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Presented by Dr. J. Thomas Cox, MD
Release Date of Activity: November 2009
Expiration Date of Activity for AMA PRA Credit: November 30, 2012
Estimated Time to Complete This Activity: 1 hour
Authors and Reviewers Biosketches |
To register for the Online CME Series click here
Course Summary and Competency Goals
The management of women with the Pap interpretation of atypical squamous cells, or ASC, was historically fraught with experts' disagreement on best management options until the 2001 ASCCP Consensus Conference and the National Cancer Institute's emerging data from the ASCUS/LSIL Triage Study (ALTS) converged to provide evidence based guidelines for the management of women with abnormal cervical cytology. The difficulty in managing women with ASC has been due its commonness and the low risk for most women given this Pap interpretation, yet the fact that the largest percentage of cervical intraepithelial neoplasia (CIN) 2,3 detected in the United States comes from this pool of women. The management of low-grade squamous intraepithelial lesion (LSIL) cytology was never as contentious as the management of ASC, although post-colposcopy follow-up of women with LSIL who were not found to have CIN 2,3 varied widely until the 2001 guidelines were published.
This lecture presents the guidelines for the management of women with ASC and LSIL Pap results that were first developed at the 2001 ASCCP National Consensus Conference for the Management of Women with Cytological Abnormalities and Cervical Cancer Precursors, held at the National Institutes of Health, and updated at a reconvening of the conference in 2006. The data from ALTS, that provided much of the evidence for the ASCCP Guidelines, is presented as well as that of other important relevant studies. The Guidelines provide clear guidance to clinicians on both the initial and the post-colposcopy management of women with atypical squamous cells and women with LSIL.
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 Bethesda 2001 cytology categories for atypical squamous cells (ASC) and low grade squamous intraepithelial lesion (LSIL);
- determine the best initial management options for women with ASC, ASC-H, or with LSIL cytology results;
- determine the best post-colposcopy management option for women referred to colposcopy for the evaluation of ASC or LSIL cytology; and,
- discuss the data from numerous studies that provide the evidence supporting the ASC and the LSIL guideline recommendations.
Intended Audience
This course was designed for all clinicians participating in the screening of women by cervical cytology for the prevention of cervical cancer. It was designed to meet the CME needs of the practicing obstetrician-gynecologist, family physician, gynecologic oncologist, pathologist, resident in either obstetrics/gynecology or family practice, nurse practitioner, certified nurse midwife, and physician's assistant.
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 (Author) - 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.
Hope K. Haefner, MD (CME Reviewer) - served on the speakers' bureau for Merck & Co and receives an honoraria. Effective March 2010 forward, she has had no financial relationships or conflicts to disclose.
Beth Colvin Huff, MSN, NP (CME Reviewer) - is a shareholder, receiving dividends with Hologic and serves on the speakers' bureaus of Merck & Co and Qiagen, for which she receives honoraria.
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 (CME Reviewer/Accreditation Committee Co-chair)
Kathleen Poole (ASCCP Executive Director, Planner)
Carol Noonan (ASCCP Assistant Course Administrator, Planner)
CME Inquiries
For all CME certificate inquiries, please contact Ms. Carol Noonan at cnoonan@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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