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Cervical Cancer Screening Recommendations

    Presented by Dr. Hershel W. Lawson, MD

Release Date of Activity: February 2011
Expiration Date of Activity for AMA PRA Credit: February 28, 2014
Estimated Time to Complete This Activity: 1 hour

Authors and Reviewers Biosketches 
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Course Summary and Competency Goals
Most obstetricians-gynecologists, family physicians, advanced practice clinicians (APC), and some internists, provide cervical cancer screening tests for their female patients.  Primary cervical cancer screening guidelines were modified in 2002 by the American Cancer Society (ACS) and in 2009 by the American College of Obstetricians and Gynecologists (ACOG).  However, a number of surveys and the pretest findings of the American Society for Colposcopy and Cervical Pathology (ASCCP) indicate that there is still a serious lack of understanding and appreciation of these guidelines, and therefore, poor adherence to the recommendations.   Professional gaps identified include: a) limited understanding of the natural history of HPV and cervical oncogenesis as it relates to cervical cancer screening; b) limited knowledge of many of the primary cervical cancer screening recommendations; c) poor comprehension of the evidence/reason for each of the recommendations; d) limited knowledge and understanding of the management recommendations for women age 30 and over screened with a combination of cytology and HPV DNA testing; and, e) a lack of understanding of how HPV vaccines and new technologies may impact primary cervical cancer screening in the future.

In consideration of these professional practice gaps, and to improve adherence to recommended primary cervical cancer screening guidelines the following important concepts are included in this CME lecture:
  1. The relationship between primary cervical cancer screening recommendations and the natural history of HPV infection, the development of cervical pre-cancer and progression to cancer.
  2. The recommendations from the USPSTF, ACS and ACOG on when to begin screening, when to end screening, and what intervals are appropriate based on age and screening history.
  3. The recommendations for the management of women 30 and older with various results from co-testing with a Pap test and HPV DNA test.
  4. How typing for HPV 16 and 18 may change/enhance management guidelines and why.
  5. How successful population uptake of HPV vaccination may change cervical cancer screening in the future.
This evidence-based online activity was specifically designed to improve patient care, medical knowledge, practice-based learning, and systems-based practice gaps.

Learning Objectives
Upon completion of the learning activity and its post-test, participants should be able to:
  • Describe the natural history of HPV particularly as it relates to primary cervical cancer screening recommendations;
  • Determine appropriate age-specific cervical cancer screening recommendations, and appropriate management of women age 30 and older screened by co-testing with a Pap and HPV DNA test;
  • Choose the cervical cancer screening option, or options, most likely to benefit the patient; and,
  • Develop skills in counseling about HPV infection, the purpose of cervical cytology screening, and the reasons for specific screening recommendations for an individual patient based on age and history.

Intended Audience
The Cervical Cancer Screening Recommendations activity was developed for those physicians and advanced practice clinicians (e.g., nurse practitioners, physicians’ assistants, nurse midwives) who will be counseling and treating women with any of these cytologic abnormalities.  Previous experience with our online courses demonstrated that both ASCCP members and non-members will participate in this online program.  These include clinicians from a variety of specialties including obstetrician-gynecologists, family physicians, residents in obstetrics/gynecology and family medicine, advanced practice clinicians working in family planning and other community clinics, private offices and hospital settings, pathologists who supervise residents and fellows, and for physicians with administrative responsibility for patients.

Accreditation Statement
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.
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:
L. Stewart Massad, MD (Accreditation Committee Co-chair/CME Reviewer/Planner)
Herschel W. Lawson, MD (Author/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 contact 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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