current guidelines for cervical cancer screening rachael chambers, do may 29, 2015
TRANSCRIPT
![Page 1: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/1.jpg)
Current guidelines for Cervical Cancer Screening
Rachael Chambers, DO
May 29, 2015
![Page 2: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/2.jpg)
Objectives
• Review current cervical cancer screening guidelines
• Discuss role of HPV testing in cervical cancer screening
• Discuss role of primary HPV testing in cervical cancer screening
![Page 3: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/3.jpg)
Background
• Initial Bethesda system classification – revised in 2001
• ASCCP consensus conference 2006• Updated guidelines in 2008
– Not from a national consensus conference
• 2012 follow up consensus conference– Data from KPNC, NCI, ALTS
![Page 4: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/4.jpg)
2012 Consensus Conference
• 47 experts • 23 professional societies• Goal to provide revised evidence-based
consensus guidelines for managing women with abnormal cervical cancer screening tests, cervical intraepithelial neoplasia and adenocarcinoma in-situ
![Page 5: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/5.jpg)
Major changes 2012 guidelines
• ECC showing CIN 1 – manage as CIN 1
• Repeat unsatisfactory cytology– Even when HPV results are known
• Negative cytology with absent or insufficient endocervical cells can be managed without early repeat
![Page 6: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/6.jpg)
Major changes 2012 guidelines
• Genotyping triages HR HPV positive women to colposcopy earlier after negative cytology– Colposcopy indicated for ASCUS +HPV
regardless of genotyping
• HPV negative ASCUS– Follow up at 3 years with co-testing
– Not sufficient for exiting women from screening at age 65
![Page 7: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/7.jpg)
Major changes 2012 guidelines
• CIN 2+ follow up is more clearly defined with incorporation of co-testing
• Women age 21-24– Conservative management
– Pap only
– Co-test in certain circumstances
• Incorporate co-testing post colposcopy
![Page 8: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/8.jpg)
Guidelines
• Available at:• www.asccp.org/Portals/9/docs/ASCCP%20Mana
gement%20Guidelines_August%202014.pdf
• App available for iPad, iPhone and Android
![Page 9: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/9.jpg)
Routine Screening
• Cytology every 3 years• Co-testing every 5 years
– Women age 30-64 only
• Multi-year intervals ok only if risk of developing CIN 3+ is low
![Page 10: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/10.jpg)
Case 1
• 55 year old G2P2• Menopause at age 52• No history of abnormal pap testing• Pap test with physical shows:
– Insufficient cellularity. HPV co-testing is negative.
• Now what?
![Page 11: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/11.jpg)
Unsatisfactory Cytology
• 1% or less across all preparations• Decreased with use of liquid based pap• Most cases now due to insufficient squamous
cells
![Page 12: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/12.jpg)
![Page 13: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/13.jpg)
Case 2
• Same patient as in Case 1• Now pap test shows normal results, but no
EC/TZ• HPV remains negative
• Now what?
![Page 14: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/14.jpg)
![Page 15: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/15.jpg)
Cytology NILM but EC/TZ Absent/Insufficient
• Suggests squamocolumnar junction may not have been adequately sampled
• Reported rates 10-20%• More prevalent in older women• Good specificity and negative predictive value• HPV testing is independent of TZ sampling
– Adds margin of safety when co-testing is performed.
![Page 16: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/16.jpg)
Management
• Age 21-29: routine screening• Age 30-64
– HPV negative: Routine screening
– HPV unknown: Test for HPV or repeat cytology in 3 years
– HPV positive: Cytology +HPV in 1 year or HPV genotyping
![Page 17: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/17.jpg)
![Page 18: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/18.jpg)
Case 3
• 32 year old G1P0• No previous pap testing available• Here for initial prenatal care• How do we screen her?
![Page 19: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/19.jpg)
Case 3 continued
• Pap test normal• HPV co-test is positive
• Now what?
![Page 20: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/20.jpg)
Management Negative Cytology, HPV positive
• Due to increased risk for CIN 3+ if hrHPV positive guidelines balance risk of observation vs intervention
• Return for earlier retesting• HPV genotyping
– Higher risk of CIN 3+ with type 16/18
• Colposcopy if 1 year follow up is ASC or HPV + or immediately if HPV 16/18 are positive
![Page 21: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/21.jpg)
![Page 22: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/22.jpg)
Case 4
• 30 year old referred to you for management of ASCUS pap
• What else do you want to know?
• Was she HPV co-tested?
![Page 23: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/23.jpg)
Atypical Squamous Cells of Undetermined Significance
• Most common cytologic abnormality• Lowest risk of CIN 3+
– 2/3 are NOT HPV associated
• Women >60 years have higher risk for cervical cancer even if HPV negative compared to women with negative co-testing.
