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Presented by Dr. Mark Spitzer, MD
Release Date of Activity: December 2009
Expiration Date of Activity for AMA PRA Credit: December 31, 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
This lecture will provide a broad, evidence-based understanding of the best management options for women with the Pap interpretation of high-grade squamous intraepithelial lesion (HSIL).
High-grade squamous intraepithelial lesion (HSIL) is a Pap test report that suggests the presence of cervical intraepithelial neoplasia (CIN) 2,3, a precancer of the cervical squamous epithelium. Understanding the epidemiology and natural history of HSIL and CIN2,3 is critical for all obstetrician-gynecologists, family practitioners and advanced practice clinicians concerned with the general welfare of their patients. Despite the importance of this cytologic abnormality and the precancer it may reflect, many clinicians have a limited understanding of the natural history of this disease, the differences in natural history when the condition affects special groups of women (e.g., adolescents, pregnant women), or how this natural history should affect the management of women with these conditions. The ability to recognize the more subtle manifestations of both HSIL and CIN2,3 on colposcopy is also key to the optimal care of patients in order to maximize the ability to detect the disease through well-directed biopsies.
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:
- formulate a plan of management for adult women with HSIL Pap test results according to the 2006 ASCCP Consensus Guidelines;
- formulate a plan of management for special groups of women (e.g., adolescents, pregnant women) with HSIL Pap tests according to the 2006 ASCCP Consensus Guidelines;
- recognize the colposcopic appearance of CIN2,3 lesions and cervical cancer using colposcopic features of color, margins, vessels and contour; and,
- improve detection of CIN2,3 and cancer through better understanding of the importance of taking multiple biopsies.
Intended Audience
The target audience of the Online CME lecture "The ASCCP Guidelines for Managing HSIL" is all clinicians who manage women with abnormal cervical cancer screening tests, including all practitioners participating in cervical cancer screening, the follow-up of women with abnormal cervical cytology, and in the diagnosis of preinvasive and invasive cervical neoplasia disease. This activity was designed to meet the CME needs of the practicing obstetrician-gynecologist, family physician, gynecologic oncologist, pathologist, obstetrics/gynecology or family medicine resident, 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 (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.
Charles J. Dunton, MD (ASCCP Program Committee Chair/CME Reviewer) - serves on the speakers' bureaus of Merck & Co, GlaxoSmithKline, and Qiagen and receives honoraria. He also serves on an advisory board for Nycomed and 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.
Mark Spitzer, MD (Author) - serves on the advisory boards for Merck & Co and CytoCore and for which he receives honoraria. He also serves on the speakers' bureau for Merck & Co and receives honorarium. He is a book author and a shareholder of the SABK Corporation and serves as a book editor for Elsevier for which he receives a royalty for services.
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 Reviewe/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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