In 2012, several professional groups, including the American Society for Colposcopy and Cervical Pathology (ASCCP), issued updated guidelines on cervical cancer screening.[1]Now, the ASCCP has updated its 2006 guidance for managing women with abnormal cervical cancer screening tests and cancer precursors, issuing 19 algorithms that address clinical scenarios ranging from women with unsatisfactory cytology to those with various grades of squamous and glandular intraepithelial neoplasia.[2] Given the growing use of co-testing, which combines cytology with assessment for high-risk human papillomavirus (HPV), this new guidance is timely.
With these new guidelines, certain women with screening results for whom colposcopy with cervical biopsies were previously recommended should now be initially managed without colposcopy. For instance, for women ages 21-24 years with cytology indicating either atypical squamous cells of undetermined significance (ASCUS) or a low-grade squamous intraepithelial lesion (LSIL), the new guidelines do not recommend initial colposcopy. Instead, when HPV reflex testing following ASCUS cytology is negative in such women, they should resume routine screening. If the initial screen reveals ASCUS with positive HPV or LSIL, repeat cytology is recommended at 12 months.
A second algorithm that caught my attention concerns the management of women with LSIL. If LSIL is found in the course of performing co-testing, and the HPV result is negative, repeat co-testing in 1 year is now the preferred management. In contrast, if LSIL is not accompanied by an HPV test, or if such testing is positive, colposcopy is recommended.
The algorithms included in this new guidance are too complicated to memorize, so I plan to keep a copy handy where I see patients. I would like to thank Dr. Karl Smith, Director of Gynecologic Oncology at my institution, for his helpful review of this commentary
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