![Page 24: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/24.jpg)
ASC-US
• Reflex HPV testing preferred– Type 16/18 positive women have twice the risk of
CIN 3+ compared to other hrHPV positive women
• HPV negative– Repeat cotesting in 3 years
• HPV positive– Colposcopy
– If no CIN co-test at 12 months
![Page 25: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/25.jpg)
ASC-US
• Cytology only– Repeat cytology in 1 year
– Colposcopy if > ASC
– Routine screening if normal
![Page 26: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/26.jpg)
![Page 27: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/27.jpg)
ASC-US in Special Populations
• Postmenopausal– Manage the same as general population
• Women age 65 and older– Repeat screening in 1 year when considering exit
from screening• Cytology• Co-testing (preferred)
![Page 28: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/28.jpg)
ASC-US in Special Populations
• Pregnant women– Identical to nonpregnant women
– Acceptable to defer colposcopy until 6 weeks postpartum
– ECC is unacceptable
– If no suspected CIN 2+ at initial colposcopy, follow up postpartum
![Page 29: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/29.jpg)
Case 5
• 21 year old, G0• No previous pap test• Seen for complete physical• Pap test shows LSIL.
• What next?
![Page 30: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/30.jpg)
Young Women
• No screening before age 21• Routine screening with initial normal pap test is
every 3 years– Cervical CA risk is low through age 25
– HPV is common
– Most lesions will regress
• Less intensive management• Encourage HPV vaccination, smoking cessation
![Page 31: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/31.jpg)
Young women
• ASCUS/LSIL Cytology every 12 months preferred– HPV reflex is acceptable
• Follow up is repeat cytology if positive• Routine screening if negative
• Colposcopy only if ASC-H, AGC, HSIL at follow up
![Page 32: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/32.jpg)
![Page 33: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/33.jpg)
Low-grade Squamous Intraepithelial Lesions
• ALTS Trial showed natural history to be similar to ASC-US HPV+
• Women 21-24 have lower risk CIN 3+• Estimated 77% of LSIL are HPV positive
![Page 34: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/34.jpg)
LSIL Management
• Colposcopy (recommended)– Manage based on colposcopic findings
• If co-test is negative, repeat co-test in 1 year– If cytology negative and HPV negative
• Repeat co-testing in 3 years
– If >ASC or HPV positive• Colposcopy
![Page 35: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/35.jpg)
![Page 36: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/36.jpg)
LSIL Management
• Pregnant women: – Colposcopy preferred
• ECC unacceptable• Acceptable to defer until 6 weeks postpartum
– If no CIN 2+, follow up post partum
![Page 37: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/37.jpg)
![Page 38: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/38.jpg)
LSIL Management
• Postmenopausal– Obtain HPV test
– Repeat cytology at 6 and 12 months
– Colposcopy
– Repeat cytology in 12 months if HPV negative or no CIN on colposcopy
– If HPV+ or ASC-US or greater on repeat cytology perform colposcopy
– Routine screening after 2 negative cytology
![Page 39: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/39.jpg)
Atypical Squamous Cells, Cannot Exclude High-Grade
Squamous Intraepithelial Lesion• Higher risk of CIN 3+ compared to ASC-US or
LSIL– Risk also elevated for women age 21-24, but
overall CIN 3+ risk remains lower than older women
![Page 40: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/40.jpg)
ASC-H Management
• Colposcopy for all women• High rate of HPV + makes reflex testing
unsuitable• 5 year cancer risk among ASC-H, HPV negative
is 2%
![Page 41: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/41.jpg)
![Page 42: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/42.jpg)
High-Grade Squamous Intraepithelial Lesion
• CIN 2+ identified in 60% of women at colposcopy
• Consider immediate excision of transformation zone
• Cervical cancer found in 2% at colposcopy– Risk rises with age
– Risk modifies with HPV result
• HPV result from co-test may help inform choice
![Page 43: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/43.jpg)
Management HSIL
• Immediate LEEP• Colposcopy
– Diagnostic excisional procedure recommneded for inadequate colposcopy
• Except if pregnant
![Page 44: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/44.jpg)
![Page 45: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/45.jpg)
HSIL in Young Women
• Colposcopy– If no CIN 2+ observe with colposcopy and
cytology at 6 month intervals for 24 months.
– If CIN 2/3 present manage with colposcopy and biopsy or treat
![Page 46: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/46.jpg)
![Page 47: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/47.jpg)
Atypical Glandular Cells
• Interpretation is poorly reproducible and uncommon
• Associated with – Polyps – Metaplasia– Neoplasia
• Adenocarcinomas– Endometrium, cervix, ovary, fallopian tube and other
sites
![Page 48: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/48.jpg)
AGC
• Risk of neoplasia higher if reported as AGC favor neoplasia or AIS
• Cancer risk is lower in women <35, but risk of CIN 2+ is higher
• Commonly associated with squamous lesions including CIN 1
![Page 49: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/49.jpg)
AGC Management
• Colposcopy with ECC• Do not use HPV testing to triage• Endometrial sampling is recommended in
women 35+– Also for women <35 if clinical indictors suggesting
risk for endometrial neoplasia.
