ASCCP Interim Guidance for Timing and Treatment Procedures for Patients with Abnormal Cervical Screening Tests
May 26, 2020 - In light of the current unprecedented COVID-19 pandemic, and in settings where all non-essential medical office visits
and elective procedures have been suspended, ASCCP recommends the following:
- Individuals with low-grade cervical cancer screening tests may have postponement of diagnostic evaluations up to 6-12 months.
- Individuals with high-grade cervical cancer screening tests should have documented attempts to contact and diagnostic evaluation scheduled within 3 months.
- Individuals with high-grade cervical disease without suspected invasive disease should have documented attempts to contact and procedures scheduled within 3 months.
- Individuals with suspected invasive disease should have contact attempted within 2 weeks and evaluation within 2 of that contact (4 weeks from the initial report or referral).
The decision to proceed with colposcopy and/or treatment should be made in the context of both medical and logistical considerations. Consideration should be given to the risks of postponing individuals' evaluations and/or treatments, as well as the risks and benefits of expediting semi-urgent clinical care depending on the current and anticipated local circumstances. Refer to the American College of Surgeons (ACS) "COVID-19, Guidance for Triage of Non-Emergent Surgical Procedures" for guidance on the management of non-emergent procedures. To assist in triage, the ACS recommends evaluation based on the Elective Surgery Acuity Scale (ESAS). This is a scale with 3 tiers which considers both the acuity of the procedure as well as the health of the patient and suggests a surgical action plan. For example, based on the ESAS, most procedures for high-grade cervical disease without suspected invasive disease would fall in the Tier 2a risk category. The ACS also provides guidance for the resumption of elective surgery which can be found here and here.
The use of personal protective equipment (PPE) should be considered for all patient visits. The decision as to type of PPE should be directed by current CDC recommendations, specific regional or hospital guidance and patient COVID-19 status. When performing procedures requiring electrocautery, smoke evacuators should be used to mitigate potential aerosol dispersal.
These recommendations are not to be considered definitive management guidelines and recognize that some individuals with abnormal cervical cancer screening tests and histologic findings will require case-by-case review. These guidelines are subject to change due to the fluidity of the healthcare environment. Providers should continue use of tracking protocols to ensure that patients with abnormal results may be called in when the concerns for COVID diminish to the point that routine care for non-essential issues may be reinstated. Once the COVID-19 outbreak is contained, patients should again be managed as per the ASCCP Colposcopy Standards.
Disclaimer: These recommendations should never be a substitute for clinical judgment. Clinical judgment should always be used when applying a recommendation to an individual patient since they may not apply to all patient-related situations.