New Guidance for Management of Women with Abnormal Cervical Cancer Screening Results

In 2012, the American Cancer Society, American Society for Clinical Pathology, and American Society for Colposcopy and Cervical Pathology (ASCCP) issued new guidelines for cervical cancer screening (JW Women's Health Apr 12, 2012). Now, the ASCCP has updated its recommendations (first published in 2006) for managing women with abnormal cervical cancer screening tests and cancer precursors. This guidance was developed based on a literature review, input from 23 professional societies, and clinical experience with 1.4 million women seen at Kaiser Permanente Northern California. The 19 algorithms cover clinical scenarios ranging from unsatisfactory cytology to various grades of squamous and glandular intraepithelial neoplasia. They are timely, given that co-testing (cytology plus assessment for high-risk human papillomavirus [HPV]) has become increasingly common.

One notable algorithm concerns management of women aged 21 to 24 with cytology indicating either atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL). The 2006 guidelines recommended colposcopy with cervical biopsy for women with ASCUS plus positive reflex HPV test results, as well as for those with LSIL. The current guidelines do not recommend initial colposcopy for women in this age range. Instead, when HPV reflex testing is negative in women with ASCUS cytology, routine screening should resume. If the initial screen reveals ASCUS with positive HPV — or LSIL — repeat cytology is recommended at 12 months. The results of this 12-month cytology then determine whether colposcopy or repeat cytology at 12 months is indicated.

A second noteworthy algorithm relates to management of women with LSIL (for whom colposcopy had been recommended under the 2006 guidance). If LSIL is found during the course of co-testing and the HPV result is negative, repeat co-testing in 12 months is now the preferred action. In contrast, if LSIL is not accompanied by an HPV test — or if such testing is positive — colposcopy continues to be recommended.