Williams & Wilkins.",
year = "2020",
month = apr,
day = "1",
doi = "10.1097/LGT.0000000000000529",
language = "English (US)",
volume = "24",
pages = "132--143",
journal = "Journal of lower genital tract disease",
issn = "1089-2591",
publisher = "Lippincott Williams and Wilkins",
number = "2",
}
