Why risk-based management?
Nearly all cervical cancer is caused by HPV, and with the availability of HPV vaccination, HPV testing, cytology, histology, and excisional treatments, most cases of pre-cancer (CIN3) can be detected and treated. Research into the natural history of HPV disease allows us to more precisely recommend the most effective and efficient testing strategies for women with abnormal screening results. Understanding a woman’s vaccination history, past history of high grade cervical precancer, and recent HPV test and cytology results can dramatically affect her risk of precancer and subsequent management. Failing to include a woman’s history when interpreting her current testing results will lead to over-testing and treatment in low risk women and under-testing and treatment in high-risk women.
What is planned for the guideline process?
ASCCP is embarking on hosting a consensus process to update the 2012 Consensus Guidelines for Managing Abnormal Cervical Cancer Screening Tests and Cancer Precursors. While several organizations issue screening guidelines, the consensus process hosted by ASCCP has historically yielded the most prominent recommendations for management of positive screening results.
This round of updates, as before, involves a close collaboration with NCI. The overall goal of the project is to combine risk data generated by NCI with clinical action thresholds developed during the consensus process—the end result providing a new set of Risk-Based Management Guidelines. The goals of the new Risk-Based Management Guidelines are to introduce a paradigm based on patient risks instead of test results. A group of over 26 organizations, including, for the first time, patient representatives, will determine through a consensus process what risks of cervical cancer and pre-cancer will guide clinical actions, such as repeat testing, colposcopy, and treatment.
We aim to achieve consensus and broad buy-in through the early involvement of key stakeholders and organizations, and the inclusion of extended periods for public comment. We will establish working groups that will review data on multiple aspects of care, including natural history of HPV infection, costs, and provider and patient preferences. Working groups will suggest risk-based clinical action recommendations that will be discussed and voted on at two additional consensus meetings. After consensus has been achieved, technology will be created to support clinician use of the guidelines, including an updated version of the current ASCCP app, which is scheduled for release in 2020.