• If no CIN 2+ co-test at 12 and 24 months and routine screening if both are negative.
![Page 50: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/50.jpg)
![Page 51: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/51.jpg)
![Page 52: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/52.jpg)
PRIMARY HPV SCREENING
What’s next?
![Page 53: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/53.jpg)
Primary hrHPV screening
• Rate of hrHPV is common in sexually active population
• Most infections are transient• FDA previously approved hrHPV testing
– For triage of ASCUS
– Adjunct to cytology for women age 30+
• April 2014 FDA approved labeling of hrHPV assay to include primary hrHPV screening in women 25+
![Page 54: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/54.jpg)
Primary hrHPV screening
• Highly sensitive• Specificity depends on subsequent evaluation
strategies and screening frequencies
![Page 55: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/55.jpg)
2011 guidelines
• American Cancer Society, American Society for Colposcopy and Cervical Pathology and American Society for Clinical Pathology
• “in most clinical settings, women age 30-65 should not be screened with HPV testing alone as an alternative to co-testing at 5 year intervals or cytology alone at 3 year intervals”
![Page 56: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/56.jpg)
Consensus panel
• Met via conference call and face to face• Invited to scientific summary presentation by
Roche Diagnostics of the Addressing the Need for Advanced HPV Diagnostics (ATHENA) trial
• MEDLINE database review– 11 papers reviewed in addition to significant
papers published prior to November 2011
![Page 57: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/57.jpg)
Consensus panel: Primary question
• Is hrHPV testing for primary screening as safe and effective as cytology-based screening?
• Negative hrHPV provides greater reassurance of low CIN3+ risk than negative cytology.– Several large trials have evaluated this
![Page 58: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/58.jpg)
Consensus panel: Primary question
• Can primary hrHPV screening be considered as an alternative to current US cervical cancer screening methods?
• hrHPV can be considered as an alternative to current cytology-based screening because of equivalent of superior effectiveness.
![Page 59: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/59.jpg)
Additional questions
• How Should Positive hrHPV be managed?– Combination of triage of genotyping and reflex
cytology appears to be a reasonable approach• Based on data from ATHENA and other studies
• What is the Optimal Screening interval?– No sooner than every 3 years
• Limited data available
![Page 60: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/60.jpg)
Additional questions
• At What Age Should One initiate primary HPV screening?– Not before age 25
![Page 61: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/61.jpg)
Additional questions
• How does the performance of primary hrHPV screening compare to co-testing?– Most reassurance from co-test comes from the
HPV component.
– Data shows the 3 year risk following HPV negative test is less than the 5 year risk following co-testing.
– Primary hrHPV test every 3 years is at least as effective as 5 year co-testing.
![Page 62: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/62.jpg)
![Page 63: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/63.jpg)
• Currently only 1 hrHPV test is FDA-approved for primary screening.
• Comparative effectiveness studies are needed • Look for future updates
![Page 64: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/64.jpg)
Summary
• Cervical cancer screening continues to evolve.• Trend is toward less invasive methods of
screening and managing.• hrHPV screening may become the primary
screening tool in the future.
![Page 65: Current guidelines for Cervical Cancer Screening Rachael Chambers, DO May 29, 2015](https://reader036.vdocuments.us/reader036/viewer/2022062802/56649e9f5503460f94ba1ff7/html5/thumbnails/65.jpg)
References
• Massad, et al. 2012 Updated Consensus Guidelines for the Management of Abnormal Cervical Cancer Screening Tests and Cancer Precursors. Journal of Lower Genital Tract Disease, Volume 17, Number 5, 2013, S1-S27.
• Huh , et al. Use of Primary High-Risk Human Papillomavirus Testing for Cervical Cancer Screening: Interim Clinical Guidance. Journal of Lower Genital Tract Disease, Volume 19, Number 2, 2015, 91-96.
• Partridge et al. Cervical Cancer Screening: Featured Updates. Journal of the National Comprehensive Cancer Network. Volume 12, number 3, march 2014, 333-341.
• ACOG Practice Bulletin. Management of Abnormal Cervical Cancer Screening Test Results and Cervical Cancer Precursors. Number 140, Volume 122, No. 6, December 2013, 1338-1367
• Saraiya, et al. Evolution of cervical cancer screening and prevention in United States and Canada: Implications for public health practitioners and clinicians. Preventive Medicine, Volume 57, 2013, 426-433.
• Dinkelspiel and Kinney. State of the Science: Cervical cancer screening in transition. Gynecologic Oncology, 133, 2014, 389-393.
• Cannistra and Niolff. Cancer of the Uterine Cervix. The New England Journal of Medicine. Volume 334, number 16, 1996, 1030-1038.