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Education
Management of Cervical Abnormalities in Adolescents and Young Women

 
 
  Presented by Anna-Barbara Moscicki, MD and Judith T. Burgis, MD

Release Date of Activity: July 6, 2011
Expiration Date of Activity for AMA PRA Credit: July 31, 2014
Estimated Time to Complete This Activity: 1 hour


Authors and Reviewers Biosketches 
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Course Summary
Over the past eight years, an increasing understanding of the natural history of HPV and cervical neoplasia has changed national guidelines dramatically. Nowhere has this been more of a sea change than in the cervical screening and management of adolescents and young women with abnormal cytology and histology results. The ASCCP Consensus Guidelines identify adolescent females as women under the age of 21 years and, because evidence recognizes the natural history of abnormal cytology to be different in adolescents than adults, as a special population.  

Data from the Centers for Disease Control and Prevention (CDC) show that many practitioners neither adhere to the ACOG/ACS guidelines for when to initiate cervical cancer screening nor to the 2006 ASCCP Guidelines for Management of Abnormal Cervical Cancer Screening Tests and CIN/AIS. This lack of adherence results in considerable overtreatment (e.g., excisional therapies such as LEEP), which can be associated with poor reproductive outcomes, including approximately a doubling of such significant risks as preterm delivery and low birth weight. Currently, practitioners and consumers equate the Pap test with reproductive health care. It is essential that practitioners and consumers recognize the importance of these health care elements as being independent of each other.

This activity is designed to educate learners as to a) the natural history of HPV and cervical oncogenesis as it relates to cervical cancer screening in adolescents and young women, b) the evidence and rationale behind the screening and management guidelines for cervical abnormalities; and, c) the evidence and rational for why treatment and HPV testing may be harmful in this special population.  

Course Competencies and Objectives
This course is designed to improve clinicians’ knowledge and their performance of screening and follow-up according to national screening and management guidelines. Upon completion of this activity, learners will be able to:
  • Articulate the life cycle and natural history of HPV in adolescents (Medical Knowledge);
  • Review natural history of abnormal cytology and CIN in adolescents (Medical Knowledge);
  • Identify risk factors associated with CIN progression (Medical Knowledge);
  • Understand and articulate evidence leading to the new guidelines for cervical cancer screening among adolescents (Medical Knowledge);
  • Describe and apply new guidelines for cervical cancer screening in adolescents (Medical Knowledge, Patient Care, Systems-based Practice, Practice-based Learning); and, 
  • Describe and apply guidelines for management of abnormal cytology and histopathology in young women (Medical Knowledge, Patient Care, Systems-based Practice, Practice-based Learning).

Is this educational activity right for me?
The Management of Cervical Abnormalities in Adolescents and Young Women activity is designed for all intermediate level clinicians who manage adolescents’ reproductive health care, including cervical cancer screening, STI screening and contraceptive care. It is also for those who interpret the results of cervical cancer screening tests and who diagnose and manage preinvasive disease of the female lower genital tract (e.g., gynecologists, family physicians, advanced practice clinicians (to include NPs, CNMs, PA-Cs), gynecologic oncologists, and residents in obstetrics-gynecology and family medicine).  

Learners will have active practices in outpatient gynecology that address reproductive health care in adolescents. This will include colposcopy practices. Specific professional activities will include colposcopy, colposcopic differential diagnosis, management of abnormal screening tests and cancer precursors, and application of treatments for cervical intraepithelial neoplasia (CIN).

ACCME Accreditation
The American Society for Colposcopy and Cervical Pathology (ASCCP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education for physicians.

Continuing Medical Education (CME) Credit
The ASCCP designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Management of Conflicts of Interest and Contributed Funds
As an accredited provider of CME credit, ASCCP is required to comply with the ACCME's Standards for Commercial Support and has implemented a management process to ensure that anyone who is in a position to affect the content of the educational activity (e.g., faculty, planners, etc.) has disclosed to us all relevant financial relationships with any commercial interest and has ensured that those relationships do not influence presentation materials. All faculty have agreed to base their presentations on best available evidence. ASCCP discloses to learners any financial relationship(s) to healthcare-related commercial interests existing within the past 12 months to include the following information: 1) the name of the individual; 2) the name of the commercial interest; and, 3) the nature of the relationship the person has with each commercial interest. Slides and slide notes are reviewed for possible bias prior to the activity's release by the Accreditation Committee and peer-reviewers, and potential conflicts of interest are resolved prior to the live presentation. Any discussion of off-label use of products is noted when appropriate, as is discussion of any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. Disclosures of these commitments and/or relationships are published in these lecture materials and provided prior to the start of the activity, so the learners may formulate their own judgments regarding the presentation(s). Under ASCCP policy, anyone declining either to disclose or amend material to eliminate potential bias identified by the Accreditation Committee will be replaced.

Author, Reviewers, and Planners' Disclosure Information
The following are all reported disclosures of interest or potential conflicts from the 12 months preceding this activity:

J. Thomas Cox, MD (Project Editor) - serves on the Data and Safety Monitoring Board for Merck & Co and receives a fee for his service. He is also a scientific advisory board member for Gen-Probe and an advisory board member for Abbott, for both of which he receives an honorarium.
Anna-Barbara Moscicki, MD (Author) - serves on advisory boards for Merck & Company, GlaxoSmithKline, and BT Pharma for which she received honoraria.
Diane Solomon, MD (CME Reviewer) - serves as a Medical Monitor for the National Cancer Institute's HPV Vaccine Trial in Costa Rica: the trial receives vaccine from GlaxoSmithKline.

Those reporting no financial relationships or conflict of interest to disclose:
Judith T. Burgis, MD (Author)
L. Stewart Massad, MD (Accreditation Committee Co-chair/CME Reviewer/Planner)
Herschel W. Lawson, MD (Accreditation Committee Co-chair)
Alan G. Waxman, MD (CME Reviewer)
Kathleen Poole (ASCCP Executive Director, Planner)
Carol Noonan (ASCCP Assistant Course Administrator, Planner)


CME Inquiries
For all CME certificate inquiries, please email CME@ASCCP.org or by mail at the ASCCP National Office, 152 West Washington Street, Hagerstown, MD 21740 or by phone at 301-733-3640
   
 
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